COVID-19 Cluster Investigation After Choir Recording at Church x: A Case-control Study, Bantul Regency, Indonesia, May 2021

Background: On May 29, 2021, Public Health Center Imogiri 1 obtained information about a positive COVID-19 patient in their area. The patient attended a choir at Church X on May 19, 2021 with 27 other attendees. An epidemiological investigation was carried out to confirm the existence of the COVID-19 cluster, describe the cluster, identify the cause, and risk factors, then provide recommendations for future COVID-19 control.
Methods: This investigation study was a case-control study with a ratio of 1:1. The case definition was people involved in the church X recording process and close contacts with positive results of real-time reverse transcription-polymerase chain reaction (rRT-PCR) for COVID-19 in Bantul from May–June 2021. Those who tested negative were selected as controls. Data were obtained using a standardized electronic form questionnaire and observation at the church to identify the risk factors.
Results: There were 57 suspects, including their close contacts, with 24 (42%) testing positive. Most of the cases were female (71%) and aged between 25–44 years (46%). One (4%) case was hospitalized, and 3 (13%) patients were in isolation. A total of 17 (71%) cases were asymptomatic, 3 (13%) cases developed fever, and 3 (13%) cases had a cough. In the multivariate analysis, COVID-19 infection was significantly associated with social distancing less than <1 meter (AOR=10; 95% CI 1.84–56.08, p=0.008). The indoor rehearsal was conducted in a closed space with closed windows. Interviews with church committees revealed that singers only used a face shield without a mask during the recording process.
Conclusions: A cluster transmission occurred in church X after a choir recording with improper health protocols and inadequate ventilation. It is necessary to use digital technology for individual recording or proper health protocols for group recording. It is also essential for stakeholders to strengthen and emphasize the importance of health protocols.

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