In this Opinion article on Religion and Coronavirus from the ABC website, authors Mirjam Schilling, Joel Gamble and Nathan Gamble explore what a healthy Christian response to Covid-19 looks like in this new world we find ourselves in.
Knowing the enemy
Understanding the virus and the science of epidemics goes a long way toward explaining the decisions that are being made by public health officials. There are three main concerns for medical and public health professionals: the uncertainty, the severity and the rapidity of the virus.
First, the uncertainty: we do not yet fully know our enemy. On 31 December 2019, Wuhan, the largest metropolitan area in China’s Hubei province, reported an epidemic of cases with unexplained low respiratory infections (“pneumonia of unknown etiology”) that had started in the beginning of December. Sequencing results revealed an 82 percent identity with that of human SARS-CoV (Severe Acute Respiratory Syndrome CoronaVirus). The International Committee on Taxonomy of Viruses therefore termed it SARS-CoV-2, and the disease it causes “COVID-19.”
Coronaviruses frequently infect humans, and many are harmless (they are common culprits of the common cold). However, this century has so far witnessed two other outbreaks caused by deadly forms of coronaviruses. In 2002–2003, SARS-CoV provoked a large-scale epidemic beginning in China and involving two dozen countries with approximately 8,000 cases and 800 deaths. In 2012, MERS-CoV originated in Saudi Arabia and had approximately 2,500 cases and 800 deaths.
So coronaviruses as a group are well known, but the particularities of SARS-CoV-2 are not. It behaves in some ways similarly but other ways differently than these other known coronaviruses, as well as influenza. This makes it difficult to predict how various interventions will reduce the spread of SARS-CoV-2. A notable worry is that recent data suggests it may spread days before people become symptomatic. Asymptomatic spread is difficult to control, since people may be contagious before they know to get tested and to self-isolate.
The second leading concern for medical professionals is the severity of infections, combined with the lack of “antiviral” treatments. About 80 percent of people who get COVID-19 will experience only mild symptoms. But 20 out of every 100 require hospitalisation with severe or critical disease, involving respiratory failure, septic shock and/or multiorgan dysfunction. The elderly and people with preconditions are at highest risk of death (in one study, the fatality rate was 8.0 percent in those 70 to 79 years and 14.8 percent in those aged 80 years and older), but even the young may unexpectedly die (on a population level, a 0.2 percent fatality rate translates into tens of thousands of deaths).
For influenza, physicians can administer antivirals that help reduce the severity of infection, and the flu vaccine not only reduces the risk of infection but also its severity if one does become infected. But for COVID-19, the only mainstays of treatments are “supportive,” such as oxygen or artificial respiration for those who are seriously ill and finding it difficult to breathe (some experimental regimens are being tested, but there are no established benefits yet). And there isn’t a vaccine.
Most worrisome for health professionals, however, is the COVID-19 “tsunami” effect, the exponential rapidity of spread. This is a chief reason for the present drastic public health interventions. Without interventions, SARS-CoV-2 will keep spreading until about 70 percent of the population has been infected, at which point “herd immunity” begins protecting the other 30 percent. The more people have been infected and become immune, the harder it is for the virus to spread further because viruses need to find susceptible hosts to reproduce. Fortunately, there are interventions. If everyone adheres to public health advice (wash your hands, self-isolate if you’re sick, avoid unnecessary travel and so on), it is possible that less than 50 percent will get infected. Even so, we must prepare ourselves and our communities for the possibility that 70 percent of us will eventually become infected.
Flattening the curve
Now here’s the rub: If so many people get infected in a short period of time, there isn’t a health system in the world that can handle the influx of seriously sick patients.
Both China and Italy have tragically illustrated this for us. Literally within a day, hospitals in affected areas of Italy were overrun. Soon there were not enough regular beds and not enough respirators for all the patients who did not have COVID-19 but needed intensive care. Such conditions force physicians to make unpalatable choices about who is to receive scarce resources. Lives that could otherwise have been saved may be lost simply because it is impossible to provide ordinary care. There are also healthcare worker shortages, such that physicians from unrelated specialities are being called to help, some of whom have never worked in that area since early in their training. Unfortunately, despite protective measures, physicians and nurses are themselves being infected, which exacerbates the shortages.
In Canada, many hospitals operate near 100 percent capacity — which is to say, nearly all of the beds are already in use. Fortunately, New York City, where there is a growing cluster of infections, announced last week that it had 1,200 spare beds prepared for COVID-19 cases. Yet even that may not be enough if over 1,000 people are getting sick each day, as is currently happening in Italy. China managed to erect two new prefabricated hospitals within days, with beds for over 2,600, but such feats are unlikely even to be attempted in Europe and the Americas.
This brings us to a key principle of managing disease outbreaks: the urgency of “flattening the epidemic curve.” Instead of a sharp day-to-day increase in the number of cases, which would overwhelm local healthcare resources, one aims for a gradual increase in cases. Then, ideally, each patient receives optimal care.
The way to flatten the curve is to reduce the virus’s reproductive number — the number of other people that an infected person infects. At a personal level, we can reduce this number by washing our hands and staying home when sick. At a societal level, we can reduce this number by “social distancing,” which includes cancelling large events, avoiding non-essential travel and limiting social intermingling in general. Very simply, the fewer interactions there are between infected people and susceptible people, the fewer people will get sick. Social distancing has obvious trade-offs, and if and to what extent public health officials are justified in recommending it is not clear. Yet if they need to be initiated quickly, our hospitals still have capacity, instead of in two weeks when their intensive care units are overflowing.
