niman

FIGURE. Date of symptom onset* among persons with laboratory-confirmed cases of COVID-19 (N = 35) who attended March 6–11 church A events — Arkansas, March 6–23, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * One asymptomatic person who had a positive test result is included on the date of specimen collection (March 18). Top

TABLE 2. Estimated attack rates of COVID-19 among attendees at church A events — Arkansas, March 6–11, 2020 Characteristic All Mar 6–11 church A attendees (lower bound) All tested Mar 6–11 church A attendees (upper bound) No. of cases/no. exposed (%) Risk ratio (95% CI) p-value No. of cases/no. tested (%) Risk ratio (95% CI) p-value Overall 35/92 (38.0) — — 35/45 (77.8) — — Age group (yrs) ≤18 2/32 (6.3) 0.1 (0.03–0.4) <0.001 2/8 (25.0) 0.3 (0.1–1.0) 0.003 19–64 19/32 (59.4) Referent — 19/23 (82.6) Referent — ≥65 14/28 (50.0) 0.8 (0.5–1.3) 0.47 14/14 (100.0) 1.2 (1.0–1.5) 0.10 Sex Male 17/44 (38.6) 1.0 (0.6–1.7) 0.91 17/22 (77.3) 1.0 (0.7–1.3) 0.94 Female 18/48 (37.5) Referent — 18/23 (78.3) Referent — Church A event attendance Weekend only (Mar 6–8) 28/64 (43.8) 1.4 (0.7–2.8) 0.3 28/33 (84.8) 1.4 (0.8–2.4) 0.09 Bible study only (Mar 11) 1/9 (11.1) 0.4 (0.05–2.5) 0.25 1/2 (50.0) 1.7 (0.4–6.8) 0.21 Both weekend and Bible study 6/19 (31.6) Referent — 6/10 (60.0) Referent — Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019.

TABLE 1. Demographic characteristics, church A event attendance, and SARS-CoV-2 testing status of persons who attended church A events where persons with confirmed COVID-19 (N = 92) also attended — Arkansas, March 2020 Characteristic All attendees No. (%)* No. (%) tested† p-value§ No. (%) who tested positive† p-value§ Total 92 (100) 45 (49) — 35 (38) — Age group (yrs) ≤18 32 (35) 8 (25) 0.001 2 (6) 0.004 18–64 32 (35) 23 (72) 19 (59) ≥65 28 (30) 14 (50) 14 (50) Sex Male 44 (48) 22 (50) 1.0 17 (39) 1.0 Female 48 (52) 23 (48) 18 (38) Church A event attendance Weekend only (Mar 6–8) 64 (70) 33 (52) 0.28 28 (44) 0.16 Bible study only (Mar 11) 9 (10) 2 (22) 1 (11) Both weekend and Bible study 19 (21) 10 (53) 6 (32) Abbreviation: COVID-19 = coronavirus disease 2019. * Includes all persons who were confirmed to have attended church A events during March 6–11; percentages are column percentages. † Percentage of attendees (row percentages). § Calculated with Fisher’s exact test.

