A COVID-19 Outbreak in an Ohio Amish Community, May 2020

In May 2020, a husband and wife in an Amish community in Wayne County, Ohio, fell ill with COVID-19. Within days, five more community members tested positive, and one — an adult family member with cancer — died on May 21. Community leaders told the county health department that many more people had symptoms. At a testing clinic the department organized with a community bishop, 23 of 30 people tested — 77% — were positive.

How it spread

The husband, who had chronic obstructive pulmonary disease, had attended church services on May 2 and 3. He became ill on May 9, was hospitalized with COVID-19 pneumonia on May 15, and went home on May 17. Community members reported six social gatherings in the two weeks before the clinic:

Among the 30 people with confirmed COVID-19, the average age was 46 (range 12 to 86), 70% were men, and eight had underlying health conditions. By June 28, another 39 community members had been tested after symptoms or close contact, and 25 were positive — evidence of continued spread.

What community members said

CDC and Ohio investigators held 11 anonymous interviews with community leaders and members. Most knew how the virus spreads — "coughing, sneezing" — and how to prevent it — "handwashing, social distancing, and staying at home." But they described barriers:

• Information: "access to health care is not an issue…access to good information is the problem."
• Masks: some believed masks could cause harm, and "the need to wear a mask has never been a part of this community." Some believed vitamins and herbs could prevent infection.
• Distancing: "fellowship is as important to us as worship," one said — and "call it physical distancing…social distancing has the connotation of social isolation."
• Testing: "transport is a challenge because we need to hire a driver; testing clinic today made it easy."

The interviews also highlighted community cohesion, selflessness, a strong work ethic, and a sense of individual and community responsibility.

Context

The Wayne County Amish belong to the Greater Holmes County Area Settlement, Ohio's largest Amish population (36,955 in 2020). Amish communities traditionally limit engagement with government and conventional medicine, except during crises affecting the wider community — such as a 2014 measles outbreak in an Ohio Amish community — and prefer natural approaches to health. Social and religious gatherings are central to community life, and such gatherings are known to fuel outbreaks. Rural residents also tend to be older, have more underlying conditions and have less access to health care.

What public health officials recommended

1. Keep building trusting relationships with Amish institutions and leaders.
2. Share health information through local networks: Amish newspapers and radio, local Amish steering committees that liaise with government, and businesses that employ Amish workers — electronic communication is rarely used.
3. Use culturally acceptable language emphasizing protection of family and community.
4. Make testing timely and convenient, with the active support of community leaders.
5. Keep sharing information and concerns about prevention both ways, with points of contact inside communities.

Building on the Amish belief in communal responsibility, the authors suggest, could help limit spread.

Limits

More traditional members may not have come to the clinic, the interviews were a convenience sample, and attack rates are hard to estimate, because members of one church district — 20 to 40 families — often join gatherings in others.

Sources

Based on Hammad Ali, Karthik Kondapally, Paran Pordell, et al., "COVID-19 Outbreak in an Amish Community — Ohio, May 2020," Morbidity and Mortality Weekly Report, volume 69, Centers for Disease Control and Prevention; a work of the United States government in the public domain.