Churches inviting people to in-car church services — drive-in church, inviting families to get into a car, drive to a parking lot, and sit in the car for a worship service — are likely now putting those families at substantially increased risk for COVID-19 infection in many areas.
Putting a family in such a small and mostly sealed space as a vehicle for such a long time makes it likely that if any one member of the family has the virus when getting in the car, then they will all be infected before the closing prayer in many instances. Experience and studies indicate that if the family would have stayed home, there is a much better chance the non-infected family members would have avoided infection.
The household transmission rate — the household secondary attack rate — in the United States, Korea, and China for COVID-19 found in early, separate studies cited by the Centers for Disease Control, Korean Centers for Disease Control and Prevention, and World Health Organization of 3.0% – 10.5% for symptomatic is very low compared to the very high risk of in-car transmission found for the flu in a 2012 study for a 45-60+ minute time in a newer car, which approached 90-99% in conditions similar in relevant respects to those associated with drive-in church.
In-home, an infected family member may have the opportunity to detect symptoms and isolate before infecting others, much less the entire family, and our experience with other viruses tells us that just because one family member gets it does not mean that the entire family will contract it, and we are especially vigilant now.
The in-car approach presents a likelihood of infecting the entire family at once in many instances, and the closeness and prolonged nature of the in-car interaction permits even unaware, “not very contagious” members to infect the whole family at once.
For some families (e.g., a family of 2 who kiss constantly and spend each evening on a loveseat together watching TV or such a family with a small child), the comparative risk might not be very different, but for many families (e.g., an active family with kids having more independence who are all often busy doing their own thing), the difference could be enormous. Studies indicates it often takes more than sporadic, brief contact to transmit the virus via the air, and efforts like hand washing, disinfecting, and not touching faces can make a real difference on avoiding transmitting via surfaces, too.
Drive-in church essentially brings the transmission via air and via surfaces possibilities into a close-to worst-case environment, with the whole family within spitting distance surrounded by surfaces feet or less away, immobile, people and surfaces unable to avoid the remnants of a cough or sneeze, enclosed space, mouths open, mouths and noses at roughly the same height, etc., for a prolonged time.
Drive-in church might have been low-risk in most areas a few weeks ago, but now that the virus has spread widely in the United States, church leaders and family members should reconsider for the sake of the health and lives of their families.
Putting the Family in a Small, Sealed Test-Tube With a Virus for a Long Time
For drive-in church, with 2 – 5 people in a largely sealed test-tube (a car) in which they are all 1 – 6 feet apart and stationary for 60-90 minutes, if one of them is infected getting into the car, then all or most of them stand an excellent chance of being infected by the time they get out, even by the time of the closing prayer.
Droplets with the virus can be breathed, coughed, and sneezed out into the surrounding air in the car. Singing might also project droplets.
The close proximity of the family members in a mostly enclosed space of a car, combined with their immobilization and fixed spacing of mouths and noses at similar heights, can facilitate droplets expelled by one infected family member into the air going quickly to very near, on, or into the intake areas (mouth, nose, etc.), hands, and bodies of other family members. The virus also survives on surfaces for some time, and thus droplets breathed, coughed, sneezed, or sung onto surfaces in the car can immediately or soon be picked up by another family member when they touch those surfaces, which closely surround the family within feet or less.
The vehicle can in effect be like a test-tube containing the virus, a relatively small amount of air, and the whole family. Such churches are essentially asking whole families to be within the distance the CDC (Centers for Disease Control) and other authorities say to avoid, and not just briefly or sporadically, but for a long time, 60-90 minutes or more with time for services and travel, and in an enclosed space and immobile state.
A 2012 study estimated the risk of transmitting the flu over a 90-minute car trip ranged from 59% to 99.9% when air was recirculated in newer, more air-tight vehicles. COVID-19 transmits more easily than the seasonal flu generally, per reports.
Nature reports that scientists disagree on whether COVID-19 meets the technical definition of airborne, stating, “Most transmission occurs at close range, says Ben Cowling, an epidemiologist at the University of Hong Kong. But the distinction between droplets and aerosols is unhelpful because ‘the particles that come out with virus can be a wide range of sizes. Very, very large ones right down to aerosols’, he says. And if SARS-CoV-2 is transmitting in aerosols, it is possible that virus particles can build up over time in enclosed spaces ….”
A car presents an easy opportunity for all modes of COVID-19 transmission, direct in close range, by air over close range, in aerosols (e.g., singing, talking, air re-circulating or suspending, all at close range), while surrounded by surfaces to touch that may hold virus droplets by touching surfaces with the virus and then one’s face, etc. COVID-19 is new and there are many unknowns. A key point is that the family in the car remains very close to one another for a very long time, allowing extended intake of virus droplets over a concentrated time, sufficient to cause infection.
This sustained, close contact makes it easier for even a “not very contagious” family member to transmit it to another family member, for example.
People Can Be Infected Long Before Notice Symptoms & Be Contagious Before
Often, people do not know they are infected, as it can take 2 – 14 days or more for symptoms to emerge, if they do. People appear to be most contagious when they show symptoms, but they can be contagious and transmit the virus to others before showing or noticing symptoms. And many do not notice mild symptoms even when having them for some time. Up to 25% of those infected with COVID-19 may not show symptoms, per the director of the Centers for Disease Control, and Dr. Fauci says it could be as high as 50%.
