Holy Week Services and the Common Cup

Dear Saints’

As we look forward to Holy Week, I wanted to let you know that as of this coming Sunday we will offer Holy Communion in both kinds (bread and wine) to those who would like to once again receive from the common cup.

No one is ever required to receive the wine but, for those who are comfortable, you will now have the option to again receive by drinking from the common cup.  Intinction (the action of dipping the wafer into the cup, is NOT permitted due to the increased possibility of spreading germs).  At the bottom of this letter is an article addressing the sharing of the common cup from a medical perspective which I would encourage you to read.  

As has been our practice throughout the pandemic, clergy will distribute communion at the base of the chancel steps.  If you would prefer to continue receiving only the bread, please come forward as usual and then return to your seat after you have received. If you would like to receive the wine, after you have consumed the wafer simply step towards the clergy distributing the cup and it will be offered to you.  For the time being, we will continue with one station for communion.   Please pause and allow the person receiving in front of you to have a moment to receive before stepping forward to receive communion yourself.

Holy Week Schedule

Sunday 8am, 9am, 11am               Palm Sunday with the reading of the Passion

(The procession will begin in the church this year.  As you arrive, please be seated and the service will begin from the chancel steps.)

Wednesday 12:10 and 6pm         Stations of the Cross

Thursday 12:10 and 6pm               Maundy Thursday Eucharist and Foot Washing 

(also, stripping of the altar following the 6pm service)

Friday 11am                                        Veneration of the Cross

Saturday 8pm                                          Great Vigil with Bishop Steve

Sunday 8am, 9am, 11am               Holy Eucharist

(with Bishop Steve at 11am)


The Common Cup and SARS-CoV-2 Infection Risk

The Reverend Michael Garner MSc MDiv

Public Health Advisor to the Bishop of Ottawa

Background:

Over the last hundred years, concerns regarding the hygiene of the common cup have been raised. Despite these concerns, there is limited research regarding the infection risk associated with the practice of the common cup. As a result, a recent review[1] found only four experimental studies,[2],[3],[4],[5] one clinical survey[6] and three reviews[7],[8],[9] on the topic. In the Anglican Church of Canada, focus on risks associated with the common cup emerged in relation to the AIDS epidemic in the 1980s: investigations at that time identified extremely low risk of transmitting the HIV virus through the use of the common cup.[10] In general, the majority of the research has focused on determining if virus or bacteria can be isolated from the common cup after use (i.e., after all eucharistic participants have been served) rather than on whether transmission of disease can occur from one participant to the next through sharing the common cup. To date, there is no documented evidence of disease transmission through the common cup. 

The COVID-19 pandemic has resulted in the suspension of the use of the common cup from the eucharistic practice of the Anglican Church of Canada. The present paper seeks to determine whether continued suspension of this practice is warranted, or whether its reintroduction is a justifiable action in the midst of the pandemic.

SARS-CoV-2 Transmission:

The dominant route of SARS-CoV-2 (i.e., the virus responsible for the COVID-19 pandemic) transmission is respiratory, i.e., inhalation of the virus through both aerosols and droplets.[11] While both asymptomatic and symptomatic persons can transmit SARS- CoV-2, transmission is more likely from symptomatic individuals.[12] Proximity to an infectious person and ventilation of the space are extremely important factors that affect the probability of infection transmission. To date, there is no conclusive evidence of SARS-CoV-2 transmission through direct physical contact with an infectious person or fomites (i.e., objects that may be contaminated with infectious agents and serve in their transmission), although these transmission routes remain theoretically possible, and the emergence of new variants may increase or decrease this likelihood.[13]

Although the amount of SARS-CoV-2 that must be contracted to cause infection (i.e., infectious dose) is unknown, initial evidence suggests that it higher than for SARS-CoV-1 and lower than Middle East Respiratory Syndrome (MERS), e.g., approximately a few hundred viruses.[14] It is important to note that the focus of SARS-CoV-2 infectious dose research has focused on viral inhalation rather than on transmission via direct contact or gastrointestinal exposure. It is likely that a non-respiratory route of infection would require a higher infectious dose than a respiratory route.

COVID risk and the Common Cup:

Over the course of a regular communion service, a chalice becomes contaminated with the saliva of the participants.[15] While the cup may serve as a vehicle for transmitting infection, the risk of infection transmission is very small.[16] Given SARS-CoV-2’s transmission route, the risk of transmission is far greater from breathing the air exhaled by an infectious person next to you at the communion rail than from sharing a common cup.

Despite the extremely low risk of SARS-CoV-2 transmission from a common cup, there are practices that should be maintained for the duration of the pandemic to ensure that this risk remains low: the exclusion of symptomatic persons from participation in church services, particularly from sharing in the common cup; the wiping of chalice between communicants; and physical distancing during participation in Holy Communion.

