The Role of Inadequate Ventilation in COVID-19 Transmission and the Implications for Church Building Reopenings

By Robin G. Jordan

A factor in church building reopening planning that is not receiving as much attention as it may warrant is ventilation. In discussions of factors involved in super-spreader events in which a gathering became the nexus of a large cluster of COVID-19 cases, poor ventilation is often cited as a contributing factor.

A Chinese study into how the COVID-19 coronavirus was transmitted in hospital settings found that inadequate ventilation played a key role in the building up of high concentrations of virus particles in hospital rooms and other enclosed spaces. Rooms that were naturally ventilated, that is, rooms which had windows that opened to the exterior of the building and which admitted fresh air from outside of the building and in which fresh air was circulating had lower concentrations of virus particles than those that were mechanically ventilated.

The highest concentrations of virus particles were found in COVID-19 patients’ bathrooms. This was attributed to three factors—the size of the room, poor ventilation, and virus particles shed in urine and feces. Later research has drawn attention to the problem of “toilet plumes” which occur when a toilet is flushed with the toilet lid up. A toilet plume is a column of air that rises from the toilet and bears virus particles from urine and feces. One way to prevent a toilet plume is to close the lid of the toilet but toilets in bathrooms and restrooms in buildings like hospitals and churches often do not have lids.

In an early set of guidelines the Centers for Disease Control recommended that churches relaunching in-person services and gatherings should hold these services and gatherings either outdoors or in a large open room with mixed-ventilation. The doors and windows of the room should be open to admit fresh air and electric fans should be used to draw fresh air into the room, exhaust stale air out of the room, and to circulate fresh air in the room. The CDC also recommended that churches limit the size of these services and gatherings, seat the congregation by households groups separated from each other by at least six feet on each side and by an empty row of chairs or pew in front of each household group and behind each group.

Unfortunately the White House modified and diluted these guidelines, arguing that they were “too precise,” before authorizing their publication. A number of health experts who reviewed the published guidelines concluded that they were so ambiguous that they were practically useless. They made the same recommendations for a range of settings for which more specific guidance should have been given.

Few church buildings are designed to take advantage of natural ventilation. Most church buildings that were built in the last century or more recent times rely on mechanical ventilation. Older church buildings have been retrofitted with mechanical ventilation. In the past the principal form of ventilation in church sanctuaries was entryways—doors and passages that led to the exterior of the building. Some church sanctuaries had windows that could be opened. Many did not. As a consequence the interior of the church sanctuary often had a musty smell.

Sunday school classes often meet and choirs rehearse in rooms in which the windows do not open or which have no windows. The latter is common in church buildings in which the basement or undercroft is used for these purposes. Church offices, restrooms, gyms, chapels, nurseries, and kitchens also frequently do not have windows. If they do have windows, they often do not open. The type of facilities in which churches hold their various activities is one of the factors in why a church can become the site of a super-spreader event. It only takes one or two people who are super-spreaders to infect a sizeable number of people in these settings. Super-spreaders have been described as “virus chimneys.” “Virus factories” would also be an apt description. For reasons that we do not yet understand, these individuals produce and shed tremendous amounts of the COVID-19 coronavirus. Under the right circumstances a super-spreader can turn a church into a virus hotspot.

While churches typically try to make use of all available space in their building or building complex, the role inadequate ventilation plays in the transmission of the COVID-19 coronavirus points to the necessity of a more restricted use of that space.

Due to the restrictions placed upon the number of attendees that may gather church sanctuary at one time, a number of churches are transforming other rooms into spaces where additional attendees may watch the service on a TV monitor. These spaces, if they are not properly ventilated, will themselves be as much an unsafe setting as a church sanctuary that is not properly ventilated.

Small enclosed spaces that are poorly ventilated should not be used for gatherings of any kind. This includes small classrooms that do not have windows which can be opened and in which the air circulation is limited. As a consequence many Sunday school classes and small groups will need to continue to meet online.

In the earlier set of guidelines to which I previously referred, the CDC recommended reducing the number of people in choirs and music ensembles and spacing the members of the choir or music ensemble at least six feet apart when they were rehearsing as well as performing. In a more recent set of guidelines, the CDC recommended that churches place a moratorium upon the use of choirs and music ensembles and congregational singing and chanting since singing and loud talking had been implicated in the transmission of the COVID-19 coronavirus. This recommendation was quickly suppressed by the White House which maintained that it should not have been published with the guidelines. Guidelines subsequently released by the State of California and the Ecumenical Consultation on Protocols for Worship, Fellowship, and Sacraments recommended moratoriums on congregational and choral singing and corporate recitation for this reason. The Northern Ireland Executive’s Guidelines for Safe Worship offers this guidance.

