In Skagit County, Washington, 45 members of a 60-person choir rehearsal became ill with COVID-19. 

None had shown symptoms prior to attending rehearsal and there were no known cases in their county, despite people contracting the novel coronavirus in nearby Seattle.  

In Austin, Texas, 28 out of 70 students who booked a plane to Mexico for a spring break trip have tested positive for the virus.

Meanwhile, a town in Georgia where more than 200 mourners gathered to attend a funeral has become a viral hotspot, with dozens of relatives and attendees falling ill.

And a radio host who was covering the coronavirus quarantine in New Rochelle, New York, in early March hosted a 90th birthday party for her mother on March 8. She later tested positive for COVID-19. Since then, eight people who attended the party have come down with the illness, including both her parents. Two of the infected party attendees have died.

Each of these — and many other similar cases — highlights just how quickly COVID-19 can spread from even a relatively small gathering of people.

It also indicates how a case-free area can quickly become a viral epicenter. 

Current recommendations from the Centers for Disease Control and Prevention (CDC) call for canceling gatherings of more than 250 people in places without any reported cases and canceling events of any size where there’s substantial community spread of the disease.

Coming to a community near you

These cases underline that canceling events, staying at home, and practicing social distancing might be the only way to prevent or limit a sudden surge of COVID-19, even if it’s not widespread in a community.

For instance, while many places in the United States, especially rural areas, have yet to experience a confirmed case of COVID-19, it’s unlikely any community will escape the spread of the illness, experts say. 

Relatively isolated communities are often not self-sufficient and that means they still receive supplies and contact from the outside world, said Eleanor J. Murray, ScD, assistant professor of epidemiology at Boston University in Massachusetts and co-host of the Casual Inference podcast

In the absence of extensive and rigorous testing, that means the virus reaching these places is inevitable. 

“Rural and remote communities may be protected in the short term because of the limited contact between them and other areas. However, we know from past outbreaks (including 1918 influenza, HIV, etc.) that widespread infectious diseases do reach remote and rural areas,” Murray told Healthline.

“When they do, these areas often suffer disproportionate death rates because of a lack of easy access to care, and interdependency among community members for essential services. For example, if an area has one doctor and she gets sick, that’s a very big deal.”

Why the virus is so contagious

Right now, we don’t know exactly how contagious COVID-19 is compared to other illnesses, but it appears to be around two or three times as contagious as the flu, according to Tista Ghosh, MD, MPH, medical director at healthcare company Grand Rounds and a former member of the CDC’s Community Preventive Services Task Force.

In fact, a group of experts has reportedly told Trump administration officials that talking and even breathing could spread the disease.

“Epidemiologists use the term R0 (R “naught”) to explain how contagious a virus is,” Ghosh told Healthline. “If a virus has an R0 of 1, that means each person [with the infection] can spread the disease to one other person. We’re still learning about the R0 of this new coronavirus, but some studies have suggested an R0 between 2 to 2.5 — meaning for every person [with the disease], approximately ‘two-ish’ people will contract the virus.”

Other studies put that number higher, closer to 3 or 3.5, she noted. 

“Now let’s imagine that the first person [with the virus] stays at home and doesn’t interact with anyone. Then the virus doesn’t have the opportunity to [transmit to] three more people. Those three people don’t have the opportunity to [affect] nine more people,” Ghosh explained. “So social distancing (staying away from each other) interrupts the virus’s ability to spread and infect.”

“Right now, it’s the only tool we have to stop this spread because we don’t have a vaccine,” she noted.

That’s a big deal when a viable vaccine is likely more than a year away.

The CDC recommends that all people wear cloth face masks in public places where it’s difficult to maintain a 6-foot distance from others.

This will help slow the spread of the virus from people without symptoms or people who do not know they have contracted the virus.

Cloth face masks should be worn while continuing to practice physical distancing. Instructions for making masks at home can be found here.

Note: It’s critical to reserve surgical masks and N95 respirators for healthcare workers.

Governments begin cracking down

People either unable or unwilling to ignore those social distancing rules put themselves at considerable risk.

A new interactive map from the New York Times illustrates the spread of the disease when people began to stop traveling more than a couple of miles.

In places such as Florida and Louisiana, several pastors have continued to hold large congregations.

Local governments have been cracking down on such events.

The pastor of the Life Tabernacle Church in Central, Louisiana, who has been defying Governor John Bel Edwards’ orders to end mass gatherings, was recently charged with six misdemeanors violations for continuing to hold services. 

“This is not an issue over religious liberty and it’s not about politics,” Central Police Department Chief Roger Corcoran told local TV station WAFB. “We are facing a public health crisis and expect our community’s leaders to set a positive example and follow the law.”

A Tampa, Florida, pastor was arrested this week for similar reasons and charged with unlawful assembly and violation of public health emergency rules. 

Experts say these measures are necessary to preserve public health and curtail preventable deaths from the virus. 

“We know that when people cough or sneeze, or when they sing or talk loudly, they produce little particles that can travel about 6 feet (or 2 meters) and can land on people or surfaces,” Murray explained. “These particles can be infectious for hours or days depending on where they land, and if someone touches them and then touches their eyes, nose, or mouth, they can [contract the virus].”

“Large church services are a bad idea because it’s very unlikely that people will all be more than 6 feet apart and that no one will come into physical contact,” she added. “Choir practices and other singing events should be canceled because even being 6 feet apart might not be far enough.”

Testing, distancing, and isolation

Reports have surfaced this week that 25 to 50 percent of people with COVID-19 don’t have noticeable symptoms and could be unknowingly spreading the virus to others.

“As long as there are asymptomatic people wandering around, transmission to others will continue to occur,” Michael G. Schmidt, PhD, a professor of microbiology and immunology at the Medical University of South Carolina (MUSC) in Charleston, South Carolina, told Healthline.

One way to limit transmission of the virus from those who are asymptomatic would be rigorous testing of the entire population, a capacity the United States has not yet accomplished. 

“[With SARS], the thing that really helped with that was really testing and tracking and contact tracing to identify who is sick, who has been exposed to them, who needs to be locked down. And in the U.S., even once we knew that we had cases [of COVID-19], we weren’t doing that because we didn’t have the testing capability,” Murray said. “And so, without being able to test people, we couldn’t lock down people who might be infected or infectious and everything kind of proceeded as normal. Given the testing situation, I think it would have been appropriate to say all mass gatherings should be canceled because we have no idea whether COVID is here or in what quantity.”

That makes self-quarantine if you’re sick, self-isolation if you have come in contact with someone who is sick, and social distancing if you’re otherwise healthy all the more important, she said. 

We’ll likely have to continue to do this in some measure or another until a vaccine is developed.

“As soon as you stop these social distancing type things you run the risk of starting up a whole new chain of infection,” she said.

 

All data and statistics are based on publicly available data on 4/01/2020. Some information may be out of date.