Stay at Home, Online Church, Can Avoid Infection Even From a Family Member
If, in contrast, that same family of 2 – 5 people had stayed at home and engaged in a form of the generally recommended hygiene (such as some combination of washing hands frequently, avoiding touching faces, disinfecting surfaces, not coughing or sneezing around others, staying many feet — preferably 6+ as much as possible — apart the vast majority of time if they can, and isolating those showing a symptom, etc.), then the non-infected stand a very good chance of avoiding infection.
That is, it is not true that if one family member gets it, that the whole family is going to get it anyway, based on studies of COVID-19 and experience with other viruses.
The Centers for Disease Control and the World Health Organization report preliminary studies showing symptomatic secondary attack rate among household members for confirmed COVID-19 patients of 3.0 – 10.5%. This was for February and earlier cases. It seems likely that there is wider-spread awareness and implementation of hygienic measures now in the United States than at the time of these studies that could bring this rate down. Of course, these are preliminary, early studies, and the household secondary attack rate could be much higher.
Families have one member come down with a cold virus or seasonal-flu virus all the time without the entire family getting it. Sometimes yes, sometimes no. We now know to take special care at home, giving all a better chance of avoiding infection. Each family’s situation is different, and their ability to engage in various hygiene measures vary. Much depends on the family’s situation, and inter-family infection can be avoided in many of them.
But the drive-in church changes the odds considerably.
Health Department and Churches Say Drive-In Services Are a No Go For Other Reasons, Too
Many health departments, cities and counties, churches, police departments, and others have recognized the health and other risks associated with drive-in church. For example, multiple health departments have warned churches that drive-in services do not meet requirements for social distancing or are otherwise unhealthy during the COVID-19 pandemic, including Georgia, Oklahoma City Randolph County, Illinois, Oldham County, Kentucky, and Riverside County, California. Louisville’s mayor has explained that drive-in services “conflict with our imperative to #StayHome to protect our neighbors & loved ones.” Washington state has discouraged or prohibited them. The Mayor of Chattanooga, Tennessee likewise asked that drive-in services not take place, stating that “Allowing people to gather, even in their cars with the windows rolled up, will be considered a violation of our directives.” In North Carolina, Wake County concluded similarly. Georgia’s governor said they were not illegal under certain conditions but urged Georgians not to go to them for health reasons. Kentucky’s Attorney General cautioned about the legality of law enforcement targeting them, but said he is not going to one and urged people to stay home Sunday instead.
Some churches, including ones in Alabama, Arizona, Arkansas, California, Florida, Georgia, Illinois, Iowa, Kentucky, Kentucky, Minnesota, Oklahoma, Pennsylvania, and Tennessee, cancelled their drive-in church, including in light of the risk of virus spread or local or state rules. A Methodist conclave of 864 congregations in East Tennessee, Southwest Virginia, and North Georgia prohibited its churches from holding drive-in services in light of in-family transmission and other concerns. The Police Department in Wilmington, North Carolina said holding drive-in services is contrary to the advice of health professionals, but they are not illegal under the North Carolina governor’s executive order. A city in Mississippi issued $500 tickets to church members who attended a drive-in church service there. And some churches ended their drive-thru confessions and prayers over COVID-19 concerns. And many of these concerns appeared separate from and in addition to the issue discussed above, the whole-family-in-car concern.
Some executive orders make an exception for family members relative to the order’s six-foot rule. This is because it is impractical and unreasonable for the government to order people to stay six feet away from all family members at all times. It is not because it is safe for family members who might be infected to go near their grandparents, parents, spouse, children, or any other person. The virus does not know who is related.
Most states, like Alabama, do not prohibit drive-in church if it meets the goals of the executive orders, which are aimed mainly at community spread (not family spread) and other large-scale public-health concerns (e.g., keeping large groups from congregating), but this does not mean that it should be done. Alabama’s Department of Health, for example, says drive-in and other services “can proceed” under certain conditions, but also says “To help prevent COVID-19 transmission, every effort should be made to conduct these services through remote participation.” Many governments are appropriately hesitant to regulate or prohibit what might be considered church matters and it is controversial for them to do so. Some might be overly deferential, some overly regulatory.
Regardless, family health and lives in this context are primarily the responsibility of the adults in the family and church leadership.
Not Prohibited by the Government is Not the Same as Safe for Families
It is important to remember that a government not prohibiting something is not a determination that it is safe for families. Just because a government says it is legal to meet under certain conditions does not mean that it is safe for families to meet under those conditions.
In other words, while it might or might not be unlawful, it is up to the church leadership and family members to think about situations and not put the health and lives of families in danger when it is not necessary. The theme of all of the orders is that families are much safer at home during this time of COVID-19 uncertainty and people need to make decisions right now that favor health and life.
An additional issue is that people may need to leave their cars regularly to go to the bathroom, for example, and be exposed intra-family, either at the church or a nearby facility. Drive-in churches would need to allow for this, increasing intra-family exposure risk.
