November 4, 2009

Notes from our Bishops and Diocesan Council
on worship and workplace precautions during flu season

Theological Statement

While God’s will for us is to live and thrive in community and in celebration of God’s gifts to us, it is also God’s will that no unnecessary risks be taken that might complicate or compromise the health of our people. Our foremost concern is that we continue in the apostles’ teaching and fellowship, the breaking of bread, and the prayers. The guidelines that follow provide our faith communities ways in which the Eucharist may continue to be our central act of worship week by week while we take precautions against the unwitting exposure of our people to the flu virus. Many of our traditions came into use during past times of threat from disease or contagion; we can continue to employ those same cherished traditions in ways that follow today’s best practices for preventing the spread of illness. Approaching these suggestions with a sense of humility, common sense and humor will make them more readily accepted by those with whom we worship. While we are God’s people, we are still people. We still get sick. We still require care for our bodies. Such self-care and care for others neither endangers nor diminishes the holiness and mystery of our God, whose hands reach out to us in the moment of Holy Communion. This same God came to us as a human requiring human care and nurture to grow into one who would give his life for us. This God accepts us in our own humanity. So if we, individually, are to become Christ’s body in the world, we must take what measures are available to keep our bodies whole, sound and ready for the ministry to which Christ calls us. It is in that spirit that we offer the following direction.

Suggestions for Liturgical Practices

For the immediate future and for the time we find ourselves living under the threat of pandemic, we recommend the following liturgical revisions:

Contact at the Peace:  Refrain from shaking others’ hands during the Peace and from holding hands during the Lord’s Prayer. Hand-to-hand contact provides a high degree of transfer of infection from one person to another. Realizing that the act of human touch is very important, and that from week to week some members of our congregations experience the touch of another only during the Peace, some suggest congregants touch each other on cloth rather than on skin. Patting shoulders, embracing forearms (avoiding the inside elbow where people are asked to cough and sneeze), and even hugs around shoulders will spread less illness than shaking hands. Some ways to avoid touch altogether include bowing to each other, or using American sign language (left palm over right and then right palm over left) or the old ‘60s peace sign. If in doubt, carry and use a small dispenser of alcohol-based hand sanitizer before and after the Peace.

Hand disinfection by clergy and Eucharistic ministers before Communion distribution:   Many of our congregations keep the practice of using a lavabo for the ceremonial washing of the clergy’s hands at the beginning of Communion. What has been a cherished symbol may now be a matter of health and safety. Some recommend adding vodka in an adequate amount to the lavabo before the service for the clergy and Eucharistic ministers to dip fingers and wash hands in the alcohol. Some recommend using really soapy water. Then continue the practice of pouring water over the fingers to remove all excess alcohol or soap. Still others use alcohol-based hand sanitizer either before or after the ritual washing in water. If possible, allow all Eucharistic ministers to take part in this practice.

Avoid contact when distributing the bread:  When distributing the bread, some clergy are in the habit of touching or squeezing communicants’ hands. We recommend that the bread be distributed without making hand-to-hand contact to minimize risk of spreading the virus from one person to the next.

Discontinue the practice of intinction by parishioners: In many of our parishes it is common practice for communicants to dip a wafer they have received in their hands into a common cup. In some cases this is the cup from which others drink; in other cases it is a cup reserved for intinction. In either case, this practice often promotes a high rate of exposure to infection, as communicants’ fingers often touch the wine. In some places all intinction may be done by the priest and placed on the tongue of the parishioner (with care that the priest does not touch the communicant’s mouth or tongue), and in other places the priest may dip the wafer and place it in the communicant’s hand without touching the skin. We recommend discontinuing intinction altogether.

Continuation of the common cup: Drinking from the common cup is a treasured symbol of unity in the life of the church and it may be continued, although scientists disagree as to whether the wine carries enough disinfectant power to kill the virus. Some say the risk of infection is negligible if the cup is properly wiped and a silver or other fine metal chalice is used. Stress to all chalice bearers the importance of washing their hands, using disinfectant gel or participating in the lavabo practice before serving Communion. Instruct them to wipe both the outside and the inside lip of the cup after each communicant is served and encourage those communicants who would help guide the cup to their lips to do so by touching only the base and not the bowl of the cup. However, neither drinking from the one cup nor intincting is required to receive the fullness of the sacrament.

