As part of our mission in this world, the church can be a strong agent to prevent sickness and protect the vulnerable. We are an integral part of our community, and many social contacts run through our church. If we can recognize the early signs of a local COVID-19 outbreak, we can lead in protecting those inside and outside our churches. But I have worked with enough disease control efforts to know that it is not enough to convince people they should act. People need to be given simple tools to help them take action.
Churches in the US are in uncharted territory regarding how to respond to the current epidemic. We will all continue to learn as this epidemic evolves. But based on my recent experience, here are two simple tools to help churches make good decisions in real time: (1) a simple way to assess what kind of actions a church should take based on the local risk of transmission, and (2) a framework that can help churches develop a specific plan to prevent infection and increase social distancing that can be implemented as soon as it is necessary.
As cases of COVID-19 increase, we are seeing a lot of anxiety and uncertainty about what the church should do. But responses can be based on sound epidemiologic principles. I use traffic light imagery to help churches think through their local risk of transmission and what kind of actions they should take (see figure). After all, all transmission of this virus occurs locally. Your actions should not be based on what is happening 50 miles away; they should be based on what is happening in your particular community.
Carry out discussions within the church and make concrete plans to modify, cancel, or replace church activities as needed. The church leadership should be engaged in this process. Now is the time lay a good foundation in preparation for what the church might face next.
Because of the huge mobility of people and ease of travel, many communities have started to see COVID-19 cases imported into their community. As soon as a case from another community enters your community, your church is in the “yellow light” zone. If no one who came into contact with this case is infected, this indicates there was no further transmission of COVID-19. When one or more of the contacts are infected, but no one else in the community is infected, this means transmission has not spread to the broader community. The church is still in the yellow zone. At this point, what should your church be doing?
Your church moves into the “red light” zone as soon as a resident of your community becomes infected but has not traveled recently to another area with cases and cannot be linked to any other case. This raises alarm because it means transmission in the community was previously undetected. Epidemiologists call this community transmission. A community is also in the red zone when multiple generations of transmission in the community are linked to an imported case. As soon as you are in the red zone, your church should do the following:
In my work with the three churches in Seattle, I found that they all initially struggled with diverse opinions about what activities to cancel or modify when planning their response to COVID-19. I developed a framework to help them. Using a spreadsheet, we listed church activities, thought of possible transmission of the virus during each activity, rated risks, provided modifications or substitutes, and then made decisions for each (see figure for an example).
The key is to work out the how transmission, whether direct or indirect, can occur through each activity. Keep in mind the ways COVID-19 is transmitted. When assessing the risk of direct transmission, ask: How likely are people to cough, sneeze, or generate respiratory droplets toward others? How likely is direct hand contact? Activities like singing, talking at very close quarters, giving handshakes, and hugging will have increased risk. To decrease risk, consider increasing distance between people, preferably to more than six feet.
When assessing the risk of indirect transmission, ask: How likely will people touch surfaces that could be infected? Activities that involve touching surfaces, such as offering plates, Communion plates, Bibles, and coffee dispensers will increase risk. To decrease risk, implement frequent hand-washing and use of hand sanitizers.
Consider the age groups involved when planning what activities to modify or cancel. The much higher risk of severe illness among the elderly and those with chronic illnesses means we need to protect this group from infection.
Remember, the decision of what church activities to modify, cancel, or substitute largely depends on the level of community transmission (see figure). If the level is low, you may just modify some activities but not cancel any. But as the level of community transmission increases, canceling activities becomes a better idea because it is increasingly likely that an infected person will enter the church unknowingly. Finally, follow public health recommendations.
When using this approach, a pastor said, “We determined that children’s ministry was high risk because kids are constantly touching each other and we can’t control it. If they spread infection among themselves, they can bring it home to their parents and grandparents. Besides, many of our teachers are elderly, and we don’t want them to get infected. So, we quickly decided to close children Sunday school.”
An elder said, “Our choir had people of all ages participating. But with singing during rehearsals or when standing in rows and singing during worship, there was a medium-to-high risk of transmission. So, we decided to substitute the choir with a quartet, especially since some choir members were elderly.”
An executive pastor said, “I was getting calls and emails from individual ministry leaders about what to do with their activities. It was really helpful to list all the activities and review their risk of transmission all in one go because we could compare the risk of one activity to that of another. This helped us to be consistent when making decisions about individual activities, and we were able to clearly communicate why we made these decisions. That was so helpful to our team.”
When developing your church’s response plan, communicate with church members. Some members’ anxiety will decrease when they know that your church is making a plan. They can better understand the rationale behind the church’s decision process and take comfort knowing it is based on good science. Develop a communication process because decisions often have to be made in real time and then clearly and effectively communicated to the congregation.
Reflecting on our experience in Seattle over the past weeks, I am struck by how fast this outbreak took off. COVID-19 is going to hit many communities hard and fast. There is no time to waste. Because our church activities can facilitate the transmission of this virus, our churches should “first do no harm,” a dictum I learned in medical school. Using the tools described above, which are based on our current understanding about this virus, our churches can have a response plan in place to quickly protect ourselves and the most vulnerable among us. By implementing such a plan, our churches can play a major role in stemming the tide of this epidemic and reduce its harm on society.
The approach discussed here is admittedly heavy on good public health and epidemiological approaches for decision making but light on empathetic response and engagement around those who have the virus and are suffering from its more potent effects. I hope that, having understood how the virus spreads and harms, this response plan can also include ways to serve with compassion those who are sick, care for the most vulnerable, and become a congregation more sensitized to and engaged with the needs of the world.