In a Car, Much Harder to Avoid Infection
The 2012 laboratory study’s indication that virus transmission in a car over a 90-minute period can be 59% to 99.9%, the CDC’s recommendations, fluid mechanics relative to the air and expelled droplets, and considering the in-car situation suggests that having a family in the car for 60-90 minutes presents a significant risk of infection to the whole family if one family member is infected.
In the car, passengers are typically fixed just feet apart, often much less than the 6 feet recommended by the CDC and mandated by many governmental authorities. And, in the car, the out-breathing mouth of the infected person often remains at roughly the same height as the in-breathing mouths and noses of the other family members and within a few feet for 60-90 minutes.
The intensity of contact between family members — very close, enclosed space, close surfaces, etc., for 60-90 minutes of driving and parking time — related to drive-in church seems likely to increase the risk of transmission in many instances well beyond what it would have been had that family stayed home.
The chances that one infected family member infects the entire family likely go way up in the car during that time.
That is, but for all getting into the car together for 60-90 minutes, infecting others in the family, possibly the entire family during drive-in church, probably could have been avoided.
And we are talking about possibly the whole family.
And the Down-Side is Awful: People Suffer and Die Alone, Impacts Young and Old
Reports have COVID-19 victims suffering and dying alone, as their families and friends cannot visit them in the hospital.
It sounds like an awful way to go, with struggles with breathing and ventilators.
And people react differently to this virus. One person might have mild symptoms, while another might experience severe symptoms. It does not impact just older and immunocompromised people.
Not True That Having Family Member Infected Makes it Foregone Conclusion for All
Some will argue that if a family member is infected, then the whole family is going to be infected anyway and that getting into the car to go to an in-car service will not materially increase the risk of transmission. That appears to be untrue, however, both based on experience and the studies mentioned above, at least for many families.
In-home infection can be avoided in many instances by taking appropriate hygiene steps while the intensity of contact (close for a long duration) in the car makes it seem hard to avoid transmission, nearly guaranteed in many instances, if one person is infected, even giving a good chance for a “low contagious” or “not contagious in normal settings” person to transmit with lots of time and close proximity in the car.
In the car, the ceiling and side surfaces are very close to your mouth and nose, where you can intake the virus, for example. At home, rooms are much more open. In the car, you often remain 1-6 feet away from the infected person for a long duration. At home, in many families, you can avoid being within 1-6 feet of most of the family the vast majority of the time, particularly if you are practicing hygiene steps in this time of COVID-19. Not every family, of course, but family members are generally more than 6 feet away from other family members the vast majority of the time at home. In the car, during drive-in church, the family is likely singing and talking, projecting any droplets with some force, with their mouths and noses at roughly the same height. At home, even two people in bed together, if they are only sleeping and winding down for the evening, unless they are coughing or sneezing, their projection of droplets may be limited with shallower breathing.
In the car, you are seated and largely immobile at the time another person sneezes or coughs and remain within the 3-6 feet that the droplets travel. At home, you typically have much more room to quickly get out of range. In the car, the out-breathing mouth of the infected person remains at roughly the same height as the in-breathing mouth and nose of the other family members and within a few feet for 60-90 minutes. At home, people move around much more.
The differences go on and on.
As one car-sales site puts it, “Your car is waaaay smaller than 6’ between passengers. If Joe in the backseat coughs or sneezes, you WILL be getting some droplets your direction. Gross, but true.”
In-Car Church Service Involves Putting Multiple Families in This Position
Multiply that single sealed-tube event for those 2-5 people described above by the number of cars in the church parking lot who otherwise would have stayed home and likely avoided infection, and consider the situation in which at least some of those cars — those test-tubes — are likely to contain an infected person and thus the COVID-19 virus, then do the math. That seems like a major increase of inter-family transmission risk for the congregation that would not have been created but-for that parking-lot service.
Many Churches Serve People Who Are or Who Interface With the Most Vulnerable
Most churches serve persons most vulnerable to severe reactions and death from COVID-19, older persons, or who interface with them. So not only does calling such an in-car service put that number of cars into the lot with increased risk of inter-family transmission, it can call into more intense contact a higher-risk population or add to their risk, too.
This concern would, of course, apply to the family taking such a lengthy car ride or staying in a sitting car for such a long time in many instances, not just drive-in church.
The in-car can lessen intra-family transmission, but it appears to come with a trade-off of increasing inter-family transmission risk to an extremely high level.
Conclusion — Commentary — Online Only
1. I generally recommend against holding or attending drive-in church during this time of COVID-19 and would continue with only online services.
My suggestion is that if church leadership wants to proceed, that it ask itself if it is really necessary and worth it to do so over online-only.
2. If it continues to wish to do so, it should raise this issue of inter-family transmission in detail with a knowledgeable doctor and discuss the health aspects and safety of the proposed approach.
3. Also, I suggest consulting your health department relative to this specific issue of inter-family transmission, the increased risk in the confines of a car. If the risk of inter-family transmission is increased along the lines I described for their situation, I would not have the service and would default to online only.
4. If church leadership decides to proceed anyway, I suggest that those invited (the members, etc.) be clearly and fully informed by the church of this specific risk to their families.