Discussion This investigation identified 35 confirmed COVID-19 cases among 92 attendees at church A events during March 6–11; estimated attack rates ranged from 38% to 78%. Despite canceling in-person church activities and closing the church as soon as it was recognized that several members of the congregation had become ill, widespread transmission within church A and within the surrounding community occurred. The primary patients had no known COVID-19 exposures in the 14 days preceding their symptom onset dates, suggesting that local transmission was occurring before case detection. Children represented 35% of all church A attendees but accounted for only 18% of persons who received testing and 6% of confirmed cases. These findings are consistent with those from other reports suggesting that many children with COVID-19 experience more asymptomatic infections or milder symptoms and have lower hospitalization rates than do adults (4,5). The role of asymptomatic or mildly symptomatic children in SARS-CoV-2 transmission remains unknown and represents a critical knowledge gap as officials consider reopening public places. The risk for symptomatic infection among adults aged ≥65 years was not higher than that among adults aged 19–64 years. However, six of the seven hospitalized persons and all three deaths occurred in persons aged ≥65 years, consistent with other U.S. data indicating a higher risk for COVID-19–associated hospitalization and death among persons aged ≥65 years (6). The findings in this report are subject to at least four limitations. First, some infected persons might have been missed because they did not seek testing, were ineligible for testing based on criteria at the time, or were unable to access testing. Second, although no previous cases had been reported from this county, undetected low-level community transmission was likely, and some patients in this cluster might have had exposures outside the church. Third, risk of exposure likely varied among attendees but could not be characterized because data regarding individual behaviors (e.g., shaking hands or hugging) were not collected. Finally, the number of cases beyond the cohort of church attendees likely is undercounted because tracking out-of-state transmission was not possible, and patients might not have identified church members as their source of exposure. High transmission rates of SARS-CoV-2 have been reported from hospitals (7), long-term care facilities (8), family gatherings (9), a choir practice (10), and, in this report, church events. Faith-based organizations that are operating or planning to resume in-person operations, including regular services, funerals, or other events, should be aware of the potential for high rates of transmission of SARS-CoV-2. These organizations should work with local health officials to determine how to implement the U.S. Government’s guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities (2). Top Acknowledgments Members of the congregation of church A, including the pastor and his wife; Arkansas Department of Health; Suzanne Beavers, CDC; Laura Rothfeldt, Arkansas Department of Health; state and local health departments where out-of-state visitors resided. Top Corresponding author: Allison E. James, [email protected], 501-614-5278.

