Tuesday, October 20, 2009

Precaution or Fear

I watched in horror on a TV morning news program as they people on the couch, egged on by a medical professional of some kind, droned on about the dangers of passing the flu (regular and H1M1) in worship, and specifically, in the common cup (chalice). For some time now the news has highlighted congregations where hand sanitizers outnumbered crosses, where latex gloves were used by those who serve the altar, and by the elimination of the sharing of the peace. All preventative measures since, now hear this, NO PROOF HAS BEEN OFFERED TO SHOW THAT ANY OF THESE WERE RESPONSIBLE FOR THE TRANSMISSION OF THE FLU...

Precautions are one thing. We ought to take precautions. We ought to wash our hands, cough into our arm pits, use tissue, stay home if we have symptoms, etc... I agree with all of this. But precaution has given way to fear and somebody has to yell STOP!

Studies have shown us and current literature and expert medical advice have concluded:
1) sipping from the common cup represents a minimal risk of transmission of contagion;
2) sharing a handshake in the exchange of the peace presents a minimal risk of
transmission of contagion.

Study and Findings #1

A report by Sault Ste. Marie Marie cardiologist David Gould was distributed across Canada by Anglican bishops. Dr. Gould was asked to update the report he initially wrote in 1987 for the church's faith, worship and ministry committee, of which he is a member.

Back then, the focus was on dealing with people's fear of catching AIDS from the common cup. In fact, a person with AIDS who may have a highly depressed immune system immune system has much more to fear from his fellow parishioners than the reverse.

The first thing to realize, according to according to Dr. Gould's report, is that it appears to be remarkably difficult to contract any illness by sipping from the chalice. If that were not the case, one would expect regular reports of one disease or another rifling through a congregation. "In some 2,000 years of the practice, there's no episode that's ever been suggested to be due to the cup," Dr. Gould said in an interview.

Similarly, priests, who tend to drink more wine from the cup than anyone else in the congregation, would be calling in sick with one illness or another all the time. The research suggests the opposite is true.

"No episode of disease attributable to the common cup has ever been reported," Dr. Gould writes. "Thus for the average communicant it would seem that the risk of drinking from the common cup is probably less than the risk of air-borne infection in using a common building."

Dr. Gould notes in his paper that exposure to a single virus or bacterium does not result in infection. Rather, for each disease there is a minimum number of the agent (generally in the millions) that must be transmitted before infection can occur. Experimental evidence shows that wiping the chalice with the purificator (cloth used to clean the chalice after the celebration of the Eucharist) reduces the bacterial count bacterial count by 90 per cent.

"Our defenses against stray bacteria are immense and can only be overwhelmed by very large numbers of the infective agents," Dr. Gould writes. "Each infective agent has its own virulence and each individual has his/her own `host factors' which determine that person's susceptibility to infection. The interaction of the two determines the risk of infection for the individual."

Thus, people with active AIDS or who are on chemotherapy, are far more prone to infection with small amounts of bacteria. "Those people conceivably could be at risk," Dr. Gould said. "But we have no proof that anyone has ever contracted anything that way."

Other churches, notably the Roman Catholic and Lutheran churches, have also researched the issue extensively and found no problem, he said.

It is a myth that the mouth is more dangerous than the hand, Dr. Gould said. "Medically, we know that hands are much worse transmitters of infection than lips. Our mothers always told us to wash our hands before eating, because our hands pick up germs. And they had a good reason for saying that."

In fact, the bread is more likely to spread contagion than the cup because it is in contact with hands of the people, Dr. Gould said. There is much less risk of contagion if the priest places the host in the mouth than if the people receive it in the hand.

In order to ensure the risk of any disease transmission is as small as possible, the report offers advice to servers about proper hand washing and chalice cleaning. If intinction (dipping the host) is used, a single person should dip the bread, taking care to avoid touching the wine with his or her fingers.

Thus for the average communicant it would seem that the risk of drinking from the common cup is probably less than the risk of air-borne infection in using a common building.

Study and Findings #2

The Center for Disease Control says it has been answering the question for more than 20 years. In 1998, the CDC included this statement in the American Journal of Infection Control:

For more than two decades, the Centers for Disease Control and Prevention (CDC) has stated an official position to inquirers (e.g., lay public, physicians, nurses, and other health care professionals) about the risk of infectious disease transmission from a common communion cup. Although no documented transmission of any infectious disease has ever been traced to the use of a common communion cup, a great deal of controversy surrounds this issue; the CDC still continues to receive inquiries about this topic. In this letter, the CDC strives to achieve a balance of adherence to scientific principles and respect for religious beliefs.