5. Also, if church leadership decides to proceed anyway, the families should be told of options to reduce the risk, those suggested by the medical professionals the church consults. If the church required one person per car, perhaps, but I have some doubt about feasibility and compliance. Keeping the windows rolled down during the entire trip and while parking might help relative to inter-family transmission (or might not — and it might also blow a sneeze from the front like a jet stream into the face of someone in the back), but then with the windows rolled down, the intra-family risk goes up if other cars are nearby in the parking lot. Turning off air-recirculation might help (it switches on automatically in several situations in many cars, though), as might turning up air-fan speed for ventilation, but whether and how much it does is not clear, depending on the car and situation. Not singing might help. Disinfecting constantly might help. Gloves and masks might help. Consultation with and following medical professionals’ recommendations here would be needed.
6. Overall, recommend against having or attending drive-in church, for the health and lives of families, particularly during this time of uncertainty and very early information.
Each family’s situation is different, of course. And each church’s situation is different. Medical professionals should be consulted and this specific question asked them to determine the risk and appropriate course of action in your situation. I raise these things because things are moving quickly and people have a lot to think about and may not realize what getting in the car together during this time means. The drive-in option seems initially attractive, and I am encouraging close consideration of the changing situation and risk and threat to the health and lives of families.
I like it when the congregation gathers together. I like going to church and understand why people like to go and want to go.
When I first heard of the in-car church service, it seemed like a good idea in this time of COVID-19, particularly as an alternative to in-person meetings if church leaders insist on such. But when I paused on the concept, I realized that it, too, unfortunately, presents significant risks and threats to the health, safety, and lives of our families.
Love is Patient and Always Protects
To say it is acceptable to put an entire family into an in-car situation in which they all may be nearly certainly to be infected within an hour if one family member is infected unaware, particularly based on a view that the whole family is probably already infected or will be infected in-home anyway, seems fatalistic, inconsistent with evidence and experience, giving up on hope, impatient, and not protective of the family’s health and life.
“Love … always hopes, always perseveres.” (1 Cor 13:7)
We can avoid losing hope that our family can avoid infection. We can persevere, continuing to protect the family even if one member is infected.
The way we can best express our love for our families and our neighbors is to stay home.
“Love is patient, love is kind. … It does not dishonor others, it is not self-seeking, …. It always protects …” (1 Cor 13:4-7)
Prayers for all of you.
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Sources & Notes
See generally Steve Gardner, “10 Reasons Churches Should Not Have In-Person Services for a Time: COVID-19 and Flattening the Curve,” AuthenticTheology.com (March 14, 2020) (and sources cited therein).
See generally Steve Gardner, “Church of Christ in Quarantine After Assembling Despite Warning, Then Positive COVID-19 Test,” AuthenticTheology.com (March 20, 2020) (and sources cited therein).
See generally https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html
Drive-in church popular: Time
Singing might also project droplets: L.A. Times (“One of the authors of that study, Jamie Lloyd-Smith, a UCLA infectious disease researcher, said it’s possible that the forceful breathing action of singing dispersed viral particles in the church room that were widely inhaled. “One could imagine that really trying to project your voice would also project more droplets and aerosols,” he said.”); see also Nature (added 4/3).
Nature (added 4/7)
Symptoms 2 – 14 days: CDC.
Up to 25% do not show symptoms: New York Times (added 4/1)
Could be as high as 50%: New York Times (added 4/5)
2012 Study: Queensland University of Technology Also see NPR (“People shouldn’t cram into cars with the windows rolled up, he says, and officials need to keep crowding down in mass transit vehicles such as trains and buses.”)
Added: NIH abstract (“… we estimated the risk of airborne influenza transmission in two cars (1989 model and 2005 model) by employing ventilation measurements and a variation of the Wells-Riley model. Results suggested that infection risk can be reduced by not recirculating air; however, estimated risk ranged from 59% to 99·9% for a 90-min trip when air was recirculated in the newer vehicle. These results have implications for interrupting in-car transmission of other illnesses spread by the airborne route.”); L.D. Knibbs et al., “The risk of airborne influenza transmission in passenger cars,” Epidemiol. Infect. (2012), 140, 474–478. (added 4/5)
The study reflects a moving car at various air ventilation and recirculation settings, with greater ventilation yielding lower transmission rates. A non-moving car would likely offer less air-flow and thus less of a ventilation (and air circulation) effect than these moving vehicles. The effect of open windows while sitting would likely depend somewhat on wind speed. Also, the cars tested in Knibbs et al. were, of course, older than current cars. I wonder if cars have generally become more environmentally sealed and less ventilated than the models tested. (added 4/5)
Also see New York Times (“The risk goes up with sustained contact — during face-to-face conversation, for example, or by sharing the same air space for a prolonged time.”) (added 4/1)
COVID-19 transmission: CDC, Johns Hopkins, NPR. See also New York Times (“The new virus spreads about as easily as flu, …”) (added 4/1)
More on similarities between covid-19 and flu: WHO, Johns Hopkins (added 4/10)
Staying away within family: CDC, KidsHeath.com, The Atlantic
Lower within household, 3 – 10.5%: CDC, Stat, USA Today, WHO.
