THE COMMON CUP AND THE COMMON COLD - Dr. Greg Kenyon M.D
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Is the Common Communion Cup Safe?
I have been asked to for a comment on the safety of the Common Cup from a hygiene point of view.The safety of the common communion cup has been questioned many times. This issue was on the agenda of the Synod of the Free Reformed Church of North America held in June 1996. This is the denomination I attend. My own congregation uses a common cup.At that time, one of our Free Reformed congregations submitted an overture suggesting that the use of the common cup is a health risk. It included documentation obtained from another denomination which appeared to support the health risks of the common cup.This supporting evidence included the following list of common respiratory diseases that were said to be transmitted via secretions and/or eating utensils. I do not think it is responsible to distribute such a list without the informed commentary of a medical professional. I include it here only to facilitate the discussion.
Adenovirus infection: Viruses causing infection of upper respiratory tract, including colds, sore throats, fevers, enlarged lymph nodes, croup, bronchitis.
Bronchiolitis: Inflammation of the bronchioles, which are the smaller tubes that lead to the lungs. Symptoms included runny nose, rapid respirations, abnormal lung sounds, dry cough, wheezing, fever, possible dehydration and rapid heart rate.
Bronchitis: Inflammation of the bronchi, which are the main branches leading form the trachea to the lungs. Symptoms may include chilliness, soreness behind the sternum, coughing and fever.
Common colds: Symptoms include coughing, headache, fever, runny nose, itchy eyes.
Coxsackievirus: Group of viruses (29 in total) that produce a variety of illness including aseptic meningitis, conjunctivitis, upper respiratory infections. Symptoms of meningitis include high fever, nausea, vomiting, severe headache, irritability, confusion, convulsions, neck and shoulder pain and petechia (small purplish spots on the skin). Conjunctivitis is the inflammation of the mucous membrane of the eye, commonly know as pink eye.
Echovirus: Group of viruses that produce many different types of diseases, including forms of meningitis and various respiratory diseases.
Epstein-Barr virus: Causative agent in infectious mononucleosis.
Herpes Simplex: Cold sores (7% of aseptic meningitis cases are due to the herpes simplex virus).
Infection Mononucleosis: Acute infectious disease of the lymph system caused by the Epstein Barr virus. The virus is excreted in the saliva of those that have the active disease or of those who are carriers. Symptoms include sore throat, fever, swollen lymph nodes, neck pain, aches, skin rash, enlarged spleen. Complications could result in a ruptured spleen, respiratory failure, liver failure, kidney failure.
Influenza (flu): Symptoms include headache, fever, cough, muscle soreness. Complications may lead to pneumonia, heart block or inflammation of the heart muscle.
Legionnaires disease: severe, often fatal disease characterized by pneumonia, dry cough, muscled pain, dysfunction of major organs, high fever, chills, rapid respirations. Complications may lead to respiratory failure, which is the inability of the lungs to perform their normal breathing function.
Meningitis: Inflammation of the membranes of the spinal cord or brain. (See coxackievirus for symptoms of meningitis listed above.)
Pneumonia: Inflammation of the lungs which can be caused by bacteria or viruses. Symptoms include fever, chills, rapid respirations, cough (dry or productive), shortness of breath, pain in chest muscles.
Pharyngitis: Inflammation of the pharynx (strep throat). Symptoms include fever, headache, vomiting, rash. Complications can lead to kidney infections, pneumonia, ear infection, meningitis, rheumatic fever.
Tuberculosis: Infectious, inflammatory communicable disease that commonly attacks the lungs. Symptoms included fatigue, anorexia, weight loss, low fever, night sweats, indigestion, cough, coughing up blood, chest pain, shortness of breath. An individual can experience no symptoms, or they may experience the symptoms so gradually that they are unaware of the onset of the disease.
After reading the information just presented one would think we should all be on our knees profusely thanking God for doing such a good job at sparing us from the ravages of disease that lurk in or on the rim of our communion cups. To think that we have been risking meningitis, ruptured spleens, respiratory failure, kidney failure, and even death! The risk of disease looks so great that one would think that God must be using supernatural means to spare us. As God is not likely to seek His glory by requiring His children to take unnecessary risks in worship, one would think that He would want us to use individual cups where there is no risk. One would wonder why we are even debating this issue, that is, of course, assuming that the information presented above is true.I hope you have begun to wonder about the accuracy or the usefulness of the information presented. Whenever we consider changing something that our forefathers have established we ought to carefully research the issues in light of God's word. For this discussion the principle from God's Word that may be most often abused is the ninth commandment, "You shall not bear false witness." (Editorially emphasized) The corollary of this is that we must present the most accurate information possible, so that we are making decision based on truth and not on falsehood or ignorance.Thus, researching the question of the health risk of the common cup is a good idea. I am a Family Doctor. I am not a specialist in infectious disease. My experience comes from my training completed in 1989, my practice, reading, and ongoing teaching in our local general hospital.In one sense, just living in this world is a health risk. There is a constant battle between our bodies and a multitude of possible infections. There is no way to guarantee anything we do in this world will have no health risk. In this sense the common cup is a health risk, and likely a greater risk then individual cups. I believe that the size of the health risk should be considered.In considering the size of the risk of infection both the potential for transmitting the infection and the seriousness of the infection that can be spread should be considered. A very serious infection with a lower risk of transmission of infection may be given more weight in the decision then a minor infection with a significant risk of transmission of infection.A cursory reading of the type of information some have presented (table above) makes the size of the risk seem large from both the seriousness and the number of possible infections. I do not believe that the risk is as significant as implied.The list provided above is said to be one of "common respiratory diseases that are transmitted via secretions and or eating utensils." To help you to understand how to approach the issue of the possibility of transmission of infections by use of a common communion cup, I would like to make a number of comments with respect to the list provided.
