[Episcopal News Service] Has the sound of coughing and the sight of runny noses got you questioning whether to shake hands during the peace or sip from the common cup on Sunday?

With this flu season said to be the worst since 2009, you have reason to be concerned for your health, but Episcopal leaders are advising parishioners to use common sense during worship without letting their precautions get in the way of participating fully in the life of the church.

“There are, I suppose, a million ways to get the flu, and it troubles me that we bring so much of our attention to the common cup as a particular danger,” Diocese of New York Bishop Andrew Dietsche said in a Jan. 19 letter to the diocese, adding there is little evidence that sharing wine during the Eucharist poses a great risk of spreading illness.

“I am concerned that extraordinary practices adopted during the flu season may send the message to our worshippers that the cup is a threat to us – that communion with one another is itself a threat to us – and that those perceptions may be hard to overcome later when the flu danger passes,” Dietsche writes.

The Rev. Thomas Mousin, rector at St. John’s Episcopal Church in Charlestown, Massachusetts, summed up his advice to the congregation with the phrase, “Be a good neighbor.”

“If you are sick, or feeling sick, stay home if you can,” Mousin said Jan. 25 in his weekly email message to parishioners. “It is OK to miss a Sunday at church if you have any reason to believe that you might be catching the flu or are capable of spreading it.”

For those who are well enough to attend services, it also is fine if they choose a friendly wave instead of a handshake as a sign of peace, Mousin said, and “since we understand that Christ is fully present in both the bread and wine, you may choose to refrain from receiving the wine until the flu season has passed.”

Mousin told Episcopal News Service in a phone interview that he agreed with Dietsche that fear of infection need not prevent Episcopalians from remaining active in their congregations, especially when celebrating the Eucharist.

“We don’t want to discourage people from seeing this as a communal activity that’s meant to be part of our regular life,” Mousin said. His intent was to provide liturgical guidance to parishioners so they could decide for themselves whether to alter their routine during the flu season.

Peak flu season typically occurs sometime from November through March, according to the federal Centers for Disease Control and Prevention, which reports that flu activity now is widespread across the country.

The influenza virus can cause mild to severe respiratory illness that in some cases can lead to hospitalization or death, especially among high-risk populations, such as young children, older patients and people with certain health conditions. Symptoms may include fever, cough, sore throat, runny nose, muscle or body aches, headaches, fatigue and sometimes vomiting and diarrhea.

The CDC’s top recommendation for preventing the flu is to receive the vaccine, even in years when the particular flu strain may seem more resistant to vaccination. Some Episcopal churches have done their part by hosting vaccination clinics, like the one in October at Grace Episcopal Church in Fairfield, California. Grace Episcopal wanted the community to see the church as a “health and wellness resource,” outreach coordinator Ron Cupid told the Daily Republic.

The CDC’s other recommendations for preventing the flu’s spread include avoiding close contact with sick people, covering your nose and mouth when you cough or sneeze, washing your hands with soap and water and avoiding touching your eyes, nose and mouth.

Episcopal Relief & Development’s website also offers faith-based guidelines for how to respond to large-scale outbreaks of diseases like influenza. For example, clergy members should wash their hands before services. Other guidelines mirror the advice Mousin and others have given their parishioners: Stay home if you’re sick. Share the peace with a wave if you don’t want to shake hands.

“Those who are concerned may abstain from communion or receive ‘in one kind’ (host only),” Episcopal Relief & Development advises, though it also says there is little need for concern. “Use of the common cup with proper purificator procedure presents relatively low risk; intinction should be avoided.”

Cases of flu and hospitalizations are on the rise across the country, and the CDC said last week people are seeing their health care providers for flu-like illnesses at the highest rate since the 2009 pandemic, when the flu season also was dominated by fears of a strain called “swine flu.” Congregations took special precautions during that flu outbreak, too, with some going as far as to replace the handshake with a bow and doing away with the communal cup altogether.

The precautions being considered this year aren’t limited to Episcopal congregations.

The Roman Catholic Diocese of Portland, Maine, announced in January it was asking parishes to suspend certain rituals of Mass: sharing wine, shaking hands at the peace and holding hands during the Lord’s Prayer. In Buffalo, New York, the Roman Catholic diocese issued a similar list of directives, including a command to parishes to drain their holy water fonts and clean them regularly.

Mousin emphasized that the precautions at St. John’s are voluntary, and he hasn’t noticed a decrease in the 75 to 80 people who typically attend the church’s two services on Sunday.

“Our parish has not, knock on wood, been significantly affected by the flu this season,” he said.

Dietsche, in his letter to the Diocese of New York, shared his personal list of precautions, which he followed during the 2009 flu outbreak and is following this year, starting with getting the flu shot and washing his hands often.

“I never failed to drink from the common cup. I never failed to shake the hands of my brothers and sisters as I greeted them at the door. I used a little Purell after those greetings. I washed my hands before I ate food.

“I didn’t worry about getting the flu at church.”

– David Paulsen is an editor and reporter for the Episcopal News Service. He can be reached at dpaulsen@episcopalchurch.org.