On March 16, 2020, the day that national social distancing guidelines were released (1), the Arkansas Department of Health (ADH) was notified of two cases of coronavirus disease 2019 (COVID-19) from a rural county of approximately 25,000 persons; these cases were the first identified in this county. The two cases occurred in a husband and wife; the husband is the pastor at a local church (church A). The couple (the index cases) attended church-related events during March 6–8, and developed nonspecific respiratory symptoms and fever on March 10 (wife) and 11 (husband). Before his symptoms had developed, the husband attended a Bible study group on March 11. Including the index cases, 35 confirmed COVID-19 cases occurred among 92 (38%) persons who attended events held at church A during March 6–11; three patients died. The age-specific attack rates among persons aged ≤18 years, 19–64 years, and ≥65 years were 6.3%, 59.4%, and 50.0%, respectively. During contact tracing, at least 26 additional persons with confirmed COVID-19 cases were identified among community members who reported contact with church A attendees and likely were infected by them; one of the additional persons was hospitalized and subsequently died. This outbreak highlights the potential for widespread transmission of SARS-CoV-2, the virus that causes COVID-19, both at group gatherings during church events and within the broader community. These findings underscore the opportunity for faith-based organizations to prevent COVID-19 by following local authorities’ guidance and the U.S. Government’s Guidelines: Opening Up America Again (2) regarding modification of activities to prevent virus transmission during the COVID-19 pandemic. On March 10 and 11, the wife of the church pastor, aged 56 years, and the pastor, aged 57 years, developed fever and cough. On March 12, the pastor, after becoming aware of similar nonspecific respiratory symptoms among members of their congregation, closed church A indefinitely. Because of fever, cough, and increasing shortness of breath, the couple sought testing for SARS-CoV-2 on March 13; both were notified of positive results by reverse transcription–polymerase chain reaction testing on March 16. The same day, ADH staff members began an investigation to identify how the couple had been exposed and to trace persons with whom they had been in contact. Based on their activities and onset dates, they likely were infected at church A events during March 6–8 and the husband might have then exposed others while presymptomatic during a Bible study event held on March 11. During March and April 2020, all persons in Arkansas who received testing for SARS-CoV-2 at any laboratory were entered into a database (Research Electronic Data Capture [REDCap]; version 8.8.0; Vanderbilt University) managed by ADH. Using a standardized questionnaire, ADH staff members interviewed persons who had positive test results to ascertain symptoms, onset date, and potential exposure information, including epidemiologic linkages to other COVID-19 patients; this information was stored in the database. Close contacts of patients with laboratory-confirmed cases of COVID-19 were interviewed and enrolled in active symptom monitoring; those who developed symptoms were tested and their information was also entered into the database. Church A–associated cases were defined as those in 1) persons who had laboratory results positive for SARS-CoV-2 who identified contact with church A attendees as a source of exposure and 2) actively monitored contacts of church attendees who had a test result positive for SARS-CoV-2 after becoming symptomatic. The public health investigation focused on the transmission of SARS-CoV-2 among persons who attended church A events during March 6–11. To facilitate the investigation, the pastor and his wife generated a list of 94 church members and guests who had registered for, or who, based on the couple’s recollection, might have attended these events. During March 6–8, church A hosted a 3-day children’s event which consisted of two separate 1.5-hour indoor sessions (one on March 6 and one on March 7) and two, 1-hour indoor sessions during normal church services on March 8. This event was led by two guests from another state. During each session, children participated in competitions to collect offerings by hand from adults, resulting in brief close contact among nearly all children and attending adults. On March 7, food prepared by church members was served buffet-style. A separate Bible study event was held March 11; the pastor reported most attendees sat apart from one another in a large room at this event. Most children and some adults participated in singing during the children’s event; no singing occurred during the March 11 Bible study. Among all 94 persons who might have attended any of the events, 19 (20%) attended both the children’s event and Bible study. The husband and wife were the first to be recognized by ADH among the 35 patients with laboratory-confirmed COVID-19 associated with church A attendance identified through April 22; their illnesses represent the index cases. During the investigation, two persons who were symptomatic (not the husband and wife) during March 6–8 were identified; these are considered the primary cases because they likely initiated the chain of transmission among church attendees. Additional cases included those in persons who attended any church A events during March 6–11, but whose symptom onset occurred on or after March 8, which was 2 days after the earliest possible church A exposure. One asymptomatic attendee who sought testing after household members became ill was included among these additional cases. Consistent with CDC recommendations for laboratory testing at that time (3), clinical criteria for testing included cough, fever, or shortness of breath; asymptomatic persons were not routinely tested. To account for this limitation when calculating attack rates, upper and lower boundaries for the attack rates were estimated by dividing the total number of persons with laboratory-confirmed COVID-19 by the number of persons tested for SARS-CoV-2 and by the number of persons who attended church A during March 6–11, respectively. All analyses were performed using R statistical software (version 4.0.0; The R Foundation). Risk ratios were calculated to compare attack rates by age, sex, and attendance dates. Fisher’s exact test was used to calculate two-sided p-values; p-values <0.05 were considered statistically significant. Overall, 94 persons attended church A events during March 6–11 and might have been exposed to the index patients or to another infectious patient at the same event; among these persons, 92 were successfully contacted and are included in the analysis. Similar proportions of church A attendees were aged ≤18 years (35%), 19–64 years (35%), and ≥65 years (30%) (Table 1). However, a higher proportion of adults aged 19–64 years and ≥65 years were tested (72% and 50%, respectively), and received positive test results (59% and 50%), than did younger persons. Forty-five persons were tested for SARS-CoV-2, among whom 35 (77.8%) received positive test results (Table 2). During the investigation, two church A participants who attended the March 6–8 children’s event were found to have had onset of symptoms on March 6 and 7; these represent the primary cases and likely were the source of infection of other church A attendees (Figure). The two out-of-state guests developed respiratory symptoms during March 9–10 and later received diagnoses of laboratory-confirmed COVID-19, suggesting that exposure to the primary cases resulted in their infections. The two primary cases were not linked except through the church; the persons lived locally and reported no travel and had no known contact with a traveler or anyone with confirmed COVID-19. Patient interviews revealed no additional common exposures among church attendees. The estimated attack rate ranged from 38% (35 cases among all 92 church A event attendees) to 78% (35 cases among 45 church A event attendees who were tested for SARS-CoV-2). When stratified by age, attack rates were significantly lower among persons aged ≤18 years (6.3%–25.0%) than among adults aged 19–64 years (59.4%–82.6%) (p<0.01). The risk ratios for persons aged ≤18 years compared with those for persons aged 19–64 years were 0.1–0.3. No severe illnesses occurred in children. Among the 35 persons with laboratory-confirmed COVID-19, seven (20%) were hospitalized; three (9%) patients died. At least 26 additional confirmed COVID-19 cases were identified among community members who, during contact tracing, reported contact with one or more of the 35 church A members with COVID-19 as an exposure. These persons likely were infected by church A attendees. Among these 26 persons, one was hospitalized and subsequently died. Thus, as of April 22, 61 confirmed cases (including eight [13%] hospitalizations and four [7%] deaths) had been identified in persons directly and indirectly associated with church A events.