Within the CDC, the consensus of the National Center for Infectious Diseases and the National Center for Human Immunodeficiency Virus, Sexually Transmitted Diseases, and Tuberculosis is that a theoretic risk of transmitting infectious diseases by using a common communion cup exists, but that the risk is so small that it is undetectable. The CDC has not been called on to investigate any episodes or outbreaks of infectious diseases that have been allegedly linked to the use of a common communion cup. However, outbreaks or clusters of infection might be difficult to detect if: (1) a high prevalence of disease (e.g., infectious mononucleosis, influenza, herpes, strep throat, common cold) exists in the community, (2) diseases with oral routes of transmission have other modes of transmission (i.e., fecal-oral, hand-to-mouth/nose, airborne), (3) the length of the incubation period for the disease is such that other opportunities for exposure cannot be ruled out unequivocally, and (4) no incidence data exist for comparison purposes (i.e., the disease is not on the reportable disease list and therefore is not under public health surveillance).

Experimental studies have shown that bacteria and viruses can contaminate a common communion cup and survive despite the alcohol content of the wine. Therefore, an ill person or asymptomatic carrier drinking from the common cup could potentially expose other members of the congregation to pathogens present in saliva. Were any diseases transmitted by this practice, they most likely would be common viral illnesses, such as the common cold. However, a recent study of 681 persons found that people who receive Communion as often as daily are not at higher risk of infection compared with persons who do not receive communion or persons who do not attend Christian church services at all.

In summary, the risk for infectious disease transmission by a common communion cup is very low, and appropriate safeguards -- that is, wiping the interior and exterior rim between communicants, use of care to rotate the cloth during use, and use of a clean cloth for each service -- would further diminish this risk.

Study and Findings #3

As a United Kingdom health journal put simply and clearly in 1988:

No episode of disease attributable to the shared communion cup has ever been reported. Currently available data do not provide any support for suggesting that the practice of sharing a common communion cup should be abandoned because it might spread infection.

So. . . let us practice precaution but let us not act in fear, ignorance, or panic. This is not the plague. We have nothing to fear in the practices of our congregation. We have nothing to fear from the Lord -- quite apart from science, do you think that God would bestow upon us a Sacrament whose practice would in and of itself bring risk or danger to us? If you do, you believe in a very different God than I do.

Enough said.

4 comments:

Rev. Allen Yount said...

Have you seen some of the items that religious supply companies are selling in response to this hysteria? One such item is a metal cylinder with a handle and a trigger. A pre-filled plastic tube full of wafers is loaded into the top of the cylinder. Then, as the pastor goes along the altar rail distributing communion, he presses the trigger to drop a host into each communicant's hand - just like someone handing out change from one of those belts!

Hey, why not go a step further? Make something that actually shoots the wafer into someone's mouth. Then a pastor could distribute communion with that in one hand and a fancy squirt bottle containing the wine in the other.

Absolutely horrendous.

Grace said...

Yuk... if only there were not so many entrepreneurs, perhaps we would not have half the stuff that religious supply houses have for sale... convince of the need then fill the need... too bad.

Anonymous said...

I firmly believe that anything instituted by Christ Jesus will NOT be harmful to us!

Carl Vehse said...

"NO PROOF HAS BEEN OFFERED TO SHOW THAT ANY OF THESE WERE RESPONSIBLE FOR THE TRANSMISSION OF THE FLU..."

Consider, for a moment, what kind of valid and reputable experimental study would be needed just to determine a quantitative risk value for disease transmission using the common cup.

The testing protocol would require sampling and analysis of the consecrated wine and the surfaces of the common cup before, during, and after distribution. Doing this within the worship service and without the knowledge of the communicants and the pastor would be difficult. Each communicant would need to have mouth and lip wipes taken before and after communing.

Conducting a "mock communion" within a controlled laboratory environment using unconsecrated wine would not be comparable. Such a setting introduces a confounding factor, in that the pastor and communicants are aware beforehand of the testing to be done and may alter (even subconsciously) certain behavioral patterns that might affect the test results. The method of double-blind testing would be a prerequisite for any such experimental study.

It would be necessary to medically examine all participants for specific infectious diseases, immunodeficiencies, or lesions in and around the mouth or lips. If the participants had no infectious diseases, subsequent testing to quantify risk would establish nothing. Thus, to test disease transmission, it may then be necessary to experimentally place one or more infected persons (using double-blind techniques) into the group of communicants. The communicants would then have to be isolated, or else the selected infectious agents would need to be identified by DNA analysis, in order to connect the infection to the test rather than from some other disease transmission vector. Which disease agents, the number of infected people, and their order in the communion distribution would have to be determined through parametric testing. Again, doing this in a closed communion setting and without the pastor's knowledge or permission would be, to put it mildly, difficult.

For these and probably other cost, legal, ethical, and theological problems, such scientific experimental projects, which would determine quantitative risk values for various age groups and other with special health problems, are not likely to be carried out.