According to the U.S. Centers for Disease Control and Prevention, at last count Washington state had 4,896 reported COVID-19 cases. That puts our neighbour to the immediate south eighth in the ranking of states by total number of reported cases. (By contrast, New York leads the way with a staggering 67,131 reported cases.)
You would think the sheer numbers would reinforce the need for social distancing in the state, but this is a situation that is changing so rapidly that the general public's thinking has shifted from just a few short weeks ago.
Case in point: consider that way back on March 10, Skagit County—home to communities such as Mount Vernon, Burlington, Anacortes, and La Conner—confirmed its very first COVID-19 case. On that same day, some 56 members of the Skagit Valley Chorale (almost half of the choir's 121 members) gathered for a practice at Mount Vernon Presbyterian Church.
Today, two of those 56 are dead, and at least three have been hospitalized. In total, 45 members of the choir have been diagnosed with COVID-19.
According to reporting by goSkagit.com, the Skagit Valley Chorale board of directors had not yet heard of a local positive case when it decided to hold rehearsal, "but it did urge its members to stay home if anyone felt sick or showed symptoms of cough, fever or shortness of breath".
“On the day of the rehearsal, there were no cases of COVID-19 announced in Skagit Valley. There were no closures of schools, restaurants, churches, bowling alleys, banks, libraries, theater, or any other businesses,” according to a statement released later by the board.
At the practice, a greeter offered incoming members hand sanitizer, and the choristers refrained from their usual habit of hugging one another.
Nonetheless, many got sick, and two died—which offers a stark reminder that even asymptomatic people who make no direct contact with each other can spread the virus just by gathering together in close quarters and, in this case, releasing it into the air through the act of singing.
The official line from the World Health Organization is that the COVID-19 virus is transmitted not in "aerosols", but through much larger "respiratory droplets", as when an infected person coughs or sneezes. The Los Angeles Times, however, reports on a study published in the New England Journal of Medicine that found "when the virus was suspended in a mist under laboratory conditions it remained 'viable and infectious' for three hours—though researchers have said that time period would probably be no more than a half-hour in real-world conditions."
One of the authors of that study, UCLA infectious-disease researcher Jamie Lloyd-Smith, told the Times that it’s a real possibility that, in the Skagit Valley cluster, the forceful breathing action of singing did disperse viral particles into the church room, which were then widely inhaled.
“One could imagine that really trying to project your voice would also project more droplets and aerosols,” said Lloyd-Smith, who noted that the Mount Vernon outbreak would be considered a “super-spreading event".
According to goSkagit.com, choir director Adam Burdick said, “We are getting a flood of national media attention right now. We’re dealing also with people who are responding in a pretty unpleasant way, saying that we should known better, and that we’re at fault. Which is hard to deal with.”
Burdick said the choir simply made decisions based on the information that it had at the time, three weeks ago.
“Things have changed dramatically since then,” he said. “And now, I’m hopeful that there’s nobody who is unclear about it.”
The Skagit Valley Chorale story should serve as a cautionary tale, helping the public understand the risks. Burdick noted that another lesson to be gleaned from this tragedy is that some of those risks are still unknown.
“Some people are understanding that, and some people are not,” he said.