Summary What is already known about this topic? Large gatherings pose a risk for SARS-CoV-2 transmission. What is added by this report? Among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). An additional 26 cases linked to the church occurred in the community, including one death. What are the implications for public health practice? Faith-based organizations should work with local health officials to determine how to implement the U.S. Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities.

High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020 Early Release / May 19, 2020 / 69 Allison James, DVM, PhD1,2; Lesli Eagle1; Cassandra Phillips1; D. Stephen Hedges, MPH1; Cathie Bodenhamer1; Robin Brown, MPAS, MPH1; J. Gary Wheeler, MD1; Hannah Kirking, MD3 1Arkansas Department of Health; 2Epidemic Intelligence Service, CDC; 3COVID-19 Response Team, CDC. https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e2.htm?s_cid=mm6920e2_w

https://health.wyo.gov/publichealth/infectious-disease-epidemiology-unit/disease/novel-coronavirus/covid-19-map-and-statistics/

https://montana.maps.arcgis.com/apps/MapSeries/index.html?appid=7c34f3412536439491adcc2103421d4b

Statewide COVID-19 Positive* Cases Total Cases 641 (1 newly reported) Released from Isolation† 578 Required Hospitalization 82 Deaths 17 https://health.hawaii.gov/coronavirusdisease2019/what-you-should-know/current-situation-in-hawaii/

https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases

Maine COVID‑19 Cumulative Case Data Updated: May 19, 2020 at 11:30 AM Total Cases1 Confirmed Cases Probable Cases Recovered Hospitalizations Deaths 1,741 1,561 180 1,088 225 73 1Maine's total case count includes both confirmed and probable cases. For more information about this data, please see the "Read Details About the Data" section below. https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml Total Number of COVID‑19 Tests in Maine Updated: May 13, 202033,035 New as of 5/13/2020 Maine CDC will publish the total number of tests once a week on Wednesdays. Because of the number of outside labs that are testing samples from Maine, it is not currently possible to post a complete count of tests on a daily basis. View a Table of Maine COVID-19 Current Hospital Use and Capacity Data Hospitalized: Confirmed Cases Total Hospitalized 44 In Critical Care 19 On a Ventilator 11 Capacity Available Critical Care Beds 185 Total Critical Care Beds 395 Available Ventilators 253 Total Ventilators 314 Alternative Ventilators 439 Updated May 19, 2020 at 11:30 AM View a Table of Cumulative COVID‑19 Cases by County

