On the latest episode of Social Distance, staff writer James Hamblin and executive producer Katherine Wells answer questions from listeners.
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What follows is an edited and condensed transcript of their conversation.
James Hamblin: This question comes from Tyler Richter in Springfield, Missouri. He says, “As churches open up their doors, are they risking the safety of their congregants by singing together? Our church announced, prior to this past Sunday, that we would not be singing out of an abundance of caution. However, when we arrived we were told if we were to sing, we should do so at a very quiet volume, and most people were either mouthing the words or barely producing any sound when they sang.”
Katherine Wells: It seems like such a surreal scene.
Hamblin: Yeah, it’s kind of eerie, right? Part of the worship experience tends to be the exultation and singing loudly and joyously, and that seems to be a very risky part of this. Globally, when you look at the number of people who practice some form of religion that congregates and does some sort of either singing or chanting or praising, yelling out, exclaiming things—this is potentially a huge driver of transmission. It’s also something people are going to be quick to deem essential, as our president has. So it’s a legitimate question of how do you do this as safely as possible?
Wells: Like, how does church work now? For instance.
Hamblin: Yeah, and there’s still a lot to be understood here, but basically you have all this mucus in your nasal pharynx, and that’s where the virus is hanging out and replicating. If you sneeze, it comes out in these big droplets, and those are going to fall to the ground pretty quickly. If someone is six feet away, none of those will hit you and it’s okay. But some will be projected into the air because they’re so tiny, they’re considered aerosolized—so they can just float and linger for a long time. That happens in coughing. It’s this process of force. The forcible ejection creates the aerosolization in a way that when you’re breathing real calmly and quietly, it’s just going to produce less [viral] material. Singing, especially when you’re doing it loudly and passionately, is much closer to coughing than it is to just sitting quietly.
Wells: I remember at the beginning of this, there was a choir that sang together and everybody got sick and several people died, I think. Right?
Hamblin: That was a case where there was one person who had some flu-like symptoms and attended and spread the virus to 53 out of 61 people who were at that choir practice. We were talking with Alexis [Madrigal] on Monday about super-spreading, and this is exactly how outbreaks really pick up the pace quickly: when you have not just someone spreading it to maybe a family member or a co-worker, but one person infecting 53 people. Then the same thing has been observed elsewhere. In Amsterdam, 102 out of 130 members of a choir got infected. In Austria, 43 out of 44. A lot of people in a small space projecting a lot and usually not having good airflow, because part of this is you’re supposed to be in a chamber where the sound will resonate in certain ways. It’s not the same when it’s done outdoors.
Wells: So should people have church services outdoors?
Hamblin: This is the kind of thing where I’m going to be really hesitant to adjudicate exactly at what point it becomes okay. What Tyler said is that in his church they’ve started to transition to not just singing quietly, but having about a fourth as many people in the congregation come [to services]. I think the more masks you can wear, the more airflow you can have, the more outdoors it can be—as in, if you could leave all doors and windows open, and there’s this free flow. All of those factors are going to help, and none are going to make it risk-free.
Wells: Okay, next question. This week, this whole thing blew up about asymptomatic transmission. And it’s something we’ve talked about before. But we’ve got a question about this from Lauren. She says, “Can you guys please unpack the WHO kerfuffle on asymptomatic transmission?” Do you understand this kerfuffle?
Hamblin: Yes. On Monday, there was a comment from an official at the World Health Organization. The official said that asymptomatic spread is “very rare.” And that got picked up.
Wells: And we should just say asymptomatic spread is the idea that someone can be showing no symptoms at all and feel totally fine and that they could still be spreading.
Hamblin: Yes, and that would also include people who never go on to get symptoms. Some people who are asymptomatic later test positive and never really felt anything. There are also people who are in an asymptomatic phase which, with any viral illness, precedes the symptomatic phase. In many diseases, people are shedding the virus as it’s replicating, and they’re able to spread that before their immune system ramps up and they start to have all these symptoms of the disease.
Wells: So you may not know you have it, but you could be contagious.
Hamblin: Right. We know that people in asymptomatic phases are contagious. We don’t know the exact number of how many cases are spread by people who are completely asymptomatic the whole time, versus people who go on to develop symptoms later, versus people who are experiencing symptoms and are also contagious, but the statement from the World Health Organization was revoked, and [they] clarified that we don’t know the exact percentage. I’m not sure why they said it was very rare, and I think it was just a point of confusion.
Wells: So prior to this week it was known that it was possible to not have symptoms and be contagious, but we didn’t know exactly how [often that happened]. On Monday, a WHO official said, basically, don’t worry about it—seems very rare. And then they were like—never mind, just go back to before, where we don’t really know.
Hamblin: Right. That was sort of a blip in the news cycle that shouldn’t have happened. Someone misspoke, and a tiny fragment of a comment was taken out of context.
Wells: Got it. So if anyone saw that and took from it the conclusion that Hey, if I feel fine I’m probably not contagious, therefore I don’t need to wear a mask or I don’t have to be as careful, because I’m not feeling symptoms, so I couldn’t possibly be contagious—that is incorrect. That was a mistake. You could totally be contagious and not feel [any symptoms].
Hamblin: Yeah, the reason that was a kerfuffle is because it’s a dangerous misstatement. It’s really important that people recognize that you can be asymptomatic and still spreading [the virus]. It would be much easier and more straightforward if we could say, As long as you don’t have a cough, then you’re fine or If you don’t have a fever, then you’re not contagious. There are diseases where we can say just stay home if you’re feeling sick. But this is not one of them.