Eucharistic Practice and the Risk of Infection
Excerpts written by By David H. Gould, BA, MD,CM, FRCPC, FICA, A.Th
Introduction
With the discovery of AIDS a number of fears have arisen regarding the risk of the infection being spread by the use of the "common cup" at the Eucharist. This in turn has led to a re-examination of Eucharistic practices and their potential for transmission of infection. This is not the first instance of such a concern being raised. The influenza epidemic in 1917 raised similar concerns, and the controversy has surfaced periodically since the sixteenth century.
Transmission of infection
At the outset, it is important to recognize that there are a number of general principles that govern the transmission of infection. In no case can exposure to a single virus or bacterium result in infection. For each disease there is a minimum number of the agent (generally in the millions) that must be transmitted from person to person before infection can occur. Our defenses against stray bacteria are immense and can only be overwhelmed by very large numbers of the infective agents. Each infective agent has its own virulence, and each individual has his/her own "host factors" which determine that person's susceptibility to infection. The interaction of the two determines the risk of infection for the individual.
AIDS
It is important to note that the breakdown of all AIDS cases in the USA by risk groups has not significantly changed since the illness was first described, showing that the disease has very limited modes of spread. Not a single family member of a person with AIDS has contacted the disease, even though occasional sharing of drinking cups, eating utensils and on occasion, toothbrushes has occurred. Despite there now being many millions of cases of AIDS reported throughout the world, there remains no evidence of transmission by saliva, let alone any evidence of transmission by using common drinking utensils.(1) Furthermore, experimental evidence shows that wiping the chalice with the purificator reduces the bacterial count by 90%. It should also be pointed out that the AIDS virus is destroyed by exposure to air, soap, and virtually any disinfectant (including alcohol) and therefore that normal cleaning procedures if performed carefully ensure protection. This should be remembered not only in the context of the Eucharist, but also in reference to those who minister to AIDS patients. In an atmosphere increasingly dominated by litigation, no one in the medical profession is going to give any absolute reassurance even when scientific data indicates that strong reassurance can be provided.
The present use of the common cup is normative for Anglican churches,
and poses no real hazard to health in normal circumstances.
Other infections
It must be admitted that it is difficult to be as reassuring in regards to the use of the common cup in the case of other infectious agents as is in the case of AIDS. But in the case of Hepatitis B virus - also of concern to health care workers because it too has been isolated from saliva of persons with hepatitis - it is possible to be reassuring. There is no evidence of any transmission by the oral administration of hepatitis-positive saliva. The same is equally true of bacterial Meningitis. It must be pointed out that while the relative risk is low, it is not impossible that infection could be transmitted. This is particularly true of communicants with low resistance to infection, i.e. cancer patients on immunosuppressant therapy, and persons with AIDS
What is the risk?
Were there any significant risk to the eucharistic practices of the Anglican church for so many centuries it would seem likely that the evidence would reflect an increased risk for Anglican priests, who have been performing the ablutions for centuries. In fact the opposite is true. Nor do priests appear to have been regularly stricken with any communicable disease that could be traced to the chalice in all that time. Additionally, no episode of disease attributable to the common cup has ever been reported. Thus for the average communicant it would seem that the risk of drinking from the common cup is probably less than the risk of air-borne infection in using a common building.
Nevertheless, eucharistic ministers should be instructed in the proper way to wipe the chalice between communicants. Some procedures that are helpful include: (1) wiping the chalice on the inside of the rim as well as on the outside, (2) opening the purificator to its full size so that a clean part of the purificator is used for each communicant (it may be necessary for the minister to use more than one purificator) and (3) wiping the chalice so that the next communicant does not drink out of the same place on the cup. Similarly, chalices should be washed with soap and water following each Eucharistic liturgy.
Intinction
Intinction (dipping the bread in the wine) is in use in many Episcopal Church parishes and is increasingly being suggested in Canadian Churches as well. There is, however, real concern that many of the modes of intinction used in parishes do not diminish the threat of infection, and some may actually increase it. Hands, children's and adult's, are at least as likely to be a source of infection (often more so) as lips. Retention of the wafer in the hand of the recipient then intincting it means that the wafer, now contaminated by the hand of the recipient, is placed in the wine thus spreading the infection to it. The use of an intinction chalice would make no difference in this instance.
A further consideration with the practice of intinction is that it is only feasible when wafers are used. More and more churches are starting to recognize the sacramental value of the one loaf of bread that is then divided for distribution. Intinction would not be a tenable option in these circumstances.
Other dangers
Indeed, from the foregoing it seems obvious that another risk of infection occurs when the priest breaks the bread should his/her hands be contaminated. The ritual of the washing of the priest's hands at the offertory is therefore more than symbolic. A 30-second hand wash will eliminate 95% of all bacteria. Any other administrants of the bread should also be included, and altar guild members and others who handle wafers in preparation for the Eucharist should take similar precautions.
Priests should periodically instruct the people "If you have the 'flu, a cold, or a cold sore, please don't drink from the cup or dip the wafer into it." This should be done either through the bulletin or verbally at regular intervals. An action, which might be suggested for communicants receiving the bread only, is to take or touch the base of the chalice as they normally would, but simply not sip from it. The words of administration should be used, even when wine is not consumed. Some communicants might prefer to cross their hands over their chest as a sign to administrators to pass them by. It must be stressed however that the present use of the common cup is normative for Anglican churches, follows the practice of the universal church from its beginnings until well into the middle ages, and poses no real hazard to health in normal circumstances.
Common Cup
John Baycroft, retired Anglican Bishop of Ottawa, has written very powerfully about the Eucharist in general and the symbolism of the Common cup in particular in his small booklet The Eucharistic Way.
In the section on "Bread and Wine" he says:
"The cup is also important. Jesus took one cup and gave it to all of his disciples to drink. Perhaps it was the cup of Elijah from the Passover ritual as some people say, but it was certainly a single cup. He did not merely pour wine into the disciples' individual cups and tell them to take a drink. There is a powerful challenge in this one. We are reminded of the agonizing decision that faced Jesus when he was praying before the crucifixion: “My Father, if it be possible, let this cup pass from me; nevertheless, not as I will, but as thou wilt. (Matthew 26:39). …. We are also reminded by the one cup that we cannot drink it alone. We drink from a common cup as a strong symbol of unity and and our willingness to accept each other. We share our love and lives as we share the cup. The implications for this for fellowship and support in the local church, for relationships between rich an poor in communities and nations, and for justice between North and South and first world and world countries are enormous. The cup of love and unity is unavoidably a cup of sacrifice”.