https://dhhr.wv.gov/COVID-19/Pages/default.aspx

New Hampshire 2019 Novel Coronavirus (COVID-19) Summary Report (data updated as of May 19, 2020, 9:00 AM) https://www.nh.gov/covid19/ Number of Persons with COVID-19 1 3,721 Recovered 1,275 (34%) Deaths Attributed to COVID-19 182 (5%) Total Current COVID-19 Cases 2,264 Persons Who Have Been Hospitalized for COVID-19 383 (10%) Current Hospitalizations 105 Total Persons Tested at Selected Laboratories, Polymerase Chain Reaction (PCR)2 50,888 Total Persons Tested at Selected Laboratories, Antibody Laboratory Tests2 6,617 Persons with Specimens Submitted to NH PHL 17,583 Persons with Test Pending at NH PHL3 861 Persons Being Monitored in NH (approximate point in time) 3,775 1 Includes specimens positive at any laboratory and those confirmed by CDC confirmatory testing.2 Includes specimens tested at the NH Public Health Laboratories (PHL), LabCorp, Quest, Dartmouth-Hitchcock Medical Center, and those sent to CDC prior to NH PHL testing capacity.3 Includes specimens received and awaiting testing at NH PHL. Does not include tests pending at commercial laboratories. Cases by County County Cases Belknap 53 Carroll 44 Cheshire 49 Coos 4 Grafton 63 Hillsborough - Other 612 Hillsborough - Manchester 869 Hillsborough - Nashua 339 Merrimack 283 Rockingham 1,138 Strafford 240 Sullivan 16 County TBD 11 Grand Total 3,721

2,583 Douglas 1,475 Dakota 1,435 Hall 912 Lancaster 810 Dawson 532 Colfax 481 Platte 436 Saline 366 Sarpy 274 Dodge 271 Madison 255 Adams 136 Buffalo 54 Scotts Bluff 52 Hamilton 45 Lincoln 43 Gage 38 Howard 34 Butler 30 York 29 Merrick 28 Custer 27 Dixon 26 Seward 24 Washington 23 Cass 22 Saunders 19 Clay 19 Thurston 17 Cuming 15 Stanton 13 Gosper 13 Phelps 11 Kearney 10 Morrill 9 Polk 9 Kimball 9 Cheyenne 8 Knox 7 Johnson 7 Antelope 6 Otoe 6 Jefferson 6 Furnas 6 Cedar 5 Franklin 5 Webster 5 Red Willow 5 Burt 4 Fillmore 4 Wayne 4 Nance 3 Valley 3 Nemaha 3 Boone 2 Sherman 2 Dawes 2 Keith 2 Greeley 1 Thomas 1 Holt 1 Nuckolls 1 Hitchcock 1 Box Butte 1 Pierce 1 Richardson 1 Frontier 1 Cherry https://nebraska.maps.arcgis.com/apps/opsdashboard/index.html#/4213f719a45647bc873ffb58783ffef3

https://coronavirus.idaho.gov/

Positive 6,192 Total Tests * 142,246 Click Here to View Positive Cases By County COVID-Related Deaths in NM 276 *Numbers are cumulative persons tested through 5/19/2020, 6:09:16 PM. Test results are from the state Scientific Laboratory Division of the New Mexico Department of Health, TriCore Reference Laboratories, LabCorp, Mayo Clinic Laboratories, Quest Diagnostics, and BioReference Laboratories. https://cv.nmhealth.org/

https://coronavirus.health.ok.gov/

Total Tested153,800 Total Positive8,069 Deaths366 Recovered2,826 https://govstatus.egov.com/kycovid19

https://coronavirus.utah.gov/case-counts/

https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020COVID19/DataDashboard

As of May 18, 2020, at 8:30 PM, a total of 38430 cases of COVID-19 have been reported among Connecticut residents. Nine hundred and fourteen patients are currently hospitalized with laboratoryconfirmed COVID-19. There have been 3472 COVID-19-associated deaths. Day-to-day changes reflect newly reported cases, deaths, and tests that occurred over the last several days to week. All data in this report are preliminary; data for previous dates will be updated as new reports are received and data errors are corrected. Hospitalization data were collected by the Connecticut Hospital Association. Deaths* reported to either the OCME or DPH are included in the daily COVID-19 update. *For public health surveillance, COVID-19-associated deaths include persons who tested positive for the virus that causes COVID-19 disease around the time of death (confirmed) and persons whose death certificate lists COVID-19 disease as a cause of death or a significant condition contributing to death (probable). Overall Summary Total Change Since Yesterday COVID-19 Cases 38430 +314 COVID-19-Associated Deaths 3472 +23 Patients Currently Hospitalized with COVID-19 914 -6 COVID-19 Tests Reported 185520 +7841 COVID-19 Cases and Associated Deaths by County of Residence As of 05/18/20 8:30pm. Includes patients tested at the State Public Health Laboratory, hospital, and commercial laboratories. County COVID-19 Cases COVID-19-Associated Deaths Fairfield County 14522 1160 Hartford County 9050 1090 Litchfield County 1290 117 Middlesex County 947 131 New Haven County 10427 838 New London County 880 66 Tolland County 770 54 Windham County 326 14 Pending address validation 218 2 Total 38430 3472 National COVID-19 statistics and information about preventing spread of COVID-19 are available from the Centers for Disease Control and Prevention. https://portal.ct.gov/-/media/Coronavirus/CTDPHCOVID19summary5192020.pdf?la=en

