A recurring theme here at Anglican Watch is the issue of in-person worship or participation in the life of the church, including church schools and related activities. Recent information from the CDC and studies conducted in South Korea make clear that preventing COVID-19 transmission in these settings is problematic and almost certainly unsuccessful over time.
According to Dr. Anthony Fauci, roughly 40 percent of persons infected with COVID-19 are asymptomatic. This includes those who are pre-symptomatic, and those who never show any outward signs of infection. Others place the number as high as 50 percent, with about 40 percent of children remaining asymptomatic throughout the progression of the disease.
In the Korean study, which differentiated between pre-symptomatic and asymptomatic carriers, 30 percent of patients were found to be asymptomatic. Yet these individuals showed viral loads in their noses, sinuses, and lungs equal to those experiencing symptoms. Additionally, the study found that asymptomatic persons could transmit the virus for roughly 17 days, while those who showed symptoms were contagious for roughly 20 days — longer than American estimates.
A Lancet medical journal study also showed that social distancing is more effective than facial coverings in preventing transmission, with a distance of roughly nine feet reducing infection from 12.8 to 2.6 percent. Wearing a mask reduced the risk of infection and transmission from 17.4 percent to 3.1 percent.
Further, one British expert believes that up to 70 percent of children may not know they are infected until they have a positive test. He further theorizes that, as a result, children may be a primary vector for disease transmission.
Implications for churches
It is important to remember that the data above was amassed during spread of the less-infectious strain, versus the UK and Indian variants. Thus, even when mitigation measures reduce the transmission rate, a 2 or 3 percent incidence of spread means one does not need a large number of exposures before infection becomes statistically likely with the old strain. Transmission becomes even more likely with the newer, more infectious strain.
Moreover, asymptomatic children have been found to carry viral loads equal or higher to those of infected adults, with one Harvard study showing very high viral loads in children during the first two days of infection. Viral load is associated with increased transmissibility of the virus, with Harvard experts adding:
“I was surprised by the high levels of virus we found in children of all ages, especially in the first two days of infection,” says Lael Yonker, director of the MGH Cystic Fibrosis Center and lead author of the study. “I was not expecting the viral load to be so high. You think of a hospital, and of all of the precautions taken to treat severely ill adults, but the viral loads of these hospitalized patients are significantly lower than a ‘healthy child’ who is walking around with a high SARS-CoV-2 viral load.”
Transmissibility or risk of contagion is greater with a high viral load. And even when children exhibit symptoms typical of COVID-19, like fever, runny nose and cough, they often overlap with common childhood illnesses, including influenza and the common cold. This confounds an accurate diagnosis of COVID-19, the illness derived from the SARS-CoV-2 coronavirus, says Yonker. Along with viral load, researchers examined expression of the viral receptor and antibody response in healthy children, children with acute SARS-CoV-2 infection and a smaller number of children with Multisystem Inflammatory Syndrome in Children (MIS-C).
Thus, churches that have children present for services face an increased risk of transmission, particularly if they experience difficulty in implementing adequate social distancing and other risk mitigation strategies.
Of particular concern are church schools, particularly those with in-person classes one or more days a week. In those situations, the high prevalence of asymptomatic infection among children, combined with the high viral loads of many pediatric patients, and the close proximity inherent in most teaching settings, create a high risk for transmission. Thus, church schools run the real risk of being superspreader locations that can, within the space of a few days or weeks, create widespread swaths of infection across the communities they serve. This paradigm is exacerbated by the fact that churches already are established high-risk locations.
In short, churches that continue to hold services, or even worse, hold in-person classes at their schools, risk practical and reputational disaster by assuming that temperature checks, mandatory sick days for symptomatic children, and other risk mitigation efforts will prevent their becoming COVID-19 hotspots.