A note from Jamie Howison: As August was coming to a close, there was an increasing amount of conversation in the media around the potential of an H1N1 pandemic. Rather than simply reacting in an unreflected way, I thought it wise to sit down and have a conversation with someone who might actually have a handle on such things. What follows is the result of this conversation with Dr Pierre Plourde – who is both a medical doctor with a great deal of experience in the area of infectious diseases and a member of saint benedict’s table. **Please note that while some of these measures make sense to follow on an ongoing basis, much of what is contained here will only come fully into effect if and when the threat of a pandemic requires their implementation.
Recommendations for H1N1 Pandemic Influenza Public Health Measures
Prepared for the Anglican Diocese of Rupert’s Land
September 15, 2009
Pierre Plourde and Jamie Howison
The Public Health Agency of Canada (PHAC) has recommended that:
“faith based organizations consider how (general H1N1 public health prevention recommendations) may apply to their settings and to determine if there may be a need to temporarily modify some faith based practices in an effort to prevent influenza-like illness (ILI) transmission within their settings, especially when influenza is circulating in their community. Additionally, faith based organizations can contribute to public health efforts to prevent the transmission of influenza. Through their extensive networks, they can provide a venue to communicate key influenza prevention messages and, through their outreach programs, may also provide additional assistance such as flu buddies who can check on vulnerable individuals within their communities”.
What is offered in the following recommendations is only the opinion of the authors, and should not be interpreted as the official position of the Public Health Agency of Canada, Manitoba Health and Healthy Living, the Winnipeg Regional Health Authority, or of the Diocese of Rupert’s Land. It is hoped that these recommendations will be useful in engaging further discussion at the diocesan and parish levels, and will encourage and support parishes in making decisions with respect to helping mitigate the impact of H1N1 influenza in the wider community.
1. General Advice
Advice that applies to all persons with respect to hand hygiene, cough etiquette, and staying home if one is ill also applies to congregations. Parishioners should be informed that they are always excused from attending any church function including Sunday worship services when they are ill. Staying home when ill with ILI will especially protect the vulnerable members of the congregation (ie, pregnant women and those with underlying chronic medical conditions). Parishes may want to institute processes to monitor absences due to ILI, so that such persons may still receive pastoral support in their homes. Any parishioners doing home visitation ministry would need to pay close attention to infection control practices, hand washing being most important.
Parishioners should be encouraged to make sure they wash their hands before attending church gatherings; and should always ensure their hands are clean.
Parishioners should also be informed about proper cough etiquette, including coughing or sneezing into their sleeve or using a facial tissue (use of a facial tissue should be followed by hand washing).
Parish administration staff should ensure that adequate supplies of cleaning materials are readily available and that there are procedures for regular cleaning of potentially contaminated surfaces such as door knobs, bathroom sink taps, flush toilet handles, etc. Staff should also ensure that hand washing facilities (either sinks with soap and water or hand sanitizer dispensers) are adequate and working properly, and that there is a sufficient stock of tissues, paper towels and soaps.
2. Congregational worship practices
Although public health authorities cannot predict what will happen this fall and winter, most agree that the next influenza season will be caused almost exclusively by the H1N1 pandemic influenza strain (based on what has recently been observed in the Southern Hemisphere “winter” influenza season). This past spring, some communities in Northern Manitoba were hit particularly hard, with high attack rates on certain reserves (up to 70% of the population with illness) resulting in the hospitalization of some individuals in intensive care units. With such high attack rates and subsequent severe illness in some, parishes may need to consider temporarily modifying or suspending certain practices that would normally facilitate the spread of H1N1 influenza.
Congregational gatherings of large numbers of people does risk facilitating the spread of H1N1 influenza. Should H1N1 influenza return to Winnipeg in significant numbers as expected beginning in late September 2009, the diocese or individual parishes may decide to institute some temporary changes to congregational worship practices as follows:
- Those administering communion should always be sure their hands are clean. Some churches have started asking communion administrants to discreetly use hand sanitizers before administering communion; this seems like a very good practice to continue even beyond the H1N1 pandemic.
- Parishes should consider temporarily suspending use of the common cup during the next wave(s) of the H1N1 pandemic. While it has always been normative within the Anglican tradition to administer communion in “both kinds” (article XXX of the “Articles of Religion”), the reality of pastoral and practical exceptions has long been recognized (ie. alcohol or gluten allergies, addiction). In short, the sharing in communion in “one kind” (i.e. the bread) is to be considered a full and valid partaking in the Eucharistic celebration.
- A small amount of wine should still be consecrated along with the bread, and consumed by one person on behalf of the gathered community. While tradition might suggest that the officiant would be the most obvious person to consume the wine, parishes might consider having one of the communion administrants or servers assume this role, thus having the officiating priest/bishop model the fullness of participation in one kind.
- The practice of “intinction” (“dunking” the bread in the wine) is probably the most unhygienic way to administer communion, and should be discouraged.
- The sharing of the sign of peace through the shaking of hands should be modified; a simple exchange of words, accompanied by a nod or bow of the head is a possible substitute for a handshake. In fact, this might provide a parish community with the opportunity to revisit the theological and liturgical significance of the exchange of the peace of Christ, which is to both symbolize our mutual forgiveness in Christ and to express our openness to the fullness of Christ’s peaceable kingdom. To make and maintain eye contact while speaking the words, “the peace of Christ,” without the social ritual of a handshake, could well provide a powerful reminder of this deeper significance.
- Those who administer the anointing with oil or the laying on of hands should follow the same hand washing practice as communion administrants, but should also repeat the practices after the rite is completed.
3. “Flu Buddies”
Parishes are regarded by the Public Health Agency of Canada as a critical resource in assisting with the response to an influenza pandemic. With this in mind, parishes may want to consider implementing a “flu buddy” system, as described by the Public Health Agency of Canada, whereby parishioners would regularly check in on fellow parishioners and other “neighbours” who may not necessarily be members of the church congregation, particularly the elderly, singles, and single parent families, to help ensure assistance, if required, during an H1N1 pandemic wave. “Flu buddies” could assist with bringing essential supplies and food for those in the community who are unable to do so because of illness.
4. Hospital Visitation
Parishes that are involved in pastoral care hospital visitation should ensure that hospital visitors follow all infection control protocols that are in place in the hospital setting, with respect to hand washing and wearing gowns, gloves, masks, etc. Anyone with symptoms of influenza (cough, fever, aches, sore throat) should never visit hospitals or personal care homes – such individuals should stay at home and not expose any one else to their virus. Of course, if they are very ill, they should visit a physician (but that would be the only reason for them to visit a hospital or clinic).
Parishes should expect an increased demand for hospital visitation services during the next pandemic H1N1 influenza wave, and should plan accordingly either by increasing the number of volunteers available or by prioritizing essential pastoral care activities. Parishes should ensure that all individuals involved in pastoral care ministries are knowledgeable about the prevention of H1N1 influenza.
It is important to note that most of these recommendations (except for hand washing and cough etiquette) are meant to be temporary and not permanent changes to the practice and life of faith communities. Hence, as soon as the H1N1 pandemic has passed, congregational life will go back to normal.
The rubrics for administering communion to the sick in the Book of Common Prayer (1962) stipulate that in cases where the ill person is unable to participate in communion, the person’s faithful intent means that, “he doth eat and drink the Body and Blood of our Saviour Christ profitably to his soul’s health although he do not receive the Sacrament with his mouth” (BCP p. 584).