The impact of COVID-19 on church gatherings in the Philippines: a policy analysis

The Philippines is the largest Christian-majority country in Asia. With church gatherings playing a vital role in the nature of Christianity in the Filipino culture, the advent of the coronavirus disease (COVID-19) pandemic in the Philippines posed challenges to public religious practices amid efforts to mitigate COVID-19 community transmission. Various policy pronouncements from both the government-led InterAgency Task Force (IATF) on Emerging Diseases and the church-led Catholic Bishops’ Conference of the Philippines (CBCP) were issued. These guidelines were implemented in order to address the two-pronged problem on healthcare and religious obligations. While these guidelines were initially contributory to the mitigation of disease transmission, varied compliance by Filipinos was observed through the progression of the pandemic. Considering the value that church gatherings and religion play in the lives of the Filipino people, further studies on COVID-19 transmission in the church should be conducted in order to develop more efficient policies and guidelines on the practice of religion, particularly for religious gatherings. Furthermore, a more synergistic state and church cooperation must be encouraged in order to arrive at solutions that will mutually address the concomitant problems of the COVID-19 pandemic.


Introduction
The first confirmed cases of the coronavirus disease  in the Philippines were in January 2020. 1 In the following months, the numbers escalated, rising second only to Indonesia in the Southeast Asian region, with 1,006,428 confirmed cases by April 26, 2021. 2 The continuous rise in the number of cases and the swift escalation of the pandemic prompted the Philippine government to enact sweeping measures to curtail the spread of COVID-19. By March 2020, community transmission was already evident, and the government announced community quarantine, or the lockdown of the National Capital Region (NCR) and its surrounding provinces.
The community quarantine restrictions resulted in the prohibition of many social activities, including religious gatherings. With the Philippines being a largely Catholic country comprising 79.5 percent of its religious and Christian affiliation, restrictions on religious gatherings dealt a heavy blow to a large aspect of Filipino life. 3 In a survey conducted in December 2019, 83 percent of adult Filipino Catholics surveyed regarded religion as very important to their lives, with 45 percent of the total respondents reporting to have attended religious services weekly. 4 Even with an ongoing pandemic, 62 percent of respondents in a survey in May 2020 still want church gatherings to resume in areas under community quarantine. 5 Therefore, it is imperative to review the policies instituted by both the government and church authorities during the pandemic and examine the response of the Filipino devout regarding their practice of religion amidst this global health crisis.

The Practice of Faith in the Philippines
Religion is central to the lives of Filipinos, as the Philippines ranks fifth among the most religious countries globally. 6 With over 79.5 percent of its population baptized as Catholics, it is the largest Catholic nation in Asia. A comparison of cross-national trends in religious service attendance among various countries indicated that the Philippines has a high and stable religious service attendance, with attendance rates of Catholic church members reaching 84 percent and 80 percent during the late 1990s and early 2000s, respectively. 7 Faith plays a pivotal role in the life of most Filipinos, existing not only as an abstract belief system but also as a host of ceremonies, rituals, and experiences. Religion provides continuity in life, cohesion in the community, and moral purpose for existence. 8 It renders spiritual solace and guidance in times of crisis, more so in the midst of a global pandemic. 9 Even among the Filipino diaspora, the church remains vital in shaping migrant populations. For them, it functions as a means of social control, a center of collective identity, and a source of empowerment. 10