A CDC study published in early March found there was a 10.5% symptomatic secondary attack rate among household members for confirmed COVID-19 patients (95% CI = 2.9%–31.4%). This was of persons exposed to patients with confirmed COVID-19 in the United States in January and February. Thus, it was before hygiene measures were in wide use. The World Health Organization reported that a preliminary study in China found the secondary attack rate in households ranged from 3 – 10%.
Added: A Korea Centers for Disease Control and Prevention report put Korea’s household attack rate at 7.56%. (“There were 119 household contacts, of which 9 individuals developed COVID-19 resulting in a secondary attack rate of 7.56% (95% CI 3.7–14.26).”); Cleveland Clinic (“Scientists are still working to understand household transmission of SARS-CoV-2. In early March, scientists from the Centers for Disease Control and Prevention reported that after following close contacts of 10 patients infected with COVID-19, (n = 445), two individuals, both of whom were household members of an infected patient, tested positive for the disease. In this particular study, the secondary attack rate was about 10.5%. In both cases, the patient with secondary transmission confirmed close contact with the source patient before their initial diagnosis.“) (4/5)
One paper identified at 15% household secondary attack rate, but the paper explains it is not a peer reviewed paper and is not majorly distant from the others relative to the high risk rates found in the 2012 study, so I did not include it in the main body. (4/12)
Contagious pre-symptoms: CDC, New York Times, Health.com
Most vulnerable: CDC
Car-Sales site: Sellmax
Suffering and dying alone: NY Times
One state’s health department, etc.: The Georgia Sun. Also see Macon Telegraph; also Tulsa World; Alabama.com (added 3/31) Alabama church, Arkansas church (added 4/1); Florida and Pennsylvania (added 4/2); Tennessee (added 4/3); Alabama’s Health Department, Illinois, Iowa and Louisville’s mayor (added 4/5); Oklahoma City (4/7).
Also see Oldham County, Kentucky; Riverside County, California; Louisville’s mayor; Washington state; Mayor of Chattanooga, Tennessee; Wake County; Georgia’s governor; Methodist conclave of 864 congregations ; Wilmington, NC Police Department; see also WWAYTV3. (Added 4/9-11)
Also see Riverside County, California Public Health Department (added 4/5).
Ending drive-thru confessions: Crux
Gov Beshear of Kentucky OK’d drive-in services w/ guidelines designed to avoid intra-family transmission but said nothing about the increased risk of inter-family transmission. While I appreciate him looking for ways to facilitate church services, I doubt he or his medical people have focused on the stepped-up risk to the whole family and the environment into which that puts the family, or the increase in number of people doing this that his words will give rise to.
Air recirculation comes on automatically in some instances: e.g., 2020 Camry Owner’s Manual (added 4/5)
Problems with Drive-in Church
Drive-in church appears to virtually guarantee the whole family will be infected with Covid-19 during church if any 1 family member has it unaware in many instances.
A peer-reviewed study indicates flu transmission risk ~ 90-99% when in car for ~ 45 minutes or less in scenarios common with drive-in church in relevant respects. In-car, nowhere to escape covid-19 remnants of a cough or sneeze or droplets expelled by the infected person.
Not inevitable whole family infected in-home if 1 infected w Covid-19. CDC, WHO statistics indicate it is not likely even 1 fam member will also be infected: Household transmission rate of Covid-19 has been comparatively low, 3.0 – 10.5%, symptomatic, as reported by CDC, WHO.
In-home, can quickly step away from cough or sneeze to avoid or lower virus intake, for example. Greater air volume there. Often, less uninterrupted time w/in spitting distance in-home & more opportunity to avoid infected 1 at times of high virus output (e.g., coughing). Avoiding infection in-home is major reason call for hand washing, disinfecting, wiping, etc., in home. Can isolate when detect symptoms in some families.
In-car, whole family within close spitting distance, mouths aligned, enclosed space, immobilized, nowhere to dodge cough / sneeze, surrounded by surfaces within inches, etc… for a long time … without interruption ….
Just b/c government does not prohibit does not mean it is safe. Orders are aimed at large gatherings and intra-family, not inter-family transmission. Guarding family lives & safety is *** up to church leaders & adults in the family. ***
Families have 1 come down with a cold virus or flu virus all the time without the entire family getting it. Sometimes yes, sometimes no. Know to take special care at home with Covid-19, gives better chance. Depends on the family’s situation. Many unknowns with Covid-19.
Spread of the covid-19 has escalated, making it much more likely now that 1 family member has it unaware.
To say whole family probably has it or will in-home anyway, so might as well put them in a situation in which whole family likely to get it immediately if just 1 is infected seems fatalistic, giving up hope of health, inconsistent with evidence, impatient, and not protective of the family’s health and life.
“Love is patient, love is kind. … It always protects, … always hopes ….” (1 Cor 13:4-7)
Patience, hope, and protection by church leaders and families seem appropriate in this unique, uncertain, and dangerous time. Prayers and good luck to all.
More in the updated article.
***
The whole family getting into a car for drive-in church probably comes close to guaranteeing that if anyone has covid-19 unaware when getting in, the whole family will be infected by the time they get out in many instances. The car is like a test-tube with the family and virus in it, and drive-in church involves prolonged exposure and shaking the test-tube.
