It’s tempting, at least to the molecular biologists amongst us, to admire the cunning of this particularly slippery virus. It seems to exude evil in every perfectly tiny detail. Yet while it’s killing people, it’s not doing so intentionally. Its sole evolved purpose is to transmit itself between unsuspecting bats: even in a purely Darwinian sense, it’s not out to get us.
It must therefore be categorised as a natural evil, alongside earthquakes and floods. Those of us with a special duty to look after the sick – the authors of this article are all doctors – are required under certain circumstances to confront these kinds of natural evil as part of our calling. To risk one’s own life in defiance of a moral evil – an evil perpetrated by a set of free-willed agents – is often virtuous.
For most Catholics, however, to whom no special obligations pertain, risks taken without due cause in defiance of a natural evil are mere foolishness. Placing the burden of risk upon others is worse. We might have the right (or even duty under some circumstances) to risk our own health, but we do not have the right to risk the health of others. Opening churches for limited private worship will be permitted soon. The much more difficult task of making public worship safe requires very careful deliberation.
Some “superspreading” events, in which the virus has been transmitted to many people, have occurred during worship. One religious sect, the Shincheonji Church of Jesus, was associated with more than half the early cases in South Korea. Since the virus transmits by droplets emitted during speech, especially loud speech and singing, there is a particular risk during public worship. Diversity is a particularly excellent characteristic of the Catholic Church, with all tribes, languages and nations, not to mention age groups, represented. Adult, especially elderly, men are most likely to be killed by Sars-CoV-2, and those from BAME backgrounds are at particular risk. Children and younger women are the least likely to be affected, but are just as likely to be infected. They may easily transmit the virus to more vulnerable people.
Superspreading events have several common factors. Almost all of those identified feature many people in close proximity in a poorly ventilated space for extended periods of time. Most feature multiple social interactions, and some have involved choirs. How to mitigate these factors? The congregation must be well spaced out between households. A maximum number of people within each space must be set such that there is at least a 2-metre distance between households. An exchange of peace could occur without physical contact, or only within household groups. Parishes should increase the ventilation of church buildings to the maximum extent possible. Singing by multiple people should be avoided. Chant from a single individual, set well away from the rest of the congregation, might be feasible. Liturgy conducted in this manner could still be beautiful.
There is a lesser risk from transmission of the disease from surfaces. Frequent cleaning of places that may be touched by multiple individuals is prudent. Communion would have to be only under one kind, and priests ought to carefully disinfect their hands. It would not be possible to maintain 2-metre distance at all times, so in this context the priest or Extraordinary ministers should wear masks. Communicants would have to be instructed to maintain distance from one another.
Vulnerable individuals such as those with diabetes, obesity, or pre-existing lung, heart or kidney disease should still stay away from public worship. Many priests will be in vulnerable categories, and this may substantially limit the feasibility of early reopening in many places. We applaud the efforts to live-stream Masses, and we believe these should continue even as public worship is gradually restored.
Religious worship is, for many of us, an important factor to maintain mental health. The elderly often rely on worship in person as an essential social contact to avoid loneliness; the vulnerable often don’t have access to online worship resources. It may be possible to cater for these individuals by providing a separate Mass for them, to avoid the greater risk of picking up an infection from an asymptomatic younger person who goes out to the shops or to work.
GP surgeries have adapted to this possibility by offering an earlier session of appointments for vulnerable individuals. This could be taken into account by parishes. Another possibility, which is being tried out in schools as Year 1 and 6 pupils return, and is proposed in the community as lockdown is generally released, are “bubble groups”, where a defined cohort could attend the same Mass each week, who could then all be contacted should one of them test positive.
We acknowledge that very many devout Catholics are greatly missing the opportunity to attend Mass in person. In the UK, where immunity remains low (less than 10 per cent of the population) and the virus is still circulating (estimated 40,000 new infections per week), extreme caution is required. We hope that these suggestions will help allow the restoration of public worship in the safest way possible.
Dr Rupert Beale, Dr Luke Howard, Dr Angela Bennett and Dr Michelle Tempest