We as a species learn from stories, we remember stories. The bedrock of epidemiology is the story of outbreaks of disease. Each outbreak, once thoroughly analyzed, tells a story that helps us understand the disease, especially how a disease spreads.
So it is with the Covid-19 pandemic. The following story of the Skagit Chorale story (as reported by the CDC) should be imprinted in the mind of every thinking human: In early March of 2020, in the early stages of the epidemic in the U.S., 61 singers gathered for a choral practice that lasted 2.5 hours. One attendee had developed mild cold-like symptoms 3 days before the practice, but, in those early days of the epidemic, that person did what any of us might have done back then: he or she powered through the mild symptoms, showed up for the practice, and sang. In the aftermath, 53 attendees developed Covid-19, 3 were hospitalized, and 2 died. (for more see P.S. below)
The members of the Lighthouse Pentecostal Church, two miles northeast of the center of the town of La Grande in northeast Oregon, did not hear the lesson of Skagit Chorale–or they assumed they were exempt. In late April the Church, against the Oregon governor’s executive orders, began holding large in person gatherings (mostly outside), ignoring social distancing recommendations. According to a report in the local newspaper, The Observer, videos (since taken down) showed congregants standing close together, not wearing masks, singing and praying.
The Lighthouse Pentecostal Churchis now responsible for making rural Union County the epicenter for Covid-19 in the state of Oregon. Oregon Public Broadcastingreported on June 16 that 236 of the 365 church members of Lighthouse Pentecostal have tested positive for Covid-19. Union County, population around 25,000, then had the highest concentration of Covid-19 cases in the state (9 in 1000, nearly 1%). Public health workers are diligently working to stem the spread in the surrounding community. It is an evolving story. The deep detail work of epidemiologists and contract tracers is ongoing. But the message is clear: If you ignore the biology of this virus, if you think you’re special, and if among you there is just one person spewing virus, this virus will bite you. The virus pays no attention to your religious beliefs or your attitude toward science.
There is hope and learning lesson in another evolving story: Masks, even cloth masks, might work better than we thought. Two hair stylists working at a Great Clips in Springfield, Missouri, powered through mild cold symptoms and potentially exposed 140 clients and 6 co-workers to Covid-19. Fortunately, appointment books simplified contact tracing and notification of those exposed. As of a Washington Post article published June 17none of those exposed say they have become ill. (Click that article for a lot of detail.) Unfortunately (from a scientific standpoint), only 46 of the 146 who were exposed took the offer of testing–but all those 46 tests came back negative–in spite of close proximity with an infected stylist for up to half an hour.
The two stylists wore cloth masks. The customers also wore masks, (It is still unclear exactly what kinds of masks.) It is tempting to conclude this is evidence that masks are 100% effective. But wait. Some scientific circumspection is in order. We do not know if every infected person spews virus with the same efficiency. Perhaps the two mildly symptomatic stylists’ respiratory systems were expelling only a tiny amount (or zero) virus during the days they worked. Perhaps among those 100 individuals who were exposed but refused testing there are folks who were infected but remained asymptomatic. Good science requires circumspection–and the full investigation of this event and the Lighthouse Pentecostal incident have not been completed and published, that is, some details may yet emerge.
Still, the contrast between the masked exposure to Covid-19 at Great Clips and unmasked exposure to Covid-19 at Lighthouse Pentecostal is striking. If these two stories were properly and widely told only the willfully ignorant would refuse to wear a mask.
I take note that as staunch a Republican as Stacey Cowles, the owner and sole editorialist of the Spokesman Review, came out with a clear statement on the Opinion Page on Sunday, June 21: Wear a Mask in Public. It’s good advice based on the science, advice that only the Matt Sheas, Heather Scotts, and Donald Trumps, people who belligerently reject the best available science, will continue to ignore.
Keep to the high ground,
Jerry
P.S. The CDC report of the Skagit Chorale illustrates the importance of getting the facts right in telling the story. Some initial reports of the event that appeared in the media left the impression that the act singing itself was the major culprit in the spread of the virus. The story I took away from the media reports before the detailed epidemiological reporting suggested that the choir had practiced social distancing, used hand sanitizer, brought their own music, and avoided physical contact. In fact, when the detailed investigation was done it became clear that 1) masks were not worn, 2) distancing was 6-10 inches between chairs, and 3) because the choir re-sorted into smaller groups for part of the practice the distance of aerosol travel was uncertain. In other words, this event was more of a virus mixing bowl than the early reports suggested. Therefore, this event alone was not conclusive scientific evidence aerosol spread over distances exceeding six feet. Even so, the take-home key hypothesis (i.e. the key question for further consideration) was this: singing loudly in a group is very iffy behavior in the middle of pandemic caused by a virus that affects the respiratory system.