The proclamation is designed to prohibit large gatherings, not individual family safety. Just b/c it isn’t prohibited under a rule designed to prohibit large gatherings does not mean it is safe for the family.
In a car, the whole family is within spitting distance, in a small, enclosed space, surfaces within feet or less surrounding them, mouths / noses aligned at same height and open, immobilized, nowhere to run from a sneeze/cough, etc.
Household transmission rate for COVID-19 found in early studies cited by CDC and WHO — 3.0 to 10.5% for symptomatic — is low compared to the very high in-car transmission rate found for the flu in a 2012 study for a medium-length car trip, about 60 – 99.9% transmission.
In-home, closer contact is more sporadic for many families, rooms are wider open, room to duck a cough/sneeze, not surrounded by surfaces constantly, mouths/noses not constantly aligned, etc. Even when sleeping together at night, in many cases breathing is shallower, etc., unless coughing, etc., so less projection of droplets …. Experience tells us that just b/c one member of a family has a virus, does not mean everyone is going to get it. And we know to be especially diligent on disinfecting, etc., now. This is why we are supposed to wash hands, wipe, etc., at home.
This is different from “social distancing,” which typically relates to non-family members. This is about keeping a family safe. So even if a government entity says it is acceptable, still ought to be reconsidered for the health and lives of a family. It would be great if this were safe, as it is a neat idea, but it presents some real risks in this strange time that none of us are used to addressing. Prayers for everybody & good luck.
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Car a worst-case b/c prolonged, non-stop (guarantee short spitting distance when infected 1 sheds, projects virus), enclosed mostly sealed, tiny air volume, air recircs, mouths align, surfaces closely surround w/in inches, singing, immobilized (can’t escape sneezed droplets), etc
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Drive-in church dangerous to families: If 1 fam member w covid-19 gets in car unaware, whole fam infected by end, many times. Flu transmission rate in car<hour can b very high~99%. Household trans rate for c-19 low:~3.0-10% sym. Risk infec fam <hour in car https://authentictheology.com/2020/03/28/drive-in-church-danger-for-families-increased-covid-19-infection-risk/
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Drive-in church can infect (a) much earlier (closer together for sustained, prolonged time), (b) much quicker (happens in 60-90 minutes), (c) with a higher likelihood, and (d) more of the family than would have occurred in home in many instances.
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Using a mid-size dinner table of about 5.5 x 3.5 feet. Person sitting in a chair takes up about another 2.5 feet. Ceiling height of 9 feet. Camry volume is about 100 cu feet. It may be that this includes the space for seats, steering wheel, etc., so the air volume available to passengers is less.
Being in a car together is very different than being in a house. For example, the passenger volume of a Toyota Camry is 99-100 cubic feet. The volume of just a family sitting at the dinner table is over 4 times that amount —- over 400 cubic feet (about 8 x 6 x 9; table about 6 x 3.5 x 2.5). So try to envision a family of 4 sitting around a dinner table, then envision suddenly the table and chairs disappear and a steel box with a couple of small holes in it comes down from the sky over them, and the ceiling of that box is only a bit over 2 feet high, so they scramble to fit in the box. Now they all shift around to fit in the box together. And they stay there in the small box, close together, for about an hour. One of them has covid-19 –coughs a little, every once in a while, while in the box. Sneezes once. They all sing together several times while in the box. They are touching the floor and sides of the box. Do you think the other 3 will have it before leaving the box?
In the home, much more room. Odds are decent that not even one more family member gets infected by that one person, as there is an excellent chance that one person will either (a) develop a noticeable symptom within 2-14 days such that they try to isolate from that person, (b) not expel a sufficient volume of virus to infect anyone, (c) have a low quanta rate such that they do not expel virus at high volumes at times people are around, (d) shed virus droplets at times that no one is close to them and not on surfaces touched regularly by others, etc.
It is unclear to me whether the published Toyota passenger volume includes the area taken up by seats, etc., or not. The interior of a Camry (measured) is about 7 feet x 5 feet x 3 feet (windshield to back windshield, door to door, ceiling to floor), but various structures take up space within that volume (dash, seats, truck ingress, console, and of course people once they enter the car). Imagine if you know you are infected with covid-19 inviting your family into a steel box measuring 7 x 5 x 3 feet with multiple structures taking up space already that has just a few small air holes with you for an hour or more. The Surgeon General says we are supposed to act like we have it. Would someone who has it invite their family into that space?
It is of similar volume to a family of 4 sitting in a small loveseat with a chair pulled up to face the loveseat just a foot away and a steel box closing the entire thing in within 2 inches of their arms, heads, and legs.
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The executive orders appear focused on large-scale public health. Some of the executive orders or other government guidance specifically facilitate drive-in church. It seems irresponsible to specifically facilitate it without providing an appropriate warning to families about getting into a car together, getting into such an enclosed space, for such a long time.
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Even a very small house is enormous compared to the interior volume of a car.
