In December 2019, the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in Wuhan, Hubei Province, China. Rapid international spread of this virus led to its classification as a pandemic by the World Health Organization (WHO) on March 11, 2020.1 The United States initially reported its first cases of SARS-CoV-2 on January 20, 2020, in Snohomish County, Washington.2 A subsequent study suggested that SARS-CoV-2 cases already occurred in the United States in December 2019 with community spread that went undetected prior to established clinical awareness and testing capabilities.3 As the virus continued to spread, it became evident that transmission was subject to various factors, including contact patterns, symptomatology, age, and adoption of mitigation measures.4,5 Several reports highlighted the importance of the sociocultural and religious context in which such transmission occurred.6–9
In this study, we focus on several geographically distinct but socioculturally interconnected orthodox Jewish communities that experienced dramatic parallel community-based spread following the religious festival of Purim on March 9 to 10, 2020. Around the time of this celebration and in the absence of strong general or culture-specific public health directives, nearly synchronous transmission of infection spread through these distinct and distant, albeit interconnected, communities, ultimately contributing to the significant morbidity and mortality among these communities across multiple states in the ensuing weeks. In this large-scale study, we sought to explore the epidemiology of parallel SARS-CoV-2 outbreaks in a culturally bonded community…more