Superspreading events have played an important role in sustaining the COVID-19 pandemic. These usually occur when an infectious individual has close contacts with many susceptible individuals, for example at a festivals, bars, or social gatherings.[17] While church services, especially those with congregational singing, have been demonstrated to be a potential superspreading events, the use of the common cup is not a possible vehicle for establishing a superspreading event.

Risk Tolerance and Perception:

Perhaps the greatest barrier to the successful reintroduction of the common cup is the perception of risk by the congregation. The focus on the disinfection of surfaces as a means of minimizing COVID spread in the early days of the pandemic changed the behaviour of many people. Even in the current environment, where it is clear that spread does not happen through contact with surfaces, people still perform practices that were reasonable in the midst of the unknown but are no longer warranted (e.g., sanitizing groceries).  Parish Priests, Bishops, and lay leaders will need clear and consistent communication strategies to address the perception of risk and address the limited tolerance that many congregation members may have around sharing the common cup. Keeping messaging to the science, while making space for questions and concerns, will be important moving forward. The practice of partaking in communion in one kind (i.e., only bread) will remain important for those who are unsure of participation in the common cup. Key messages should include that: the main route of transmission of COVID is respiratory rather than gastrointestinal; vaccinated persons are protected from infection regardless of the route of exposure. Finally, as new variants emerge, infectivity through direct contact routes will need to continue to be monitored, and changes in risk considered, as the practice of sharing a common cup continues.

Conclusions:

Modified practices for Holy Communion will need to be in place for the remainder of the pandemic, particularly in making participation safe for immunocompromised congregation members or those not yet eligible for the vaccine, especially those under 12 years old. Alternative means of receiving communion (i.e., in one kind) should continue to be made available. The practice of excluding persons with respiratory symptoms from participating in Holy Communion will help to ensure that the practice remains safe for others. The latter may be considered as an ongoing practice to be adopted in the long term, particularly during winter months when respiratory viruses are circulating, especially influenza. The possibility of transmitting SARS-CoV-2 to healthy persons through the contaminated chalice rim remains an unproven but theoretically possible risk.The risks associated with the reintroduction of the common cup must be understood in contrast to the greater and more probable transmission risk associated with sharing the same airspace with someone actively shedding SARS-CoV-2.

July 13, 2021

The Reverend Michael Garnerwas ordained an Anglican Priest in the Diocese of Ottawa in Fall 2019 and is currently the Associate Incumbent of St. Thomas the Apostle in Ottawa. Michael has worked in public health and epidemiology fields since 1996. From 2006 to 2019, Michael worked as an infectious disease epidemiologist at the Public Health Agency of Canada, working primarily in disease surveillance, infectious disease research and risk assessment, and control of emerging infectious diseases. Michael has a Bachelor of Science degree from Queen’s University, a Master of Science (Epidemiology) degree from the University of Ottawa, and a Master of Divinity degree from the University of Toronto (Wycliffe College).


[1] Spandeas N, Drosou E, Barsoum M, Bougea A. COVID-19 and Holy Communion. Public Health 2020;187:134-135.

[2] Godfrey WH. Communion cup and bacteria. J Am Med Assoc 1939;112:2555.

[3] Burrows W, Hemmens ES. Survival of bacteria on the silver communion cup. J Infect Dis 1943;73:180-90.

[4] Gregory KF, Carpenter JA, Bending GC. Infection hazards of the common communion cup. Canc Publ Health 1967;58:305-10.

[5] Hobbs B, Knowlden J, White A. Experiments on the communion cup. J Hyg 1967;65:37-48.

[6] Loving A, Wolf L. The effects of receiving Holy Communion on health. J Environ Health 1997;60(1):6-10.

[7] Gill ON. The hazards of infection from the shared communion cup. J Infect

1988;16:3e23.

[8] Dorf J. Risk of the common communion cup. Linacre Q November 1980;47(4). Article 7.

[9] Pellerin J, Edmond M. Infections associated with religious rituals. Int J Infect Dis 2013;17(11):e945-8.

[10] Gould DH. Eucharistic Practice and the Risk of Infection. Report for the Doctrine and Worship Committee. April 1987.

[11] Meyerowitz EA, Richterman A, Gandhi RT, Sax PE. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. Ann Intern Me. 2021 Jan;174(1):69-79.

[12] Ibid.

[13] Ibid.

[14] National Collaborating Centre on Environmental Health The Basics of SARS-CoV-2 Transmission accessed July 8 2021. https://ncceh.ca/documents/evidence-review/basics-sars-cov-2-transmission

[15] Spandeas N, Drosou E, Barsoum M, Bougea A. COVID-19 and Holy Communion. Public Health 2020;187:134-135.

[16] Ibid

[17] Althouse BM, Wenger EA, Miller JC, Scarpino SV, Allard A, Hébert-Dufresne L, Hu H. Superspreading events in the transmission dynamics of SARS-CoV-2: Opportunities for interventions and control. PLoS Biol 2020 Nov 12;18(11):e3000897.