COVID-19

They went to church. They sat in the same seat where someone else sat at the previous service.

They went to dinner. They sat across the table from someone.

They went to church. They sat one row back from someone.

They went to a vocal lesson. They sang in the same room with someone.

They went home to their families. They went home to their housemates. They infected them. Many of them got sick.

Some died.

This is the plot summary of the latest publication in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, dated April 1. Written by six authors, the article (titled “Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020”) gives very plain and convincing evidence that backs up the guidance that public health officials are giving in the United States and the St. Louis region.

Stay home, especially if you feel sick, but even if you don’t feel sick. Just because you don’t feel sick does not mean you are not infected with the novel coronavirus (more technically known as SARS-CoV-2). Just because someone does not appear to be sick does not mean that they are not infected and cannot infect you and get you sick.

Stay home, for now, especially if you plan on doing any of the things that these people in Singapore did. And they did the most basic things. They went to dinner, to church and to singing lessons. They ate, prayed and sang with people who did not appear to be sick. But one of them was infected within the novel coronavirus, and within days that person would be sick. The people they ate, prayed and sang with would be sick – and some of their loved ones would soon be sick too. 

The guidance for church leaders (and choir directors) from this study should be especially clear. “Speech and other vocal activities such as singing have been shown to generate air particles, with the rate of emission corresponding to voice loudness,” the authors report. Literally, the louder you sing, the further you project the virus if you are infected. The louder you sing, the more people you will infect.

The authors studied all 243 reported COVID-19 cases in Singapore during January 23 and March 16 of this year. They had an advantage that public health officials in the St. Louis region do not have when reporting on COVID-19 in real time. Whereas public health officials are rightly limited by federal protections against disclosing details of someone’s health, these researchers were able to obtain and share valuable personal details about what the infected people did before and after they got sick.

Looking at the numbers, 157 of the 243 cases reported in Singapore during the time frame studied were locally acquired rather than picked up while traveling. Of those, 10 (or 6.4%) were attributed to presymptomatic transmission – the person got sick from someone who did not appear to be sick.

While that number is statistically significant and should alert everyone to the very real danger of catching COVID-19 from someone who does not appear to be sick, their findings appear to be in the low range. They point to a similar study of Chinese cases where twice as many (12.6%) of the people were infected by people who were presymptomatic.

The time frame for presymptomatic transmission, according to this report, is one to three days before the source patient develops symptoms. Presymptomatic transmission occurred in precisely the ways public health officials have been warning us: through respiratory droplets or indirect transmission.

Someone breathed or coughed or sang. They sat in a pew. They handled a dinner plate. They handled a collection plate. They shook a hand.

They went to church. They sat in the same seat where someone had sat at the previous service.

They went to church. They sat one row back from someone.

They went to dinner. They sat across the table from someone.

They went to a vocal lesson. They sang in the same room with someone.

They went home to their families. They went home to their housemates. They infected them. Many of them got sick.

Some died.

The corresponding author for the study is Vernon J. Lee, PhD, of the National University of Singapore (Vernon_Lee@moh.gov.sg).

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