Evidence-Based Guidelines to Celebrate Mass Safely Are Working
Catholic churches across the country have been open for up to four months since shelter-in-place orders were lifted. With approximately 17,000 parishes in America typically holding three or more weekend masses - and a greater number of daily masses - for the last 14 or more weeks - over one million public masses have been celebrated following guidelines to prevent the spread of the virus: in sum, follow the three W’s - watch your distance, wear your mask, and wash your hands.
The Good News: for Catholic churches following these guidelines, no outbreaks of COVID-19 have been linked to church attendance, even though we have examples - some described below - of asymptomatic, unknowingly infected individuals attending mass and other parish functions. Their attendance could have led to an outbreak if appropriate precautions were not followed, yet in each case, we found no evidence of viral transmission.
Mr. Nick Schoen, an employee of the Archdiocese of Seattle (which has been following a contact-tracing protocol for everyone who comes to church), provided a case series from the Archdiocese involving COVID-19-positive individuals who participated in various parish events or sacramental encounters but who did not spread the virus to others:
- During a July 3 funeral mass (45 attendees, capacity 885), two members of one household notified the parish that they had tested positive for COVID-19 and were infected and pre-symptomatic during the mass.
- A volunteer at a July 5 mass (94 attendees, capacity 499) became ill 24 hours later and then tested positive for COVID-19.
- During a July 11 wedding (200 attendees, capacity 908), fresh air circulated from multiple open windows with the aid of fans. The following day, an attendee developed symptoms of COVID and on July 13 tested positive. The attendee was almost certainly contagious with pre-symptomatic infection during the wedding.
- On July 12, an attendee at a parish board meeting (six attendees, room capacity 30), tested positive shortly thereafter and was determined to have been infected and contagious during the meeting.
- Finally, three priests anointed sick individuals in non-ventilated rooms during five- to fifteen-minute visits. The sick persons were not thought to have COVID-19 at the time but within two days each tested positive for COVID-19.
In each of these five examples, all participants (except for the priests at the altar and other liturgical ministers) wore masks, and maintained six-feet of distance between non-household groups - except for brief encounters such as reception of Holy Communion or anointing. In each case, public health officials and attendees were notified of possible exposure, and no individual developed COVID-19 by 14 days after each event.
We also reviewed recent public health and media reports regarding COVID-19 dissemination and found no reports of disease transmission, let alone outbreaks, in a Catholic church following such guidelines.
These findings are not surprising since wearing masks prevented all 139 clients served by two COVID-infected hair stylists from acquiring COVID-19, and these individuals were much closer to each other than socially-distanced participants at a Catholic Mass. Furthermore, a report of a mask-wearing COVID-infected individual who developed a dry cough just before a 15-hour flight with 350 passengers resulted in no other infections, even in the 25 individuals within six-feet. This demonstrates how a mask can protect those near someone who is infectious even when they have a cough.
Finally, even a simple paper surgical mask (easily purchased in many stores) can protect the wearer. Such a mask protected all 35 health care workers who wore one and were exposed for over ten minutes within six feet of a COVID-patient coughing and generating aerosols in their faces.
This encouraging news should inspire confidence that the guidelines in place - based on CDC recommendations - are working to decrease COVID-19 transmission. While nothing during a pandemic is risk-free, these guidelines mean that Catholics (and public officials) may be confident that it’s reasonably safe to come to Church for Mass and the sacraments.
Indeed, for Catholics, the Mass and above all the Eucharist are central to the Christian life. In a time like this, it is even more important that the faithful be able to come to Church and receive Holy Communion.
This past spring, groups such as the Thomistic Institute and the Catholic Medical Association issued guidelines for the safe celebration of mass and sacraments. Bishops have used these guidelines to develop diocesan policies that typically include social distancing, careful hand hygiene, and mask-wearing by the congregation.
In late July, the Thomistic Institute (TI) released updated guidelines for celebration of Mass during the COVID-19 pandemic. No evidence has emerged to suggest that distribution of Holy Communion in accordance with TI Guidelines has led to COVID transmission.
The few churches that have been reported as sources of COVID-19 outbreaks did not follow social distancing or require masks; they also promoted congregational singing. These reports were widely circulated and led to the recommendation in many jurisdictions that no church services (including Catholic masses) be publicly celebrated. In San Francisco, onerous restrictions were placed that allowed mass only outside for no more than twelve individuals.
Recent cases of Governors limiting church attendance more than other activities (e.g., gambling in casinos, eating in restaurants, or attending movies) have struck many of America’s faithful as unfairly targeting religious believers and worshipers. To date, the evidence does not suggest that Church attendance - following the current guidelines - is any more risky than shopping for groceries. And the spiritual good for believers in coming to Church is immeasurably important for their well-being.
Because we have no formal studies, continuing attention and scrutiny will remain in place. We intend to update guidelines as we learn more. In short, the data suggest that when a community follows proper guidelines, as Catholic dioceses have, people can receive the spiritual comfort of church attendance while preventing the spread of the virus.
Signed: Physician Members of the Thomistic Institute Working Group on Infectious Disease Protocols for Sacraments & Pastoral Care
Thomas W. McGovern, MD
Former Clinical Infectious Disease Researcher, US Army Medical Research Institute of Infectious Diseases
Catholic Medical Association, National Board Member
Fort Wayne, IN
Deacon Timothy Flanigan, MD
Professor of Medicine
Alpert Medical School of Brown University
Division of Infectious Disease
The Miriam & Rhode Island Hospitals
Paul Cieslak, MD
Infectious Disease Specialist
Medical Director, Oregon Public Health Division’s
Communicable Disease and Immunization programs.