• Singing is permitted. However the scientific evidence suggests a higher risk of spreading the virus is associated with louder/stronger communal singing or corporate recitation.

• Quiet pieces of praise, a small socially-distanced choir or praise group may be worth considering. Churches will have to determine their own approach alongside alternative ways to engage in worship using music without singing or silence.

The German government has adopted a stricter policy and temporarily banned singing in churches. Like the United States, Germany had an outbreak that was traced to a choir rehearsal.

If a church’s leadership team decides in favor of singing in its in-person services, it should limit the amount of singing in the service, the type of singing, and size of the choir or music ensemble. Hymnals, prayer books, and pew Bible should be removed from pews or other seating as should giving envelopes, prayer request cards, and anything else that other people can touch. Screens and multimedia projectors should be used in place of hymnals, prayer books, and pew Bibles.

The leadership team should ensure that the room or other space in which the choir or music ensemble rehearses permits social distancing and has good ventilation. A windowless room in the basement would not be a safe setting for choir and music ensemble rehearsals. Members of the choir and music ensemble should wear face masks before and after each song. Members of the choir and music ensemble should have their own sheet music and folders and not use someone else’s.

One church in Florida moved the singing to the end of the service when it reopened its building. However, attendees were not required to wear face masks. No special effort was made to make sure the church sanctuary was properly ventilated. While the church sanitized seating and the like after each service, it did nothing to disperse any concentrations of COVID-19 coronavirus particles that may have built up in the church sanctuary and which were lingering in the air. Attendees of each service may have walked into a cloud of airborne particles from the previous service. The church reopened its building around the time of the surge of COVID-19 cases began in Florida. It is too early to tell if any of the church’s services became a super-spreader event.

Choirs and music ensembles may wish to consider pre-recording hymns, psalms, canticles, worship songs, anthems, and service music before the service in a COVID-19 safe environment and lip-syncing them during the service. Lip-syncing does not require the kind of deep breathing that singing does and consequently the person who is lip syncing will not inhale or exhale the quantity of airborne virus particles that he or she would singing.

Good ventilation is one of the “layers of intervention” that church needs to have in place when it reopens its building and relaunches in-person services and gatherings. Good ventilation can prevent the buildup of concentrations of airborne virus particles in rooms and other spaces that will be used.

Another important layer is face masks. Depending upon the type of mask, a face mask can reduce how airborne virus particles staff members, volunteers, or attendees inhale and most importantly how much they exhale. Super-spreaders often as not do not know that they are super-spreaders.

Wearing a face mask will reduce the chance of infection in a poorly-ventilated room if the wearer does not remain in the room for any length of time. The longer he or she remains in the room, however, the greater the change that he or she may be infected.

Wearing a face mask will reduce the quantity of airborne virus particles that a super-spreader emits and the distance that they travel. It will slow down the buildup of high concentrations of particles in a room or other space.

Face masks should be worn before, during, and after services and other gatherings. The preacher should only lower his mask when he is preaching. Members of the choir or music ensemble and soloists may opt to lower their masks when they are singing; and liturgical ministers when they are reading Scripture or leading prayers. However, lowering their masks or removing them will increase the risk of inhaling and exhaling aerosols containing virus particles.

As an additional layer of intervention plexiglass (or perplex) screens should be mounted in front of pulpits and lecterns from which sermons are preached, Scripture is read, and prayers are led.

Should a church become a nexus of a cluster of new COVID-19 cases upon reopening the building and relaunching in-person services and gatherings, the church should close the building and suspend its services and gatherings again and do a careful assessment of what happened. The purpose of this assessment is determined what happened and what corrective actions should be taken.

I do not believe that a church should attempt too much all at once when it reopens its building. One of the reasons that I cannot endorse the Northern Ireland Executive’s Guidelines for Safe Worship is that it permits too many activities at one time. This increases the likelihood that something may go wrong and the difficulty of ascertaining what went wrong. I recommend a phased approach in which a church takes one cautious step at a time. In the United States we are seeing an explosion of COVID-19 cases because very few states followed the CDC’s recommendations which included a phased approach to reopening.