For centuries, Christians have met in sacred places that also provided safety for those seeking asylum, including runaway slaves and undocumented immigrants. But those same sanctuaries where many sing and embrace each other have become anxiety-inducing, and possibly dangerous, for many Americans who are considered higher risk for COVID-19.

More than 7 million Americans have weakened immune systems that make them more vulnerable to contracting the coronavirus and can make COVID-19 more deadly. Many have chosen to stay home. Those who are immunocompromised include people with medical conditions that weaken their immune response, as well as people taking immune-suppressing drugs because of cancer, organ transplants or autoimmune diseases.

As states across the country are lifting COVID-19 precautions such as mask mandates and some churches have dropped online services, the immunocompromised are weighing their risk of possible exposure in worship services. And some are finding their fellow parishioners and church leaders aren’t taking measures to protect them.

More on the COVID-19 pandemic

Andrea Ramsey was attending a nondenominational church in Washington where, before the pandemic, she was asked to speak in church about living with a chronic illness that prevents her from working. Ramsey has Hypermobile Ehlers-Danlos syndrome, which causes problems with her immune system.

Ramsey’s church had formed small online groups during the early months of the pandemic that became a lifeline for her, but leaders stopped the groups in 2021 to encourage people to worship in person.


“When they cut the home groups, it felt like, wait a minute, this place that cared for me and my situation was trying to move on without us,” said Ramsey, who is 44.

Her church initially required masks but many would ignore the mandate.

“I have been in church situations where I’m accused of not having enough faith,” she said. “I never got that sense from this church. It was when we were a year and a half into things I was noticing, we are not talking about vaccination from the pulpit. We’re not enforcing mask mandates.”

She said other things led her to recently leave her church, but the way the leaders treated COVID-19 caused her to lose trust.

“They had a greeting time at a gathering and said, ‘Come on, you can hug each other, we don’t need to be afraid,'” she said. “That pissed me off. We don’t need to be afraid, but we need to be careful. It was one of the incidents that cemented in my mind that it’s not going to be a safe place for me.”

Those who are immunocompromised are not a monolith and experience different degrees of immunosuppression that could impact their response to the virus, said Deepta Bhattacharya, an immunologist at the University of Arizona in Tucson. Someone who has cancer like lymphoma and doesn’t respond well to the coronavirus vaccine, for example, is likely at higher risk than someone on an immunosuppressive drug for something like Crohn’s disease.


Also, many circumstances have changed since the early days of the pandemic, Bhattacharya said. Vaccinations tend not to provide the same level of antibodies to someone who is immunosuppressed as they would for someone else, but they still reduce chances of the person getting sick or becoming seriously ill. High-quality masks like N95 masks, which are more effective than cloth ones, are more available. Doctors have access to newer treatments, though some have been in shorter supply.

Bhattacharya said he doesn’t like to think about whether something is “safe” or not. Instead, he encourages people to consider their range of risk. He encourages people to ask questions, including:

How important is the activity to you? What is the community transmission rate? Does the building have good ventilation? What are things you can do to reduce the chances of getting infected, like wearing a high-quality mask? Can you ask your doctor before possible infection if the doctor has access to drugs like Paxlovid or Sotrovimab?

“People are reassessing their own risk tolerance for different activities,” he said. “I don’t feel comfortable saying what they should or shouldn’t do. There are things you can do to reduce your risk, knowing there is risk.”

Many people who are immunosuppressed still choose to attend in-person services, including Jaye Maxey Sanchez, 19, who has been visiting Baptist and nondenominational churches in her new town of San Marcos, where she is a freshman at Texas State University. Sanchez has arthritis, fibromyalgia and gastroparesis, and is on medicine that suppresses her immune system. Her rheumatologist, who is a Christian, hasn’t discouraged her from attending services.

Sanchez said she used to wear a mask in church but decided to stop because no one else would wear one, and the people she attends with are friends she spends time with during the week anyway.


