The Role of Religion in Outbreaks

It’s time to discuss a couple of other global hot spots and want to focus on religious practices leading to the spread of disease.

South Korea is important because it is an economic and cultural bridge between East and West so it could easily act as a point of spread to other locations around the world.

The country has had only a handful of cases until mid-February. The sudden rise in cases is a good study in the need for social distancing. According to the South Korea Centers for Disease Control (KCDC), 339 out of 556 cases by Feb 23rd were linked to the Shincheonji Church of Jesus, the Temple of the Tabernacle of the Testimony. More cases were among a Catholic group of 39 people in the Andong Diocese who had traveled to the Holy Land. At the time of the KCDC report, 18 of the travelers had tested positive. By February 26, the number was closer to 30 of the travelers. 41 of the churches in the diocese had suspended mass and meetings until March 13th.

On Feb 26th, all 16 dioceses of the Catholic Church in South Korea had decided to suspend public mass, which affects 5.86 million members among 1747 churches and chapels. That has never been done in the church’s 236-year history in the country. Other denominational groups have begun to follow their lead.

The thing that I can’t determine is if they were incubating disease while in Israel. If so, this will be one of the important incidents in global spread because of the importance of Israel in world religion and as a destination for adherents from all parts of the world. It is pretty clear that if they were infectious during their time in the country that we can expect to see many more countries with cases in the next 2-4 weeks.

The situation in Iran is also very eye opening. The outbreak there likely started in Qom, which is one of the holy sites often visited by devout Muslims during the Hajj, which would start on July 28th. In an unprecedented move yesterday, the government of Saudi Arabia has closed all of the holy sites of Islam to foreigners, effectively bringing an end to any plans for the Hajj this year. This had not even been done during the Spanish Flu in 1918.

While that was a very good move on the part of the Saudis, it may be too late to help limit global spread from the Iranian epicenter. Researchers in Canada have modeled the epidemic in Iran using International Air Transport Association (IATA) data. Their conclusions are beyond alarming. “We estimated that 18,300 (95% confidence interval: 3770 –53,470) COVID-19 cases would have had to occur in Iran, assuming an outbreak duration of 1.5months in the country, in order to observe these three internationally exported cases reported at the time of writing…Given the low volumes of air travel to countries with identified cases of COVID-19 with origin in Iran (such as Canada), it is likely that Iran is currently experiencing a COVID-19 epidemic of significant size for such exportations to be occurring.”

I think what can be extrapolated is that if their conclusions are correct, we can expect to see the disease emerging in countries with a high level of air travel to Iran. I’ve copied the table from the report showing the IATA data on air passenger travel from Iran.

A similar analysis was conducted in 2009 related to H1N1 influenza that had originated in Mexico. What was striking to me at the time was the strong correlation between where H1N1 was having large impact in US cities and the amount of air travel to those cities from Mexico.

I know the inevitable questions I’m going to be getting from people is “Should I travel to destination X?” I can clearly answer that question about some countries with a resolute “no,” but to be honest, at some point in the near future, I’m not sure that I would want to do any international travel, and that is coming from someone who loves to travel internationally. I’m not going to make a blanket statement. You need to assess your own acceptance of risk, but I hope you really think a lot about what is important to you as part of your decision.

Finally, I want to encourage everyone who reads this to share it with people in their churches, synagogues, mosques, temples, and other places of worship. Given that these locations are common community gathering spots, it is time to start having conversations about what steps your religious organizations are planning to take should this disease become common in your region.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.