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I have not worked out the math and variables completely, but drive-in church looks to have a good possibility of more than doubling, possibly tripling, the number of people infected with covid-19 during the service. That is, double or triple the number who come to the service infected will leave the service infected. All in about an hour. Assume an average of a little over 3 people per car and 100 cars and a 4% infection rate in that community. Assume that half those infected have symptoms, have been diagnosed positive, or otherwise would not get in the car in the first place. That leaves 2 out of 100 cars with a covid-19 infected person. So 2 show up to the service infected. With a bit over 3 people on average per car, assume that those 2 arrive in separate cars with a total of 4 other non-infected family members. They sit for about an hour, windows rolled up, a/c on low, air recirculating in one car; in the other, they don’t turn the car on, listen to the service on a mobile phone, have one window cracked (this violates the rules but no one notices and there is little wind). The 2012 study suggests a flu risk rate of about 90-99% for the first car; it is not clear for the second car, but appears to be in the 60-80% range. So, both uninfected people in the first car and highly likely infected by the end and 1 or both are infected in the second car. So, under this analysis, while 2 people came to the drive-in church infected, 5 or 6 will leave the service infected. Compare this to the household transmission rate. I am going to assume a rate of 20%, based on the CDC, WHO, and Korea-reported household secondary attack rate of 3.0 – 10.5%, which appears to be symptomatic rate. Based on reports that non-symptomatic could be 20-50%, 20% may be high, but it seems conservative and makes the math easier. Based on this, of the 6 family members in the homes of the 2 infected members, it appears likely that either zero or 1 or possibly 2 of those 6 would be infected. Though of course, in-car infection of those analyzed in the studies would be present in the 3.0 – 10.5% rate, so it is hard to know the impact. In any event, whereas possibly 0-2 additional people might have been infected by the 2 that initially had it, drive-in church resulted in 5-6 additional people infected—– doubling, tripling, or more the number within the congregation infected with covid-19. This is the roughest of analysis and is just a start on it. Many assumptions and estimates here. 4% seems high for a current number; though I’ve seen estimates of 10-100 unconfirmed cases for every confirmed one. It may be low for some areas, but I do not know. I could not find estimates that appeared reliable regarding the current total percentage infected in various areas. I have seen estimates that put the eventual percentage infected at a very high number, 40-60% or more. Many states do not seem to be testing unless there is trouble breathing or some other extenuating circumstances, so that there are a very large number of confirmed cases for every confirmed case would not be surprising. The model above assumes even distribution of infected persons among cars. The percentage of those infected with covid-19 in the relevant community has a significant impact on the number impacted. The percentage increase in those in the congregation infected depends largely on the in-car transmission rate.
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The infection and death rate among African-Americans in the United States appears to be quite high and disproportionate. At this point, the percentage of black people infected by and who have died from Covid-19 appears to be about double the percentage of black people in North Carolina.
Among some Christian denominations with a greater proportion of black persons, the length of the service on Sunday morning can be comparatively long, lasting close to 2 hours, often longer. The length of time in the car has a significant impact on transmission rate in the car. Thus, having such a long service increases the risk of transmission to everyone in the car, should one person be infected unaware when getting into the car, even more.
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Most government restrictions are aimed at large-scale issues, public-health issues, and not family issues. They are designed to flatten the curve — slow the spread, lessen the number who are infected at once — and are not designed to stop infection of people or families completely, being designed to avoid larger-scale infections that can grow exponentially. For example, restricting gatherings to 10 or less allowed the 10 or less to infect one another, but keeping it to 10 or less slowed the spread in comparison to what it would be if larger gatherings would allowed: Instead of one person infecting 50 or 100 people in that time, that one infected person can only infect another 9 if the gathering is only of 10 people. As another example, restricting “non-essential” businesses while allowing “essential” businesses does not stop infection for a family — the virus does not know what kind of business it is in — but slows infection within the community as a whole by encouraging people to stay at home.
The lives and health of a family is the responsibility of that family and, when calling people to a worship service, the responsibility of church leaders. Referring to the government “allowing” the gathering by no means tells you that the gathering is safe for families. It only tells you that the government considers the risk of large-scale infections lower in that context.
Of course, this makes sense for drive-in church. If (and this is often a big if) families stay in their cars and keep great distances between them, there is not a person outside the car who has contact with the people in the cars, etc., the risk of large-scale infection caused by one person in a car is relatively low. The infection will be contained to the number of people in the car. But this is little consolation to a family or families who had one person in their car who had already been infected unaware, as the situation in the car (enclosed space, small air volume, spitting distance, etc.) means that the entire family in each car with an infected person stands a significant chance — highly likely to nearly certainly in many instances — of being infected before the closing prayer. While that family’s infection is not a large-scale infection, it can be devastating to that family.
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Added: https://www.washingtonpost.com/religion/2020/04/03/francis-collins-interview-coronavirus-churches/
https://www.usatoday.com/story/opinion/2020/04/22/coronavirus-car-protect-yourself-column/5166146002/ (moving car)
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Image by OpenIcons from Pixabay
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Updated: Including most recent — 4/15: Added Not singing; disinfecting to possible ideas to reduce risk. Gloves and masks might help.
Thanks for looking into this, Steve. This is helpful information you’ve compiled.
Thanks much, Mark! I hope you and your family are doing well. Stay safe!
