Investigation and Findings
On May 9 and May 11, 2020, respectively, a husband and wife in an Amish community in Wayne County, Ohio, experienced COVID-19–related symptoms. Both had nasopharyngeal samples tested and SARS-CoV-2 infection confirmed by receipt of positive RT-PCR results on May 14. The husband, who had a history of chronic obstructive pulmonary disease, participated in church services on May 2 and 3. He was hospitalized on May 15 with fever, cough, and shortness of breath, and received a diagnosis of COVID-19–related pneumonia; he was discharged on May 17. Another adult family member, with cancer, became symptomatic May 16, received a positive SARS-CoV-2 test result May 18, and died May 21. During May 13–19, four additional symptomatic community members received positive test results. After these initial seven cases were identified, community leaders contacted Wayne County Health Department (WCHD) to report that numerous other community members had symptoms** consistent with COVID-19. As a result, WCHD, with support from the Ohio Department of Health and a community bishop, organized a testing clinic at an Amish community school on May 20, where nasopharyngeal swabs were collected for RT-PCR testing. The testing clinic was publicized by the bishop and other community leaders; anyone could attend and receive testing.
CDC and Ohio health department investigators conducted 11 key informant interviews with community leaders and members. Some interviewees might have had COVID-19, but for reasons of confidentiality, interviewee names were not recorded. Consequently, interviews were not linked to cases. One interview was conducted at the testing clinic; 10 additional interviews, using snowball sampling (4), were conducted over the following 10 days. All invited participants orally consented to be interviewed. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.†† Interviews took 1 hour to complete and included open-ended questions to identify knowledge gaps related to COVID-19 prevention, transmission, and testing, and to understand attitudes, practices, facilitators of, and barriers to implementing strategies to decrease transmission. All interview notes were handwritten and reviewed by two interviewers. Theme saturation, a research term defined as the point “when a researcher begins to hear the same comments again and again” (5), was reached through iterative review and analysis. The following 10 themes were identified: 1) COVID-19 knowledge, including the spread of SARS-CoV-2; 2) myths and misinformation; 3) facilitators of and barriers to following COVID-19 prevention strategies at home, at work, and in the community; 4) use of traditional communication (e.g., newspapers) for information sharing; 5) access to testing; 6) means of transportation; 7) community cohesion; 8) selflessness; 9) strong work ethic; and 10) individual and community responsibility.
At the May 20 testing clinic and during the interviews, community members reported six social gatherings during the preceding 2 weeks, including a prechurch service§§ (May 2), church services (May 3, 10, and 17), a wedding (May 12), and a funeral (May 16) (Figure). Among 30 community members who had nasopharyngeal swabs collected at the testing clinic, 23 (77%) received positive SARS-CoV-2 test results. All community members with positive results reported multiple COVID-19–related signs and symptoms. The earliest symptom onset date was May 7, 5 days after a prechurch service and 4 days after a church service. On May 27, one person was hospitalized with fever and shortness of breath, received a diagnosis of COVID-19–associated pneumonia, and was discharged on May 30.
Among the 30 persons with laboratory-confirmed COVID-19, the mean age was 46 years (range = 12–86 years), and 21 (70%) were male. Eight of those persons reported having underlying medical conditions
https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a2.htm
