Few of us are trained to treat sick communities and continents. Unfortunately, that is our task during a pandemic. The origin of the word comes from the Greek pandemos, where pan means everyone, and demos means population. Pandemics confront us with not just one sick individual but with hundreds of thousands of ill patients. The responsible pathogen overwhelms both individual immune systems and community healthcare systems. The toll is individual and collective.
In addition to quality medical care, Christian healthcare professionals have a unique calling to fulfil, as well as unique resources to offer individuals, communities, countries and churches as everyone grapples with the novel Coronavirus (SARS-CoV-2).
Coronavirus disease (COVID-19) is devastating because it is highly transmissible, with a reproductive number (R0) between 2-3. The incubation period ranges between two to 14 days, similar to other coronaviruses such as SARS-CoV and MERS-CoV. However, the vast majority of patients present with asymptomatic infection or mild illness. The net result: infected individuals are highly contagious. A typical infected person will transmit Coronavirus to two or three other people. The growth rate of the disease may be geometric, not linear.
Because of this rapid spread, healthcare supply chains buckle. In the early weeks of the COVID-19 pandemic, healthcare professionals in New York City and other epicentres reported shortages of personal protective equipment (PPE), putting them at significant risk for infection. Social media filled with stories of healthcare professionals using and reusing their N95 respirators, while others served patients wearing only surgical masks. Calls went out for schools, dentist offices and television production sets to contribute their supplies of respirators. Faced with the potential of infection, healthcare professionals around the country have had to count the cost of their calling.
The Freedom of Sacrifice
Each of us understands the risk, but Christian healthcare professionals should experience great freedom as we count the cost. We should be the first to volunteer to take the shifts of older or immunocompromised colleagues. We should be the first to offer up our access to PPE. We should be among those who are the least afraid to come in close contact with infected patients daily. Even as we call for communities to practise social distancing, we draw near. Why?
We follow in the footsteps of Jesus. In a culture that encourages us to focus on our families and invest in our security, he called us to be willing to abandon our families to follow him (Luke 14:25-27). When others practised social distancing, Jesus reached out to touch the leper (Mark 1:40-45). Jesus calls each of us to lose our life for his sake (Matthew 10:39), to pick up the cross and follow him (Matthew 16:24) and to define love by giving our lives for others (John 15:13). Perhaps it is God’s mercy that the pandemic arrived in the United States just as Lent began. We are invited to follow Jesus wherever he leads, even when it leads to Calvary.
During the Ebola epidemic in 2014, the world marvelled at the example of healthcare professionals like fellow Christian and CMDA member Dr Kent Brantley. They could not comprehend his willingness to risk exposure and possible death by staying in Liberia. They could not understand his desire to return to Africa after he recovered. But his example should surprise no Christian and should be emulated by all Christians. Jesus embraced death to save others (Romans 5:6). He triumphed over death, so it lost its sting (1 Corinthians 15:55). As Christians, we know in whom we believe, and we are convinced he can guard what we have entrusted to him (1 Timothy 1:12).
When we follow Jesus in this way, the gospel becomes clear to everyone. This is what happened when a 75-year-old Italian pastor with COVID-19 was admitted to a hospital in Lombardy, Italy. Though he was quite ill, he read the Bible to the dying. He held their hands. Even in his death, he was a messenger of hope.
His physician, Dr Julian Urban, described the impact this pastor had: ‘Despite having had over 120 deaths in three weeks, we were not destroyed. The pastor had managed, despite his condition and our difficulties, to bring us a peace that we no longer had hoped to find. We cannot believe that, though we were once fierce atheists, we are now daily in search of peace, asking the Lord to help us continue so that we can take care of the sick.’
A Broader Commitment to Life
Because this is a new (or ‘novel’) coronavirus, our prevention and treatment tools are limited. Natural immunities do not exist. Researchers have not had time to develop vaccines. Medications have not been tested for safety and efficacy. This leads to significant morbidity and mortality, especially for the elderly and those with comorbidities.
Among COVID-19 patients, 19% of those infected will suffer severe illness or become critically ill. Most display symptoms around four days. Infected patients often present with fever (77 to 98%), cough (46 to 82%), myalgia or fatigue (11 to 52%) and shortness of breath (3 to 31%) (see here, here and here). The case fatality rate (CFR) is estimated to be 3.6%, 8% and 14.8% for those 60 to 69, 70 to 79 and over 80, often due to acute respiratory distress syndrome (ARDS). Mortality increases to 10.5%, 7% and 6% for those with cardiovascular disease, diabetes and either chronic respiratory disease, hypertension or cancer.