A final important point: COVID-19 has an incubation period of about 5 days (though up to 14 days). That means that we are unavoidably a week behind in knowing how many people currently are infected, who will soon become sick and contagious. So there will always be a delay between the decision to take action and the situation actually improving.
All this and more is involved in knowing our enemy and recognising the real risk of COVID-19: how it spreads, how fast it spreads, how to treat it, and how to prevent it.
Martin Luther’s response — and ours
How, then, are we to understand ourselves? A time-honoured way is looking to the past. Historically, Christians were no strangers to epidemics. Vivian Nutton, the esteemed historian of medicine, writes that from the fourteenth to eighteenth centuries, “A town would experience an epidemic of plague approximately every decade, and a serious devastation once in every generation.” Disease outbreaks were part of the rhythm of life. Those outbreaks caused by bubonic plague were particularly dreadful, boasting a fatality rate of 60–90 percent (for COVID-19, it is “only” 1–3 percent).
In response to these outbreaks, Christians wrote many “flight theologies,” exploring what measures Christians could take in good conscience (whether, for example one may flee a diseased town). Today, the most famous of these flight theologies is Martin Luther’s letter to his friend and fellow pastor Johann Hess, in response to Hess’s question, “Whether it is proper for a Christian to run away from a deadly plague.” Luther himself was no stranger to suffering. He endured the death of many of his family and friends, including some of his own children, and a plethora of personal ailments. Indeed, Hess had to write twice entreating Luther for his thoughts, because Luther was too ill to reply to the first letter.
In 1527, plague struck Wittenberg — the university town where Luther lived — prompting classes to be moved to an unaffected town. Yet Luther refused to leave. He chose instead to venture his life on caring for the sick and dying and transformed his home into a makeshift hospital. So when Luther gave advice, he knew the consequences and the fear attending them.
For Luther, our loving God hiddenly but surely works for our good even in the places we do not expect, including amid the evil of deadly epidemics. The fear of bodily illness and death should drive us to pray and to care for our souls, remembering that this world is not our lasting home. An epidemic is one of many evils that beset us, and we have to take that seriously; but the greater evil is the evil within (Matthew 10:28, Luke 12:4). Therefore, responding to an epidemic or any other crisis must involve turning from our sins — chief of which is the selfish love that gives thought first to self, and only secondly, if we can assure our own health and safety, to others.
Luther regarded the epidemic as a temptation that tests and proves our faith and love: “our faith in that we may see and experience how we should act toward God; our love in that we may recognise how we should act toward our neighbour.” Through faith in God and out of love for neighbour, Christians must think first how to contribute to the physical and spiritual care of those who are vulnerable, self-isolated, sick, or dying. Only then did Luther permit Christians to make private decisions about whether to flee. In an era without widespread institutionalised healthcare, Luther wrote that Christians are under a divine obligation to fill the gap: “We must give hospital care and be nurses for one another in any extremity or risk the loss of salvation and the grace of God.”
With lives at risk, Luther encourages Christians to find solace in the promises of God. The devil tempts us to “horror and repugnance in the presence of a sick person.” But striking a “blow against the devil is God’s mighty promise by which he encourages those who minister to the needy. He says in Psalm 41, ‘Blessed is he who considers the poor. The Lord will deliver him in the day of trouble’.” Therefore, “whoever serves the sick for the sake of God’s gracious promise … has the great assurance that he shall in turn be cared for. God himself shall be his attendant and his physician, too. What an attendant he is! What a physician!”
What does this mean for us and COVID-19? Our attitude toward COVID-19 should be marked by the Christian virtue of measured concern (“temperate prudence” in classical terms): measured, not panicking but heeding our Saviour’s encouraging warning, “Do not be anxious about your life … Do not fear those who kill the body but cannot kill the soul” (Matthew 6:25, 10:28); and concern, recognising the evil for what it is and not comforting ourselves with falsehoods. Instead of panicking and stockpiling so many masks that there aren’t enough for healthcare workers, or so much pasta and toilet paper that others can’t find any, we should be asking: How can we as a church and I as an individual help those in need?
Those who are researchers or health professionals should take courage in their divine calling to do good research, to seek truth and to care for the sick. Many of us in healthcare have taken oaths: “The health of our patients shall be our first consideration.” It is easy to take valiant oaths in times of tranquillity and bliss. Hardship does not nullify these oaths, but rather emphasises their sacred, inviolable nature. For Christians, there is a special duty to fulfil them, since we have been told, “let your ‘Yes’ be ‘Yes,’ and your ‘No’.”
For those of us who do not have special training to participate on the medical front lines, we are called to responsibly play our part in society: in our jobs that help keep our economy going; in our families as parents, children or siblings; in the way we communicate, listen and respond to news; in the way we care for our neighbours, cities and communities. Above all, we are called to pray for and do our best to support good journalism, research and medical care. For Christians, truth is distinctly important. Every Christian has the responsibility to find and rely on accurate sources of information, having nothing to do with either sensationalisers or scoffers.
A website like the Science Media Centre can help one interpret the headlines level-headedly, and every region has its public health bulletins with advice specific to the region. We listen to and respect our public health officials, with the expectation that their recommendations will inevitably be imperfect. Rather than criticising them, we ought to pray for them daily.
COVID-19 reminds us that lasting contentment, security and happiness is not to be found in the present world but in the world to come. As Augustine put it:
As ‘we are saved by hope’, so we are made happy by hope. Neither our salvation nor our beatitude is here present, but ‘we wait for it’ in the future, and we wait ‘with patience’, precisely because we are surrounded by evils which patience must endure until we come to where all good things are sources of inexpressible happiness and where there will be no longer anything to endure. Such is to be our salvation in the hereafter, such our final blessedness.