A protocol for Church Services in the Age of Sars-CoV-2
For a couple of months now churches around the world have refrained from meeting in order to safeguard their communities and themselves from the dangers of the SARS-CoV-2 virus.
Although there are many things that are not yet knowledge for sure about this virus, we do have some provisional knowledge that can guide our planning for how to restore our communal church lives, even though we need to always be open to changing what we do in the light of further experience, knowledge and understanding.
This is not the first coronavirus that kills, and there are many similar viruses, enveloped viruses, which are passed on in a similar way to corona virus.
Coronavirus is highly infectious: it is easily transmitted from person to person. This occurs either through touch, through breathing in droplets produced by an infected person just by their coughing, sneezing, talking or even breathing. This is direct transmission.
It is also transmitted indirectly, by handling an object that has had coronavirus-containing material land on it. Enveloped viruses can survive at cool to moderate temperatures in a range of humidities for several days, several being at least four, but possibly much longer. It survives on dense surfaces longer than on porous surfaces such as paper or cloth, but even these can carry the virus for days.
Therefore, to avoid communal activities to result in a renewed flare up of the epidemic, a number of precautions should be taken in order to continue to protect the health of both the church, our families and the wider community.
Several common disinfectant compounds have little effect on similar enveloped viruses. A good disinfectant is one that will reduce the population of viruses on a surface by at least a thousand-fold in a short time.
It has been shown in a number of tests that an effective household bleach solution is effective against all viruses on surfaces, including enveloped viruses like SARS-CoV-2, provided it has a concentration of at least 0.5% of sodium hypochlorite in water, whereas a solution of 0.06% of the same product was ineffective. This is probably the most cost-effective broad-spectrum disinfectant.
It is almost certainly true that a detergent or soap solution will be effective also. However, it is impossible to prove it in a biochemical test, because the soap also disrupts the test cells that are used to incubate any remaining viruses. Nevertheless, practical experience has demonstrated on countless occasions that hand washing and surface washing with soap or detergents reduces infection rates a great deal.
Another obvious issue is that most communal activities bring people together much closer than 2 m apart. Furthermore, indoors, the rate at which people breath when sitting (100 litres / 15 minutes per adult) means that in a building 5 m high and at a normal seat spacing of around 1 square metres, around 2% of the air in the room has been breathed by someone in 15 minutes. If one person produces the typical 40,000 air-borne droplets by an unfiltered sneeze, which will linger in the air for up to 15 minutes, there is a near certainty that a number of people in that room will have breathed in many droplets, some of which may contain the virus.
A further complication is that animal tests with experimental vaccines for SARS-CoV virus (the virus that caused an epidemic in 2003 (also starting from China) caused serious health complications in the animals given the vaccine. As a result, no safe vaccine has been successfully produced for SARS-CoV virus. It an all too human characteristic for researchers to be overly optimistic about the efficacy of their particular technological solution. Furthermore, in the haste to get a vaccine out and unlock the economy, it is almost certain that longer term or chronic consequences of the vaccine will not be discovered in time, or even worse will be ignored in an effort to get the vaccine out into the wider population.
The lesson of the animal studies is clear and sobering – a poorly trialled vaccine may be worse than the disease, and a well-trialled vaccine will take a long time to establish its safety. No government wants to hear or act on that, of course, but this is the situation, however unpalatable the news.
Further issues. People do not have to show symptoms of SARS-CoV-2 to be able to pass it on to others, although it is probably less common, but is hard to put a figure on it. People can have coronavirus for 2 to 14 days before they show symptoms, if they do show symptoms. Around 97% of people who show symptoms will do so in 11 to 12 days.
In the absence of a safe vaccine within the near future, and taking into account the reality of this virus, is there any way that churches can meet without risking the lives of their members and those in the wider community, including the doctors and nurses who will be called upon to try to treat them?
I have been alarmed by the attitude of some Christian leaders who have taken the view that preventing churches reopening is in some way an act of prejudice by the authorities. It may be so in some cases, but the wider issue remains clear and stark – churches have a responsibility to protect the lives of the people in their care. That is an absolute ethical requirement and must override all other considerations.
It has become increasingly clear that extended periods of lockdown is not helpful for people’s mental health. In the UK there are over ten thousand people seeking mental health services for the first time. This seems to partly attributable to the lock-down, as well as the damage to their own household economy.
This shows the importance of encouraging people to meet together and church life in helping people maintain a healthy inner world. Nevertheless, it would be foolish hubris to assume that the risks to people’s physical health can therefore be swept aside. Yes – God can do the miraculous, but this is rather like stepping of a tall building to prove God will look after you. Jesus was tempted to test God and He rightly refused. Why then should any of us do so?
So, it comes down to practicalities, can churches reopen without causing the reproduction rate to climb back toward and over unity? To put it simply, if a person goes to church to has coronavirus, they should have less than one, and ideally a lot less than a half chance of giving it to another person. This probability applies is not just for one service, but for the total of all the services they will attend while they are infectious.
Formulating an Approach
Given the situation, can we think though the minimum requirements that must be met in order for a church to meet – based on current knowledge.
No person who thinks they have Covid-19 symptoms (the disease that virus SARS-CoV-2 produces) should go to church until around three weeks after their symptoms have fully subsided. This three-week period is because tests have shown that the virus can remain in a person for around this time after they have recovered.
Speaking, singing, breathing as well as coughing and sneezing will produce droplets from every person. Any one infected person will in a normal church service pass these on to several others, even many others. We know of people who attend the funerals of people who died of SARS-CoV-2 before the lockdown, who then themselves contracted the virus and passed away. The 2-metre rule is a useful measure for chance social encounters like shops but on its own is almost certainly inadequate for longer community events like churches services.