“If I wore a mask, people might think I was contagious or sick,” she said. “I feel normal wearing a mask to school. But because people don’t wear them to church, it feels a little weird.”

Raised in a Christian home, church has long been an important source of community for her. She contracted and recovered from COVID-19 in early January during a church retreat where she thinks she got it while removing her mask to eat and drink.

“Sometimes I wish we would mask in seasons where the flu is high too and everyone is getting sick so we could be protecting each other. Because Texas is so conservative, that changes the churches,” she said. “I think when people think about the vaccines and masks, they think about themselves, not about doing it to protect other people, too.”

Others have stayed away from in-person services entirely. Tory Cross, 28, who has asthma and is on medication that makes her immunocompromised, said her pulmonologist cautioned her against attending services, so she hasn’t gone in person since the pandemic started. Just two years before, she had found her ideal church. After exploring the Catholic tradition, she began attending an Episcopal church in San Francisco in 2018 that fit her progressive values.

“I wanted a community that would hold my queerness. It felt very safe, like a place I could belong. I spent time in the AIDS memorial chapel thinking about queer ancestors,” she said. “I never got to go back.”

Cross moved to D.C. in the summer of 2021, and with the District’s mask mandate lifting soon, she’s wary of finding a new church.


“I have been too scared to try,” she said.

The Episcopal Diocese of Washington has a universal restriction against using the common chalice that holds wine for Communion, but otherwise it allows leaders to follow local guidelines on whether to require masks and other public health measures, said Bishop Mariann Budde. She says she has heard from people all over the spectrum and allows the clergy to make decisions based on their community needs.

Budde said she wants to create as safe of an environment as possible, but “we cannot create a perfectly safe environment for immunocompromised people. We can’t dictate our entire congregations based on that one population. We have to serve everyone,” Budde said. “We have to allow those who are compromised to make their own decisions.”

Trying to make accommodations for everyone has been tricky, said Jon Saur, pastor of a Presbyterian (USA) Church in Simi Valley, Calif. Saur said he understands what it’s like for immunocompromised folks since he has been on an immune suppressing medication for rheumatoid arthritis since he was 18.

“It’s better to be one step too cautious than one step too risky. That’s guided everything,” said Saur, who is 38. “I know there are people who are in the same position I’m in and looking around and saying, the church I’ve been going to doesn’t understand what my life looks like.”

His church follows local county guidelines, so the church will soon move to mask optional for those who are vaccinated, though he said he plans to continue holding an outdoor service through the pandemic.

He wears a double KN95 mask and asks staff to wear masks so that someone in the back doesn’t have to feel uncomfortable if they are the only ones doing so.


“We have people who are attached to the sanctuary,” he said. “Some people have been here 60 or 70 years. We try to make it as safe as possible so they can be in that space.”

When her teenage son was diagnosed with cancer as a child, members of Rachel Gillen’s Lutheran church in Fargo, N.D., would provide meals, buy gift cards and send presents. As a transplant survivor, her son is highly immunosuppressed and has received a fourth dose of a coronavirus vaccine. They have chosen to stay home from church. As Gillen’s community started to get more resistant to wearing masks, people stopped wearing them in church.

“They were supportive of our family when he had cancer,” she said. “But asking people to wear masks so we can attend was asking too much. It’s been painful. It feels a little like losing a side of your family.”

The staff at her church have been accommodating, she said, and they wear masks when she comes into work as an administrative assistant. Leaders asked if they should require masks for youth group, but her son thinks they’ll make the change just for his sake and it would make him feel too self-conscious, so he feels it’s easier not to go at all. The pastor started a monthly mask-mandated service that they tried to attend, but Gillen found mask adherence was so low that they couldn’t risk it.

Her teenagers will watch online services, but she said it’s hard to get much participation in singing or liturgy in a living room.

“According to the teachings of Jesus, churches should be the safest places for the vulnerable to be,” she said. “It hasn’t been the case in the pandemic, and that’s been hard. I worry about a lasting impact that could have on my kids. And me. On any of us.”