Why are places of worship so susceptible to COVID-19 outbreaks?

Experts say that the conditions of religious services can provide an environment for COVID-19.
Experts say that a unique combination of factors make places of worship more susceptible to spreading the virus.
Experts say that a unique combination of factors make places of worship more susceptible to spreading the virus. TODAY Illustration / Getty Images

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By Kerry Breen

As the coronavirus pandemic continues, one social space has emerged as a potential hotspot for the spread of the virus: places of worship.

Churches and other religious spaces were shut down earlier in 2020, but opened again as states tried to re-open their economies. In many places, bans on large indoor gatherings meant services were halted, but as restrictions loosened, religious activities began again.

In Arkansas, earlier in the pandemic, the coronavirus spread through a small parish, infecting more than a third of those who went to church events and dozens more in the community, even before the first case of the virus was diagnosed in the state. In Florida, a teenage girl fell ill and died after attending a church event with around 100 other children; her parents did not seek medical attention after she began showing symptoms.

In California, a couple defied health rules and regulations to have the wedding of their dreams - and days later, at least 10 people involved tested positive for the virus, with dozens more possibly exposed. In Alabama, almost an entire congregation was infected after attending a days-long Baptist church event.

Experts say that a unique combination of factors make places of worship more susceptible to spreading the virus. Barun Mathema, Ph.D., an assistant professor of epidemiology at the Columbia University Mailman School of Public Health, said that churches and places of worship can "potentially fill a lot of the checkboxes" on the list of things that allow COVID-19 to easily spread.

"Historically, we know that there have been bonafide cases of outbreaks and transmission events associated with congregations and places of worship," said Mathema, whose research revolves primarily around tuberculosis, another disease spread by airborne pathogens.

The singing of choirs was a particular concern, since some research has shown that singing spreads droplets further than just normal speaking.

"Things like a singing choir so... fit in very nicely with COVID transmission routes," said Mathema. "Even talking, you're generating a fair amount of aerosols, and you can generate even more (when singing)."

Mathema also suggested that services may not be properly distanced, and said that contact between congregants and religious leaders could lead to further transmission of the virus. In the case of the Alabama congregation that was infected, the church's pastor told a local outlet that there had been no restrictions in place.

“We let everybody do what they felt like. ... If you were comfortable shaking hands, you shook hands. If you didn’t, you didn’t,” the pastor said.

"A church at capacity is probably really not a good idea," said Mathema, who also cautioned against sharing worship materials or otherwise being too close together. "I think those are all sort of opportunities where transmission can happen."

Mathema also said that holding religious services indoors, instead of outdoors, could create a more risky environment.

People should evaluate the risks that they're going into and take the right and measured approach, in terms of protecting themselves, or more importantly protecting their neighbors.

Barun Mathema, Ph.D., assistant professor of epidemiology at the Columbia University Mailman School of Public Health

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and an infectious disease physician, told TODAY, cautioned that the age of a congregation could also make a difference in the severity of a COVID-19 outbreak. Seniors are more susceptible to the virus, and more likely to suffer from complications.

"If you have an event at a church where the average age is 70 years old as opposed to an event where the average age is lower, that’s going to mean the individuals are more likely to become symptomatic, more likely to need hospitalization, and more likely to die," Adalja said.

Both Adalja and Mathema said that religious services could be done safely, so long as some protective measures were taken. They recommended moving services outdoors wherever possible, separating congregants by at least six feet and mandating the wearing of masks.

Other protective measures include using disposable, non-shared worship materials and changing rituals to avoid physical contact as much as possible.

"Church is a safe haven, it is very communal, (and) everything we're trying to do with social and physical distance from one another is sort of antithetical to the whole idea of going to a place of worship," said Mathema. "But that is, unfortunately, probably the best way forward. ... People should evaluate the risks that they're going into and take the right and measured approach, in terms of protecting themselves, or more importantly protecting their neighbors."