Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020

Abstract

An outbreak of severe acute respiratory syndrome coronavirus 2 infection occurred among church attendees after an infectious chorister sang at multiple services. We detected 12 secondary case-patients. Video recordings of the services showed that case-patients were seated in the same section, up to 15 m from the primary case-patient, without close physical contact, suggesting airborne transmission.

Keywords: Australia; COVID-19; SARS-CoV-2; church singing; coronavirus disease; coronaviruses; disease outbreak; epidemiology; infectious disease transmission; presymptomatic; public health practice; respiratory infections; severe acute respiratory syndrome coronavirus 2; viruses; whole-genome sequencing; zoonoses.

Figure 1

Epidemiologic curve of an outbreak of infection with severe acute respiratory syndrome coronavirus 2 in a church, Australia, 2020. Red indicates symptom onset date for the index case-patient, who sang at 4 services on July 15–17; secondary case-patient symptom onset dates are color coded by date of service attendance as indicated along baseline (1 secondary case-patient attended services on July 16 and 17). The 5 case-patients with onsets of July 22–26 also had exposures to earlier outbreak case-patients in their households.

Figure 2

Schematic diagram of church layout showing seating locations of primary and secondary case-patients during an outbreak of infection with severe acute respiratory syndrome coronavirus 2, Australia, 2020. Case numbers are based on order of notification received by the Public Health Unit. Location of case-patients indicated in green and dark blue were confirmed on video recordings; the 2 case-patients indicated in light blue described their locations. The primary case-patient was located in an elevated loft ≈3 m above ground level. He was singing and playing the piano throughout the services and faced toward the piano. Other members of the congregation were seated throughout all sections of the church during the 4 services. Relatively more persons were seated in the front area of the church than in the sides or back.