Communion in one species: To receive either the bread or the wine is to take part fully in the Eucharist. Simply by choice or if a communicant is not feeling well or is experiencing some symptoms of illness, he or she may receive only the bread and refrain from the cup, waiting as the chalice bearer speaks the words that accompany the cup before returning to the pews. Some make the sign of the cross with the bread over the cup as it is offered but do not drink.

Clergy as contact point: Clergy traditionally and rightly are found at the doors of our congregations welcoming and sending out worshipers. This form of greeting and sending is part and parcel of our sense of hospitality. During any outbreak of flu, however, clergy should avoid becoming a hub for the spread of illness by employing the same mindfulness of avoiding skin-to-skin contact that is suggested during the Peace. Bottles of alcohol-based sanitizer should be placed near church entrances.

Suggestions for Lay Eucharistic Visitors and pastoral care teams: Lay Eucharistic Visitors and pastoral care visitors should use caution. As usual, be sure not to visit in homes, nursing homes or hospitals if not feeling well. Carry and use alcohol-based sanitizer. Wash hands frequently. And use caution in administering the chalice, or just give the bread.

Suggestions for staff policies and key employees: The Center for Disease Control is anticipating that 40 percent of the population may contract the H1N1 virus. While no one knows how severe the pandemic will be, we are also approaching the time of year when the seasonal flu becomes widespread. For this reason, the recommendation is for a proactive response to the concerns surrounding a healthy workplace. In addition to workplace concerns, we must remain cognizant that our parishes are not just workplaces, but communities of faith with all the unique concerns inherent to a pastoral environment. On that basis, the following recommendations are applicable to both the workplace and parish events and services.

Preventing the spread of the flu in the workplace: The best strategy for reducing the transmission of influenza includes frequent hand washing with warm, soapy water; covering the mouth and nose with tissues whenever you sneeze or cough; and properly discarding used tissues. In addition, we suggest having alcohol-based hand sanitizer available throughout common areas.

Staying home when ill: During flu season, it is critical to stay home when experiencing common symptoms of the flu. These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Other reported symptoms are diarrhea and vomiting. Currently, the Center for Disease Control recommends that people with flu-like symptoms remain at home until at least 24 hours after they are free of fever (100 degrees F) or fever signs without the use of medications such as ibuprofen or acetaminophen.

Reporting to work when not ill: During a severe influenza pandemic some employees may need to remain home to care for ill family members or simply to provide care for children during school closings. Individuals who believe they may face particular challenges reporting to work during a severe influenza pandemic should speak to their supervisor to develop contingency plans such as the possibility of working from home or a flexible work schedule.

Public gatherings: As possible, use discretion when planning any public gathering or weekly services. Unless state or local officials advise otherwise, there should be no change in public gatherings and service schedules and no one should be discouraged from attending a public function or weekly service. People should be reminded to wash their hands frequently using soap and warm water. Keep an alcohol-based hand sanitizer available in a number of visible locations and encourage people to use it, especially after coughing, sneezing or using a tissue. Have boxes of tissues readily available. Keep receptacles available for proper disposal of tissues. Remind people to cover mouth and nose with a tissue when coughing or sneezing. Most importantly, encourage parishioners and employees with flu-like illness to stay home.

Key employees and clergy: The recent focus on H1N1 and seasonal flu has given us the opportunity to make plans that we should have in place in case of any emergency. If clergy themselves are ill or symptomatic, it is suggested that a back-up plan be in place for leading worship, including training lay leaders to read Morning Prayer and making sure wardens have a copy of area supply clergy to call at the last minute. If there is enough lead time, call the diocesan offices for advice. It is also a good idea to have back-up plans about how payroll will be met, deposits made, and bills paid in the case of illness, along with sexton duties, snow removal, administrative tasks, bulletin prep and the like.

For further and up-to-the-minute information visit:
Center for Disease Control: http://www.cdc.gov/h1n1flu
Commonwealth of Massachusetts: http://www.mass.gov (reprintable files in 15 languages)
Boston Public Health Commission: http://bphc.org (more languages & useful links)

Thanks to: Becky Alden, RN, Diocesan Council member and Red Cross volunteer; The Rev. Joe Robinson, Diocesan Council member; Lynn Clark, Human Resources Manager, Diocese of Massachusetts; The Rev. Daphne Noyes, Deacon