There are 11,361 confirmed COVID-19 patients in Missouri, including 625 deaths. https://www.kshb.com/news/coronavirus/covid-19-case-tracker-where-we-stand-in-mo-ks-nationwide COUNTY COVID-19 Cases COVID-19 Deaths Adair County 30 0 Andrew County 19 0 Atchison County 2 0 Audrain County 6 0 Barry County 6 0 Barton County 0 0 Bates County 7 1 Benton County 9 0 Bollinger County 4 0 Boone County 106 1 Buchanan County 543 2 Butler County 32 0 Caldwell County 4 0 Callaway County 23 1 Camden County 36 1 Cape Girardeau County 54 2 Carroll County 7 0 Carter County 4 1 Cass County 75 8 Cedar County 9 0 Chariton County 5 0 Christian County 22 0 Clark County 1 0 Clay County 123 1 Clinton County 17 0 Cole County 55 1 Cooper County 9 0 Crawford County 8 0 Dade County 0 0 Dallas County 3 0 Daviess County 3 0 DeKalb County 4 0 Dent County 1 0 Douglas County 0 0 Dunklin County 26 2 Franklin County 135 14 Gasconade County 2 0 Gentry County 3 0 Greene County 107 8 Grundy County 0 0 Harrison County 8 0 Henry County 9 1 Hickory County 0 0 Holt County 1 0 Howard County 3 0 Howell County 5 0 Iron County 2 0 Jackson County 457 16 Jasper County 29 0 Jefferson County 330 14 Johnson County 72 0 Knox County 0 0 Laclede County 3 0 Lafayette County 68 2 Lawrence County 8 0 Lewis County 7 1 Lincoln County 78 1 Linn County 5 1 Livingston County 3 0 McDonald County 14 0 Macon County 2 0 Madison County 3 0 Maries County 2 0 Marion County 5 0 Mercer County 0 0 Miller County 4 0 Mississippi County 49 0 Moniteau County 53 1 Monroe County 0 0 Montgomery County 7 0 Morgan County 8 0 New Madrid County 14 1 Newton County 16 1 Nodaway County 6 0 Oregon County 2 0 Osage County 5 0 Ozark County 0 0 Pemiscot County 70 3 Perry County 47 0 Pettis County 70 1 Phelps County 3 0 Pike County 14 1 Platte County 58 0 Polk County 2 0 Pulaski County 33 1 Putnam County 0 0 Ralls County 2 0 Randolph County 8 0 Ray County 14 0 Reynolds County 2 0 Ripley County 7 0 St. Charles County 711 53 St. Clair County 3 0 Ste. Genevieve County 8 1 St. Francois County 33 2 St. Louis County 4,374 347 Saline County 255 2 Schuyler County 1 0 Scotland County 4 0 Scott County 86 7 Shannon County 0 0 Shelby County 1 0 Stoddard County 64 1 Stone County 4 0 Sullivan County 37 0 Taney County 12 2 Texas County 0 0 Vernon County 5 0 Warren County 29 0 Washington County 9 1 Wayne County 0 0 Webster County 17 0 Worth County 3 0 Wright County 11 0 St. Louis city 1,682 100 Kansas City 903 21 TBD 1 0

https://covid19.colorado.gov/data/case-data

I removed the link. No more propaganda links allowed.