As health systems face overwhelming numbers of COVID-19 patients, other countries have experienced shortages of ventilators for patients with ARDS. Italian doctors have had to choose which patients receive ventilators and which do not. It is a decision no healthcare professional should ever have to face. Yet, it is a critical moment to wrestle with what we believe about the sanctity of life and the inequitable distribution of medical resources. During a pandemic, these injustices become life-or-death issues.
Medical ethics, informed by centuries of Christian thought, may guide us in individual decisions of who to place on a ventilator. However, Christians in healthcare reflecting on these issues should be deeply troubled when healthcare disparities lead to these situations unnecessarily.
Research by the Kaiser Family Foundation, for example, suggests that—contrary to trends in other locations—young patients (persons under the age of 65) in the southern United States are more likely to develop severe illness than in other parts of the country. In an interview in The Atlantic, Tricia Neuman, a senior vice president at the Kaiser Family Foundation, noted, ‘Due to high rates of conditions like lung disease and heart disease and obesity, the people living in these states are at risk if they get the virus.’ The article also points out that these states often spend less on public health.
A commitment to the sanctity of life should include, but not be limited to, the abortion debate. It should also inform our commitment to provide patients across the country with equitable access to quality healthcare.
As Christian healthcare professionals, our commitment to healing extends beyond individuals to communities as well. As a former officer with the Centers for Disease Control and Prevention, I spent several years working globally to protect communities through public health initiatives. One of the most powerful tools we had was giving communities accurate information about disease and prevention. Misinformed or ill-informed communities made poor health decisions.
This is no less true during a pandemic. We have a unique opportunity to partner with pastors and leaders of other community organisations who are ill-equipped to assess the torrent of medical data that follows a pandemic. We can help them assess risk. We can help them plan. We can persuade communities to engage in acts that protect the most vulnerable.
When churches or neighbourhoods resist the need for social distancing, we should speak clearly, consistently and loudly that social distancing is one of the most effective ways to flatten the epidemic curve. By promoting social distancing, Christian healthcare professionals protect their communities from contagion, while allowing infected patients to receive proper care and treatment. Human vectors, the critical ingredient for transmission of disease, are removed by these non-pharmacologic interventions. This results in less opportunity for COVID-19 to infect others, which translates to a fewer number of deaths and sustainable healthcare capacity.
When erroneous or misleading statements are made in or by the media, we should be the first to object and to correct. We should resist politicisation of scientific data or recommendations because our loyalty belongs to Jesus. We can offer the public a calming, fact-based, truth-focused voice in a sea of anxiety-provoking news. As the pandemic ebbs, we can interpret the data and help churches and communities decide whether and when to begin meeting together again.
Disciplines of Hope
The darkness of the pandemic will not recede quickly enough. It will require many months of sacrifice, service and speaking up. However, while struggling and suffering, joy and peace are available to Christians. But it will require us to embrace two essential disciplines.
First, we must learn to lament. Fully two-thirds of all Psalms are psalms of lament through which the biblical writers poured out their pain, fear, doubt and grief before the Lord. In a pandemic, we need to lament. We will be immersed in tragedy. In these lonely places, we can find refuge in communion with God. While choruses of hope and joy may buoy our spirits, the prayer of lament will keep us honest before God and one another.
Second, we must embrace sabbath when we can find it. Sabbath invites us to embrace our limitations as created beings. We need to rest. We need to trust God is at work when we are not. We need to acknowledge he alone is the world’s saviour and healer. We are not. Sabbath confronts the idolatries of productivity and agency. When we observe the sabbath, we proclaim our trust in God. That is essential during a pandemic.
We cannot cure entire communities or continents. But we trust God can.
This article is reproduced with permission from the CMDA website, where it was originally published on 1 June 2020.
About the Author
Reverend Stephen Ko, MD, MA, MPH, MDiv, serves as Senior Pastor of New York Chinese Alliance Church in New York, New York. As an ordained Christian & Missionary Alliance pastor, he is passionate about evangelism, global health missions, and holistic ministry, as exemplified by the life of Christ. In addition to seminary training, Dr Ko’s healthcare specialties include paediatrics, preventive medicine and public health. He is currently Adjunct Professor at Alliance Theological Seminary. Previously, he served as a Global Health Professor at Boston University’s School of Public Health and as a Medical Officer for the Centers for Disease Control and Prevention. He has worked extensively in Africa and Southeast Asia on diseases of epidemic potential, helping low and low-middle income countries implement their national public health programs. He enjoys helping individuals flourish in their faith, mentoring church leaders and galvanising faith-based organisations to action. Writing at the intersection of faith, medicine and public health is a particular passion. Follow him at @drsteveko.