Government Guidelines and Policies on Religious Gatherings
The Philippine government responded by calling together the Inter-agency Task Force on Emerging Diseases (IATF), headed by the Secretary of the Philippine Department of Health. Upon its recommendation, NCR was placed under "stringent social distancing measures" on March 12, 2020. 11 On March 16, 2020, a state of calamity was declared throughout the Philippines, and Enhanced Community Quarantine (ECQ) was imposed in Luzon with only essential services allowed to operate (e.g., groceries, utilities, etc.). As far as religious activities were concerned, religious ministers were only allowed to conduct funeral rites. 11 Quarantine guidelines were modified and further consolidated with subsequent meetings of the IATF, summarized in Table 1. On April 29, 2020, the first version of the Omnibus Guidelines on the Implementation of Community Quarantine in the Philippines was released to "harmonize and codify the existing policies." 12 Mass gatherings, with July 2021. Christian Journal for Global Health 8(1) explicit mention of religious gatherings, were prohibited for areas under ECQ and the less stringent General Community Quarantine (GCQ). 12 On May 15, 2020, the conduct of GCQ was modified further, and additional guidelines were issued for two more quarantine classifications-the Modified Enhanced Community Quarantine (MECQ) and Modified General Community Quarantine (MGCQ). 13 For MECQ, religious gatherings would be allowed but were limited to not more than five persons, and only 50 percent of the seating capacity of the church was permitted for MGCQ. 13 Meanwhile, GCQ restrictions were loosened to not more than 10 persons allowed at religious gatherings. On July 2, 2020, restrictions on religious gatherings under GCQ were relaxed to allow up to 10 percent of the seating capacity (or 10 people, whichever is higher). Churches were also officially allowed to reopen in July 2020 under the assumption that churches will only be used for the sole purpose of religious services. Concomitantly, churches were required to observe minimum public health standards, such as social distancing protocols and the use of face masks, in conducting gatherings within their premises. 14 On October 22, 2020, restrictions were further relaxed to allow up to 30 percent of the seating capacity. 15 Additional provisions were added to the IATF guidelines by December 2020, requiring the use of face shields when leaving residences, including going to church. 16 Starting February 15, 2021, the government permitted churches under GCQ to operate at up to 50 percent seating capacity, just two days before Ash Wednesday, which signals the beginning of the Lenten season. 17 However, on March 22, 2021, a few days before the beginning of Holy Week, the government completely prohibited religious gatherings due to a surge in active COVID-19 cases. [18][19][20] July 2021. Christian Journal for Global Health 8 (1) With mixed reactions by Catholic and Protestant religious leaders, 21,22 the government conceded to permit religious gatherings once a day at 10 percent seating capacity by March 26, 2021. 23 However, this decision was retracted the following day when Metro Manila, along with some of its surrounding provinces, was placed under ECQ for the entirety of the Holy Week 2021. 24 Beyond the imposition of guidelines, the national government and the local government units (LGUs) have also consistently worked with church officials to ensure proper maintenance of health protocols upon the resumption of regular church activity.
LGUs created technical working groups to coordinate plans for large religious festivities. Members of the police were routinely dispatched during religious gatherings with traditionally high public turnout, such as masses during Christmas season. 25,26 The Department of Health periodically releases statements and directives to guide LGUs in the conduct of religious celebrations, such as orders for attendees to fill up contact tracing forms and the performance of regular temperature checks. 27

Guidelines of the Religious Leadership on Religious Gatherings
The Catholic Church largely responded by following the guidelines of the IATF, such as shifting worship to online platforms and limiting church capacity. Individual dioceses were the first to take initiatives in suspending masses at the start of the pandemic before guidelines were instituted by the Catholic Bishops' Conference of the Philippines (CBCP). 28 The CBCP subsequently released their own guidelines in response to government and health regulations. 29 The primary modification of live activities was through televising and online streaming of most church services. 28,29 The CBCP further elaborated on guidelines upon the easing of community quarantine, such as the use of thermal scanners, foot baths, and hand sanitizers. It gave instructions on proper entrance and exit areas and social distancing with markers on pews and standing areas. Attendees were required to use face masks during church services. 30 Mass practices were also modified, such as the omission of the offertory procession and the strict implementation of receiving the host by the hand and not directly to the mouth. Some parishes offered drive-in masses to avoid public crowding in their church and developed mobile phone applications for use by its parishioners. 31,32 Certain Catholic traditions and practices in the Philippines were also modified. At the start of community quarantine in March 2020, the CBCP published instructions for Holy Week celebrations to be held in the same month. 33 The blessing of palms on Palm Sunday was suspended and replaced by verbal blessings around the streets of the parish. Similarly, Simbang Gabi or Night Mass, a nine-day series of masses culminating in Christmas Eve, usually held between 3 a.m. to 5 a.m., were permitted to be held as early as 6:00 p.m. in response to curfew hours mandated by LGUs. 34 In addition, church officials encouraged holding masses more frequently in order to properly distribute the number of attendees. 34 Along with traditional practices in the Philippines, various Catholic religious festivals are held in different parts of the country. Numerous modifications were also instituted to conduct these festivities. For one, the Philippines is celebrating 500 years of Christianity in 2021, initially planned to be a large affair. However, with the pandemic stretching into 2021, the quincentennial anniversary will now be a year-long celebration, beginning April 2021, and with grand culminating activities postponed for April 2022. 35 Some festival events were initially allowed, but because of local spikes in active COVID-19 cases, all of the festival's physical activities, with the exception of masses, were cancelled. [36][37][38] Perhaps one of the most significant changes to religious festivities is the modification of the Feast of the Black Nazarene held every January.

