COVID-19 Confronts Reopening Churches with New Challenges

By Robin G. Jordan

Several times a day I scour the internet for new research findings regarding the transmission of the COVID-19 coronavirus and their implications for precautionary measures to suppress or mitigate the spread of the virus, particularly in regard to church services and gatherings. Two articles caught my attention yesterday evening after I had posted my article, “The Complexity of Church Reopenings During a Pandemic.” The two articles report the findings of recent studies that back up the findings of earlier research. One study involved ventilation; the other “toilet plumes.” Both studies related to the accumulation of high concentrations of COVID-19 virus particles in rooms and other confined spaces.

An earlier study conducted by the Chinese health authorities into the transmission of the COVID-19 virus particles in hospital settings determined that the type of ventilation in a room was a key factor is such accumulations as was the size of the room. In spaces that were occupied by COVID-19 patients rooms that were ventilated by mechanical means had high concentrations of COVID-19 virus particles and bathrooms that were used by these patients had the highest concentrations of the particles. Rooms that were naturally ventilated, that is, rooms which had doors and windows that opened to the exterior of the hospital and in which the air circulated had the lowest concentrations of particles. The movement of the air in these rooms dispersed the particles.

One explanation for the high concentration of COVID-19 virus particles in bathrooms was that individuals infected with the virus shed these particles in their urine and feces. An earlier study of how SARS is transmitted was referenced. An outbreak of SARS in an apartment building was traced to the building’s bathroom ventilation system. The system connected the bathrooms of a number of apartments and SARS virus spread through the system. One or more ducts in the system was not connected to  the exterior of the building as it should have been and SARS virus particles were able to travel along the duct work and infect the occupants of the other apartments in the building.

Early CDC guidelines which the White House modified on the ground that they were “too precise” before authorizing their release suggested familiarity with this early research on the part of the CDC staff who prepared the original document. The proposed guidelines recommended that churches reopen in phases, that they restrict the size of their in-person services and gatherings, and hold these services and gatherings outdoors or in a large, open room with the doors and windows open to the exterior of the building and ventilated by electric fans. They also recommended the implementation of other precaution measures such spacing of seating, social distancing, hand washing, and the like. They further recommended that the number of occupants in a restroom at one time should be limited and the restroom should be cleaned and sanitized after each use. All of these measures if properly implemented and used in combination would have reduced the risk of COVID-19 infection, based upon what was know about the virus’ transmission at that time.

The more recent study supports the need for adequate ventilation of spaces that people will be occupying to reduce the risk of COVID-19 infection. The need for adequate ventilation of these spaces may also be deduced from what we know about other airborne diseases such tuberculosis once it was determined that the COVID-19 virus was transmitted by airborne particles. Tuberculosis was rife in the crowded tenements of New York and other US cities in the nineteenth and twentieth century. It is widespread in the slums of the heavily populated urban areas of Africa, Asia, India, and South America where poor families still live in overcrowded conditions. One South African study found that tuberculosis was less common among South Africans who lived in traditional African dwellings which were open to the air than it was among slum dwellers.

The second study involved “toilet plumes.” A “toilet plume” is a column of particles that rises from a toilet when someone flushes the toilet after he or she has used it. If the individual is infected with COVID-19, this column of particles may include COVID-19 virus particles shed by that individual when he or she urinated or defecated. Electric blower hand dryers have been implicated in circulating the particles from toilet plumes in public restrooms, exposing more people to any diseases that these particles carry. The second study recommended that individuals close the lid of the toilet before they flush the toilet after using it. This prevents the toilet plume from spreading particles into the room. However, most public restrooms have toilets which do not have lids. For privacy toilets are installed in stalls in public restrooms. The stall prevents the dispersion of any particles that rise in the toilet plume when the toilet is flushed. In many small churches restrooms may be the size of a large closet. In such a confined space COVID-19 virus particles will also not disperse quickly. The next individual using the stall or restroom may walk into a cloud of COVID-19 virus particles. Whether an individual becomes infected from these airborne particles depends upon how concentrated they are and how long that individual inhales them. How large a role this phenomenon plays in the transmission of the COVID-19 virus has yet to be determined. Like contaminated surfaces it may play a role in the disease’s transmission while at the same time it may not be the primary means of transmission. This does not, however, mean that it can be dismissed as a means of transmission. It did play an appreciable role in the transmission of SARS.

These two studies show the challenges that churches face when they decide to regather. Very few church facilities were designed to help churches meet these challenges. How we can retrofit church facilities to make them safer will itself prove to be a major challenge. Churches will have to come up with better ways of ventilating the rooms of their facilities. They will have to install in their restrooms systems that not only draw air from the outside of the building into the restroom but also exhaust it from the restroom to the outside of the building. If the toilets do not have lids, they will have to replace them. They will also have to train attendees to close the lid before flushing the toilet. The latter may prove the greatest challenge of all.