Although masks have been shown to reduce the rate of infection, it is not in proportion to the 95% rating of the masks. This is because the infectivity of small droplets is little different to those of large droplets, small droplets vastly outnumber large droplets and the mask is poor at catching small droplets. It is also awkward to do public speaking, sing or pray out loud wearing a mask. So, I will ignore the use of masks.
Let us do a thought experiment. We start by assuming a church meets outside and the congregation sit 2 m apart from each other in either direction. A person who sneezes will release a cloud of typically 40,000 droplets in a plume with a volume of perhaps 100 litres. That plume size is around 0.4 m, so in a 2 m/s breeze will drift past another individual over a time interval of 0.2 seconds. A person breathes on average at 0.1 litre per second, so they may breathe in 0.02 litre of the plume. The droplet count inhaled would be 40,000 x 0.02/100 = 8 droplets on average – i.e. 16 droplets as they breath in, or none as they breath out. The size of the plume in our thought experiment means that at a 2-metre spacing perhaps a total of 2 – 10 members of a hundred-member congregation will also breath in the same plume.
So, it is not unreasonable to suppose our sneezing carrier could pass on the disease to 2 to 10 other people with a single sneeze in a single service. But even if they are not symptomatic, single, talking, even breathing will cause them to release droplets. If singing is like speaking loudly, the droplet release rate may be on average 50 per second, so in a course of 4 hymns, or around 1,000 seconds of singing, they will release 50,000 droplets, about the same as a single sneeze.
If the congregation cannot meet outside, they might meet inside but with all the windows and doors open to create an adequate through draught. A modest chapel with a 500 cubic metre internal volume, ventilated by 5 square metre of aperture (a double door and 2 windows) with a draught velocity of 1 m/s though would take 100 seconds to be cleared of droplets, a drift velocity of around 0.1 m/s. Our plume would then drift across the (well-spaced out socially distanced) congregation, the probability is that it will interact with one other person on its path but now in this case it would be within range of their breathing for 2 seconds. In that time, they may breathe in 0.2 litres of air on average. They would then each breathe in 40,000 x 0.2/100 = 80 droplets on average – 160 droplets while breathing in, or none while breathing out. Once again, 2 – 10 people may receive a load of virus-laden droplets, but at a higher load than before, and even greater probability of contracting the disease.
Every droplet may contain thousands of virus particles. Although the human body has physical defences against getting infected (mucus), we do not really know how many particles it takes to infect someone on average, so we have taken the conservative assumption that it takes only one.
Recent studies in the USA and elsewhere have shown that between 0.7% and 25% of the people have had the virus, but in most communities the percentage is in the lower end of this wide range. This means that the chance of having someone in the congregation who has the virus currently is proportional to the size of the congregation, and the number of people they give it to is proportional to the square root of the size of the congregation, IF the space is well ventilated. Therefore, if we imagine a church of 100 people, probably one person may have it, or perhaps two. That church could meet every week altogether. Our thought experiment suggests that the one infected person may infect 2- 10 others, and the next week he and many of those 2 to 10 could do the same – all the while being asymptomatic. All they are doing is participating in some community hymn singing, praying out load or just breathing, but by the end of the second service they may have infected 4 to 100 people. In an elderly church, with a 50% fatality rate, that church could be all but annihilated.
This problem rapidly gets worse the larger the congregation. Megachurches are particularly vulnerable. A 10,000-seat church may see 100 people infected each infecting 20 – 100 others in a single service. By the end of the second service the whole church and the whole community will be in a serious health crisis. The effect on the social acceptance of that megachurch will be catastrophic.
Meeting together again
So what might a potential answer look like:
- If instead a church meets in small groups of two or three, or perhaps two or three households, taking care to socially distance and being in a well-ventilated space or outdoors. Our one infected person may only be able to infect one or two others, and there it stops. All the other groups will remain unaffected because of the small numbers of ‘live’ carriers in a typical church congregation at any one time.
- It is also much more practical to meet outside, well-spaced apart, in a garden or a park in a small group. Under these conditions the probability of infection drops greatly.
- There is a 97% chance that in an 11.5-day incubation period, a person who catches the virus will show symptoms, if they are going to show symptoms at all. Therefore, were our proposed micro-churches to meet once every two weeks, rather than every week, in nearly all cases anyone getting sick would get sick in the intervening 13 days. This means that they know that either they contracted the virus from outside the church, or one of their number is an asymptomatic carrier and so they should not meet for a few weeks until all are clear of the virus.
- Given that the risk of fatality is greatest for those over 60 or with pre-existing health conditions, it may be these people may still need to participate online, or that even greater protection measures are put in place for them. However, the half-way house of a garden service with just one or two others, the elderly being seated upwind, may well be an acceptable risk.
- It is not yet clear if someone who has fallen ill with the virus can do so again, and what the probability is. At present the assumption is that contracting the coronavirus will provide immunity, but there have been some cases where it seems not to have done. Given that the goal of the protection measures is not to absolutely prevent any transmission, but rather to keep the reproduction rate of the epidemic well below unity, it seems it is reasonable at this stage to assume that the virus does confer immunity.
- Given that the virus has been shown to live on surfaces for several days – four at least, it would seem to be prudent to wipe down any touchable surfaces such as chairs, handrails, door handles and hymnbooks with 0.5% bleach solution (sodium hypochlorite). This should be done prior to every service.
- Leaders of services will produce droplets when they speak – this is could be around 20 to 200 particles per second. It would seem prudent therefore that anyone who is to speak for an extend period should do so downwind of their small group.
“Where two or three are gathered, there am I in the midst of you”
This would seem to be a text to live by in these days. I am sure most of us would prefer to have Jesus in our midst, even if we are only two or three, then SARS-CoV-2 when we meet in our tens of thousands. God bless you all,
President – Jesus Christ for Muslims