July 2021. Christian Journal for Global Health 8(1)
Traslacion, the yearly 6-kilometer procession of the image of the Black Nazarene around Manila, was cancelled. Instead, consecutive masses were held within Quiapo Church, limiting each mass to only 400 participants, or 30 percent of the church's capacity, in line with the guidelines. 39,40 In addition, simultaneous novena masses were held in numerous parishes within Metro Manila to accommodate more distant devotees. The tradition of kissing the Black Nazarene image by devotees, or pahalik, was also prohibited. 40 In lieu of this practice, the Black Nazarene was placed in front of the church for viewing by the public. Sanitation efforts were also performed by church volunteers before every new batch of devotees could occupy the viewing areas. 40

Impacts of COVID-19 on Other Christian Denominations in the Philippines
Other prominent Christian denominations in the Philippines include the evangelicals, represented by the Philippine Council of Evangelical Churches (PCEC) and the Iglesia ni Cristo (INC), comprising 2.4 and 2.6 percent of the population, respectively. Although the INC initially planned to allow their gatherings despite government guidelines, 41 they now utilize online streaming in areas with sufficient internet access and conduct household worship services in areas with relatively limited connectivity. 42 The evangelicals responded to the government guidelines in a similar way by conducting online streaming of their religious services and requiring the observation of minimum public health standards. 43 Pre-registrations were also employed for the purpose of initial health screening and ensuring seating capacity compliance. 44,45 Biannual prayer and fasting traditions by some evangelical churches were also moved online, with the provision of prayer and fasting guides and virtual prayer rooms to enable fellowship among their religious members. 45,46

Compliance and Reception of Filipinos to Church Gathering Policies
A survey released in September 2020 by Pulse Asia's Ulat ng Bayan revealed that among 1200 respondents around the Philippines, 51.8 percent have become more religious during the COVID-19 pandemic. This provides a glimpse of the value of Christian faith to the Filipino in times of crisis. 47 While the pandemic has limited religious gatherings in the Philippines, it has transformed the Christian devotion of many Filipinos from being reliant on external practices to internal reflection. 48 Contrary to other countries, where outbreaks have happened as a result of religious activities, 49 initial COVID-19 outbreak reports in the Philippines noted clusters resulted from social events, such as wakes or birthday parties. 50 In August 2020, reports on COVID-19 transmission in the Philippines were primarily healthcare facility-, prison-, or workplacebased. 51 The strict lockdown instituted at the start of the pandemic contributed largely to the adherence of the Filipinos on policies regarding church gatherings. Due to the fact that the parishes themselves were prohibited from opening their church to live masses, the public was compelled to adapt to by attending live streamed masses at their own homes.
Filipinos also complied with modifications of other religious traditions, especially during the Lenten season, observed at the height of the community lockdown. Along with online masses, videos by devotees shared ways on how to observe the season at home, such as instructions on making homemade palm crosses from palm fronds and makeshift altars. 52 Instead of gathering outside their homes for the blessing of the palm fronds on Palm Sunday, parishioners opted to set up the fronds on tables in the streets for the blessing of the priest going around the neighborhood. 53 Public novenas during Lent, or pasyon, usually initiated by devotees in their backyards, were put on hold and were instead conducted privately within July 2021. Christian Journal for Global Health 8 (1) homes. Some even used PowerPoint presentations to conduct certain prayers, such as The Way of the Cross or Via Crucis. However, despite guidelines prohibiting any form of public or religious gathering, Holy Week rituals such as self-flagellation on Good Friday were still initiated by devotees and were done publicly outside closed churches. 54 Relaxation of guidelines were eventually observed for the remainder of 2020, consequently resulting in church gatherings being permitted during the Christmas season. 55 Multiple reports state that the public and their respective parishes were compliant with the guidelines instituted by the government and the CBCP. Observations by authorities in Southern Metro Manila showed orderly and peaceful night masses, with proper social distancing. However, mass turnouts were still high despite the pandemic, 17 resulting in some parishes becoming over-crowded. 18 Similar to religious holiday traditions and practices, the celebration of religious festivals also posed an additional threat to the mitigation of COVID-19 in the Philippines. The most important of these is the Feast of the Black Nazarene held on January 9, 2021. Public turnout was still heavy, with an estimated 400,000 people attending, despite multiple warnings of the activity being a potential super-spreader event. [56][57][58] Nonetheless, this was significantly lower than annual numbers, as this procession draws in millions of devotees each year, which may signify that a large majority of Filipino Catholics adhere to the restrictions and are wary of the dangers of the pandemic. Even among attendees, strict social distancing measures were implemented, and photos of the crowds show that devotees were largely compliant, standing at least 1-meter apart from each other. 57,58

