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Andrew Junkin, MD Profile picture
Andrew Junkin, MD
@Dr_Junkin_MD
Hospitalist @BIDMCHealth | Instructor @harvardmed Passions include but not limited to caring for patients, MedEd, ethics, and equity. Visualearner. #BLM

May 24, 2020, 9 tweets

How COVID-19 spread like wildfire šŸ”„ via a series of well-attended indoor church events in a town in rural Arkansas.

A #MedTwitter summary of this paper in 7 tweets:

James A, Eagle L, Phillips C, et al. in @CDCMMWR
DOI: dx.doi.org/10.15585/mmwr.ā€¦

šŸ§µ(thread)

1/
 2 persons attended church events while symptomatic on March 6-8 and later tested (+) for COVID-19 (primary cases).

The church pastor and his wife also attended these events and became ill ~4 days later (Mar 10-11) (index cases).

2/
 The church was closed on Mar 12, but prior to that 92 people had attended church events from Mar 6-11.

Of those 92 people, 35* (38%) tested (+) for COVID-19.

Notably, this was 35 of the 45 people tested, representing a 77.7% positive test rate (!!)

3/
 While adults (age > 18) comprised only 65% of attendees, they represented 92% of those who tested (+) for #COVID-19.

Children were under-represented in both % of tests and % of (+) tests, suggesting lower symptom burden and/or lower incidence of infection.

4/
 Of this cohort of 92 churchgoers, 7 were hospitalized, and 3 died.

An additional 26 people in the community, who had not been to the church, but who had direct contact to those who had been to the church between March 6-11, tested (+) for #COVID-19, one of these people died.

5/
 In total, *at least* 61 cases of COVID-19, 8 hospitalizations, and 4 deaths can be traced back to the indoor church activities attended by just 2 symptomatic persons (prior to their diagnosis with #COVID-19). šŸ˜²

6/
 Takeaways:

1) This study demonstrates remarkably high contagiousness ("attack rate") of COVID-19 in a common setting (i.e. indoor church activities)

2) Hosting a large-group event indoors, without ensuring no attendees have COVID-19, risks the health of the entire community.

7/
 Research ?'s to consider based on this paper:
1) Would wearing [clear] full face shields decrease the attack rate of COVID-19 in otherwise similar circumstances?
2) Same ? for cloth face covers
3) Same ? for surgical masks
4) Same ? for physical distancing (i.e. 6 ft minimum)

Feedback on #HowIReadThisPaper is welcome.

Link to article: bit.ly/MMWR-5-22-20
Link to PDF: bit.ly/MMWR-5-22-20_Pā€¦

#COVID19 #publichealth
@CDCMMWR @CDCgov @CDC_NCEZID @Covid19Docs @COVID19Tracking @MassDPH @ADHPIO

/END

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