Thank you for your wisdom in these difficult times. Critical thinking is scarce in times of fear for many. While we love, we must also think and protect. …..Monica, RN
Thanks much, Monica. And thank you for those insightful words —- “While we love, we must also think and protect.” Amen.
This has to be the most ridiculous article I have read since the Chinese virus crisis began. Are you trying to tell me that a husband and and wife who sleep in the same bed and hug and kiss regularly, or parents and children who sit at the dinner table and cuddle together on the couch are all in greater danger in their car for an hour.
Ridiculous and inflammatory!
Hi Joe, Thank you for your comment.
I responded to you and Ben below.
Wait… so if I am understanding this correctly, driving in a car to a church service—with my wife—is more dangerous than sleeping next to her in bed at night? Think about what you are suggesting.
This doesn’t sound like authentic theology, more like fake theology, and scare tactics.
Hi Joe and Ben, Thank you for your messages.
A
The answer to your question, Ben, is yes, probably. Spending 90 minutes with an infected person in a small, enclosed car, surrounded by surfaces very close to you both, with the air recirculating, with both of you talking and singing and otherwise having your mouths wide open, singing projecting droplets, with your mouths and noses generally fixed at the same height, both of you generally immobile for all that time, etc., can indeed be more likely to get you infected with COVID-19 than sleeping next to the person, when both of you are breathing shallow, the room is more open, she isn’t coughing or sneezing, normal pre-sleep hygiene took place, etc.
Sleeping in a bed with someone certainly gives you a good shot at catching it, but probably not as good as sitting within spitting distance, a few or less feet away in an enclosed, small space for 60-90 minutes and talking and singing with mouths open, etc.
Avoiding infection from family members in the home is why we are washing hands, disinfecting surfaces, not touching faces, etc., at home.
And, Joe, lots of families who aren’t fortunate enough to be able to have everyone work from home. Instead they have a person who goes into the public (e.g., at the grocery store, at the doctor’s office, at a major retailer, etc.) where they might be exposed take the steps of being especially careful at home now. Some who work in doctor’s offices or hospitals or the like even sleep in the garage or basement.
B
It is important to think about more than your own situation and limited situations. And these aren’t ordinary times, as your questions seem to presume, as plenty of families are temporarily adjusting their in-home actions to keep everyone healthy and alive.
There are lots of other family situations:
+ A family of 4, a 12 year old girl and a 14 year old boy, where the dad works at home and the mom works at a grocery store, in contact with the public regularly. Mom got infected 5 days ago, but doesn’t know it yet.
+ Another family of 4, but also his mom lives with them. His wife got infected 5 days ago, doesn’t know it yet.
+ A family of 3, a mom and twin 13-year-old boys, where the mom works at a big retail store 50-hours a week. She got infected two days ago, has a slight fever, but hasn’t noticed it yet because she is so busy juggling everything.
+ A family of 5, mom, dad, two girls, 8 and 15, and a 16-year-old boy, and dad works at the medical supply store. Dad got infected three days ago.
+ A married couple in their early 60s whose 9 year old grandson lives with them, and the dad got infected yesterday while working his job at the postal service.
These families are doing what the CDC asks and washing hands, disinfecting, etc., their house. CDC’s and WHO’s research says that in-home transmission rates for COVID-19 has been 3.0 % – 10.5%, with symptoms, so relatively low. Let’s hope the research is right! (and of course when one family member has a cold virus or a flu virus, sometimes a family members gets it, and sometimes not — and we know to be especially careful right now when normally we aren’t)
So these families have a good chance of avoiding infection altogether. Out of this whole group, during the whole time, maybe 1 or 2 or 3 or 0 besides the ones already been infected will get infected if they all stay home, engage in good hygiene, etc. based on the CDC / WHO statistics.
C
But put each of these families in a car for 60-90 minutes straight for drive-in church …..
Flu studies showed a ~ 60 – 99.9% infection rate in the car with the air re-circulating for the flu. It’s warm down south and we are trying to social distance from that car next to them anyway, so they sit there with the A/C on and the windows rolled up, and between the service, the roundtrip, waving at people, and getting out of the parking lot, they are in the car for about 90 minutes.
The car is effectively a test tube with the family and the virus in it. They are all within spitting distance of their unaware infected family member, in their cars. Enclosed space, mouths and noses at similar heights, singing and talking (mouths open), droplets going in the air directly onto family members, onto the surfaces surrounding them. There are surfaces within a foot in nearly every direction. Immobilized. There is nowhere to run from a sneeze or a cough, not even the part that skips off the arm. For 60-90 minutes between round-trip and everything.
Now, guess what? All or almost all those people — the grandmother, the spouses, the kids — who weren’t infected are now infected, another 12-15 people.
D
Drive-in church just infected a bunch of people that otherwise would not have gotten infected. And in just 60-90 minutes.
E
Arguing that the family is going to get the virus at home anyway or is just as likely to get it there, so they might as well get in the car, appears to me to be giving up to the virus. And defeatist. And giving up on the family. And causing something to happen to them quickly that might be avoided. And not consistent with the research regarding household transmission rates. And not consistent with experience with other viruses. And contrary to the reason we are washing our hands at home. And ….
This is a dangerous virus, and I am suggesting that people ought to reconsider drive-in church for the health and lives of families.