First, the only secretion that would get onto the edge of the cup is saliva, not sputum (from the lungs), not respiratory droplets from a cough or sneeze, nor nasal secretions. That is, except in the very unlikely circumstance where someone coughs directly into the cup or someone's nose drips directly into the cup and the cup is allowed to continue to the next person. A number of the infections mentioned are not easily spread through saliva.
Infectious mononucleosis and Epstein-Barr virus infection are the same thing, giving this disease two entries in the list. We do not see epidemics of mono in the community. By the age of twenty-five, ninety percent of the population has been infected with this virus and are immune. Most people who get mono never knew they had it. It can be spread by saliva. It has a long communicability period. In our public schools it is not treated with prolonged isolation. Once children feel well enough they are aloud to go to school. The disease especially in children does not tend to be serious.
Herpes Simplex is the cause of Cold Sores. It is a direct contact infection. It is not serious. It is a "pain in the neck" because you can get sporadic reoccurrences for the rest of your life. Aseptic meningitis is mentioned. The name meningitis is scary but aseptic meningitis is rare and self limiting and people get better. It is much less serious then bacterial meningitis. Likely of greater concern is that direct contact with the genitals can infect the genital area, which in turn can be very serious for a new born baby. Herpes Simplex is spread through contact with infected secretions, usually infected saliva. It is generally considered that direct contact is needed. Contact with saliva that may be on the edge of a cup is indirect contact. To put the significance of risk in perspective, I believe that it is many times more likely to be spread by normal kisses between family members and friends then on the edge of the cup.
Influenza is spread by virus particles that are in the air coming in contact with respiratory mucosa. It is likely that significant contact occurs much deeper in the respiratory pathway then the lips. It is not likely spread on the edge of a cup. The person with influenza at the table who coughs is likely to spread the virus through the air, not on the edge of the cup.
Tuberculosis is known to be spread by aerosol droplets that make their way through the air into the respiratory passages. There is not any significant risk of transmission on the edge of a cup. If someone with active pulmonary (infection in the lungs) TB does any significant amount of coughing in the church then spread to others is possible.
Legionnaires disease is a very serious disease but it should also be left out of the discussion. My books say that the epidemiological evidence supports airborne transmission and that other modes of transmission are possible but have never been proven. Again, coughing is where the risk of transmission from person to person lies.
Strep. Throat, the most serious type of pharyngitis is also primarily spread by droplets, likely primarily associated with coughing. Transmission through saliva on the edge of a cup may happen. Serious complications of strep are rare today. Sitting in church close to someone who is coughing is likely a far greater risk. Also far greater then ninety percent of sore throats are not caused by the Strep. Bacteria. They are caused by viruses and are generally relatively benign (not serious) self-limiting illnesses.
Coxackievirus is spread through direct contact with nose and throat secretions. They are common enough that many adults are likely immune. Most often these infections are found in children and are self limiting but severe infections do happen, usually in children.Adenoviruses are spread by respiratory droplets and should not be of concern on the edge of a cup.The Common Cold viruses are spread by aerosolized droplets and by direct contact. Coughing into your hand, then shaking someone's hand and the that person putting his hand to his face may be a significant mode of transmission. The Common Cold is not serious.
Bronchiolitis, Bronchitis, and Pneumonia can all be grouped together. They describe the response of the infected person to a variety of infectious agents. The majority of these will be spread by droplets that are inhaled deeper into the body. I could not find a comment on this in my books but I suspect that infections that may be on the edge of a cup could not get deep enough into the lungs. Again the air around the infected person who coughs is a much greater concern.
Of all of the infections mentioned, except Herpes Simplex or Cold Sores, if they are present in the congregation at all, are in my opinion much more likely to be spread to susceptible people from others coughing and hand shaking or through their children having contact with each other than from the edge of the cup. Those concerned with using the common cup should be very concerned about sitting in church while someone else present is coughing.
A common idea in defense of the common cup is that the alcohol in the wine kills the infections. I was taught that you must leave 70% alcohol on the skin for at least 20 seconds to work as a disinfectant. Wine is much lower in alcohol content and, if it works, would likely need much longer then 20 seconds. I'm not sure whether the 20 second rule is based on theory or proven by studies. I think the disinfection argument for wine is a weak argument.
Through this presentation, I hope, you can see that God is not using supernatural means to save us from the ravages of disease lurking on the rim of the cup. Instead, we can thank God that he has allowed the defenses of fallen man to work well enough that we are able to fellowship with each other in relatively close physical contact, even that of using a common communion cup, without seriously disabling each other with diseases. The majority of us do not need to be afraid of the common cup.
Before ending, I should mention one group of people who may be at greater risk of picking up infections through such close contact. It is those who are seriously immune compromised because of seriously low numbers of immune cells (white blood cells) in their body from very severe illness, some forms of chemotherapy, some forms of leukemia, end stage AIDs, etc. These people, perhaps, should not use a common cup but they like the rest of us are still at much greater risk of being infected by the person who coughs near them than from the lip of the cup.
Finally, the best evidence of the safety of the common cup would be to perform large randomized controlled study. It would have to compare two groups of people where both groups carry the same burden of infection, and both groups are similarly healthy to begin with. One group would use the common cup and the other separate cups, for the same number of communions, at similar times of year, for a long enough period of time that any true difference could be seen. This kind of information is not likely to be found. Also, the case of someone who says they picked up an infection from the common cup is really of no value, as evidence, because, as we have seen, they are more likely to have got the infection by some other means.
Dr. Greg Kenyon M.D.