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High COVID-19 Attack Rate Among Attendees at Events at a Church – Arkansas, March 2020

Our take —

This was a descriptive, contact tracing study in Arkansas, in which 35 out of 92 church goers and 26 of their contacts became infected, presumably from 2 symptomatic church attendees. One cannot rule out community transmission among these cases; however, the report demonstrated the consequences of attending large gatherings while symptomatic. This report also showed that in the absence of high testing coverage, people may not abide by social distancing guidelines as they may assume that they are not infected.

Study design

Case Series

Study population and setting

The report concerns a church gathering among 92 attendees in Arkansas and subsequent transmission from the gathering from March 6 to March 11, 2020.

Summary of Main Findings

The Arkansas Health Department (AHD) was notified on March 16, 2020 of a couple (husband and wife) who were the first 2 confirmed cases in a rural county. The husband was a pastor of a church and the couple attended church events from March 6 to 8, 2020 after which they developed mild symptoms. AHD later discovered that two attendees of the church had symptoms on March 6 and 7, and attended church events including several indoor events that lasted multiple hours, children collecting church offerings, and a buffet style meal. Between March 6 and 11, 2020, 92 people attended church events, and 35 (38%) became infected (including 3 deaths). There were 26 secondary cases who were contacts of the infected church cases (including 1 death). Among these contacts, the attack rate among those ≤18 years of age was 6.3%, for those aged 19–64 years was 59.4%, and for those aged ≥65 years was 50.0%.

Study Strengths

The strength of this report is that it demonstrates the use of contact tracing data to monitor the impact of gatherings (e.g. church events) on transmission when individuals are symptomatic.


It is possible that some of the cases reported were due to community transmission outside of the church events. Also, the categorization of age-specific attack-rates includes a wide age range (19-64 years) that was the highest attack rate, although it is possible that most cases were among older individuals in this category. Furthermore, there was no testing was done among those who were asymptomatic, thus this is likely an underestimation of true transmission.

Value added

The report provides an example of how large gatherings can result in an instant outbreak of transmission.

This review was posted on: 10 June 2020