State and Church Cooperation in the time of the COVID-19 Pandemic
With the advent of the COVID-19 pandemic in the Philippines, both the state and the church responded through the near-simultaneous implementation of IATF and CBCP guidelines on religious gatherings. In addition, both sectors appeared to be cooperative with each other, evidenced by their coordinated mitigation efforts during high-volume events.
At face value, guidelines on religious gatherings were adequately complied with by Filipinos. However, the Philippine government's general COVID-19 response was met with the disapproval of 53.7 percent of Filipino respondents of The State of Southeast Asia: 2021 survey, 59 prompting questions on its effectiveness and in consistently mitigating the spread of COVID-19.
Despite not being primarily attributed to religious gatherings, 50 COVID-19 transmission in the Philippines saw notable fluctuations during the Christmas season and the start of the year, 60,61 during which church gatherings were of heightened importance. This was observed with an increase in the reproductive number or R0, from 1.06 to 1.15 in Metro Manila two weeks before Christmas. 60,61 Even at the start of the new year in 2021, upward trends were reported with increases in R0 to 1.17. 61 These numbers did not significantly go down as the R0 in NCR peaked at 2.21 by March 23, 2021, just a few days before the celebration of Holy Week. 62 Given this, it can be surmised that while these guidelines appear to be contributory to COVID-19 mitigation in the Philippines, its impact with regards to major religious celebrations remains debatable. Likewise, the effect of major religious celebrations in spreading the virus is still unknown. The lack of available data on religious gatherings during the COVID-19 pandemic limits the understanding of these on conjectures and unverified correlations. Hence, further studies on COVID-19 transmissions in the setting of religious gatherings, as well as on the effectiveness of present guidelines must be done in order to develop evidence-based and specific guidelines on religious gatherings.
What remains certain is that with the importance and the fundamental role of religion to July 2021. Christian Journal for Global Health 8(1) Filipinos, a more proactive approach must be taken in order to more adequately address the impact of COVID-19 on religious gatherings. Through open communication and meaningful collaboration among the church, the state, and the general public, all factors can be adequately addressed. Effective monitoring and evaluation can identify points of improvement and ensure a more effective response.
With its aforementioned value to Filipinos, and its societal, cultural, and traditional roots, future guidelines and policies must also take church gatherings and religion into major consideration. The pandemic has shown that mutual cooperation between the government and religious institutions has been beneficial to everyone in this time of emergency; since, ultimately, their constituents are one and the same, the general public. 63 This is evident in other countries that were able to demonstrate it is possible for religion and the government to cooperate, such as in Germany and in neighboring Vietnam. 63,64 While the Philippine Constitution states that the separation of the state and church must be inviolable, it is evident that the two must work together in mitigating the COVID-19 community transmission and its concomitant problems, highlighting the importance of a multisectoral approach to healthcare.

Conclusion
The high percentage of people expected to observe church services and religious practices despite the pandemic has demonstrated the deepseated nature of religion in Filipino culture. With the importance given to consistent church attendance by Filipinos, it is recommended that further studies on COVID-19 transmission in the church be done to further develop more specific guidelines in line with religious practices. Ultimately, a multisectoral and collaborative approach must be taken in addressing the concomitant problems of the COVID-19 pandemic.