Coronavirus (COVID-19) Response
THIS EMAIL WAS SENT TO ALL CHURCHES ON MARCH 10, 2020
Dear Pastors and Secretaries,
Although we haven't had any direct enquiries from our churches, I'm sure you as church leaders are aware that the World Health Organisation's International Health Regulations Emergency Committee has declared the outbreak of COVID-19 (Coronavirus) a Public Health Emergency of International Concern.
In the midst of this unfolding drama, it is good to be reminded of our trust in a loving God who watches over us all. As leaders it is important we approach the concerns of our congregations with balance. That means being informed, remaining faithful and caring, and doing all we can to provide safe and healthy environments for our church communities and ministries.
I've attached a couple of documents for your attention. The first is a general facts sheet, the second is a resource from a local GP from Launceston. I'm encouraged how he begins by encouraging churches to "continue to live and preach the gospel grace and be salt and light in our community, to look for ways to show God's love to our community (particularly the elderly, the sick, the isolated, the vulnerable, the fearful), and to protect and care for our members and visitors at our gatherings and in our networks." Both documents are great resources for leaders in our Duty of Care in implementing the appropriate measures in our churches.
As the response to this situation continues to unfold, the best way to access the latest advice, information and resources for your church or ministry, is to go directly to www.health.gov.au or https://dhhs.tas.gov.au/home. Both sites have resources that can be used to educate your community and help ensure good hygiene practices are in place. You can also call the National Coronavirus Health Information Line on 1800 020 080. It operates 24 hours a day, seven days a week. If you require translating or interpreting services, call 131 450.
We have had advice regarding insurance recommending churches do not hold any extra public/community events in the current climate. It is unlikely our policies will protect a church should they be sued by an attendee at such an event. Wise and appropriate measures, as outlined in the resources, should be followed for regular church events.
Please continue to pray for those who have been affected in Australia and globally. My prayer is that God will bring his peace and guide those who are working to resolve this Public Health Emergency and that churches across our State may be havens of hope and care for our surrounding communities.
Sincerely in Christ,
Facts Made Simple
CORONA VIRUS DISEASES-19 FACTS MADE SIMPLE
"Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less" Marie Curie, Physicist, first woman to win a Nobel prize.
Fear reigns supreme where there is lack of clarity and that is what is happening regarding the Coronavirus infection now affecting close to 40 countries. Some say it is harmless as the flu (flu still kills a lot of people) while others say this is the apocalypse and the end of the world is near. Probably the truth is somewhere in the middle and hence I have prepared this document on some basic facts of this disease in simple non-medical terms (as much as possible).
Name of the disease - COVID-19 (Coronavirus Diseases 2019).
Name of the virus causing the infection - SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2).
What is a coronavirus?
This new virus belongs to a family of viruses known as coronaviruses.
Nomenclature is based on the crown-like spikes on the surface of the virus.
Seven strains are known to infect humans, including this new virus. Four of those strains cause common colds, the other three cause more severe disease & death in humans: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) & COVID-19 (the current Coronavirus infection).
The origin of the new coronavirus
The new virus likely came originally from bats. Viruses from bats often infect another mammal first and then mutate to become more transmissible to humans. One possible way of spread from animals to man is by human consumption or close contact of some of these infected animals.
Health officials believe the outbreak originated in a large animal and seafood market in Wuhan, China. Of the first 41 cases, 27 had some exposure to that market, according to a report in the Lancet.
A study in the New England Journal of Medicine found that 55 per cent of patients in Wuhan who became ill before January 1 had a link to the market, compared with 8.6 per cent of those who became ill after that point. Scientists say it will take some time to identify the exact source.
What are the symptoms of the infection?
- Symptoms - fever, cough and body pain.
- Other less common symptoms - nausea, with vomiting and diarrhoea.
Spectrum of illness
- Mostly flu like illness.
- Mildly ill for a few days, then rapidly develop more severe symptoms of pneumonia.
Who is most at risk?
- Highest risk is for older people and those with other health conditions such as diabetes.
- Most of the 1,023 people whose deaths were included in a study by the Chinese Center for Disease Control and Prevention were age 60 or older, and/or had other illnesses.
- Younger people who have died probably had a very high inoculum to start with and high volume of disease. The immune system of younger people can fight back vigorously causing unintended collateral damage leading to multiorgan failure.
- Others die of bacterial superinfection on top of the viral infection often due to long hospital stay & interventions like Central Venous Catheters & ventilation.
How is the virus spread among humans?
It is likely spread through a cough, sneeze or other contact with saliva, Chinese officials say. There is no evidence of transmission by aerosol, or through the air. MERS and SARS spread mainly through "respiratory droplets" produced when someone coughs or sneezes. Those two viruses spread mostly through close contact.
If one touches the bed, linen or any other innominate object on to which a patient with COVID-19 has coughed & then places his fingers on to one's mouth, eyes or nose then you could self-inoculate this virus.
Scientists are also investigating whether the new coronavirus may spread in faeces, as tests have found it in the digestive tract of some patients.
What is the incubation period?
Incubation period is the time required by the virus to cause infection in a person once he or she has acquired it from someone else.
US Centre for Disease Control & Prevention 10- 14 days.
Is there a test?
- Swabs from throat or secretions from the lungs preferably sputum for PCR studies to identify the virus quickly.
- Other tests - culture & serology (more cumbersome & delayed).
- Xray chest for those having worsening respiratory symptoms & ongoing fever.
- Work up for other causes of fever in a returned traveller.
How easily does the new virus spread?
- R0 (R naught) is the number of other people one sick infected person is likely to infect on average. R0 for COVID-19 is about 2.6.
- R0 for Influenza is 1.3 and for SARS the R0 is 2.9.
- For measles it is very high, in which one infected person can infect up to 14 other people.
How deadly is COVID-19 compared to other viruses?
- Case Fatality Rate (CFR) is the ratio of deaths from certain diseases from a certain disease to the total number of people diagnosed with the illness over a period of time.
- Based on the number of confirmed deaths and cases, the CFR for COVID-19 is around 2.65% compared to 0.1% for seasonal flu.
- CFR for SARS was 14-15% & for MERS was 34%!
In summary, COVID-19 is more infectious but less deadly.
Can asymptomatic patients spread infection?
It is possible. But little is known so far. In Macau, a 15-year-old resident of Wuhan, the epicentre of the outbreak, tested positive for the coronavirus despite having no fever or cough.
The Lancet medical journal reported that coronavirus was detected in a 10-year-old boy who developed no symptoms, even though others in the child's family fell ill.
However it is not clear whether these asymptomatic cases were the cause of the infections in the family or was a result of those infections.
Some people who have contracted the infection could be having very mild symptoms and could be spreading infection in the community as they go about the routine activities.
Can face masks protect you?
- N95 respirator mask certified by an independent agency can guard against the virus.
- Paper or polyurethane foam masks don't filter out smaller particles responsible for transmitting infectious agents.
- They may in fact increase the risk of infection due to the unfounded confidence of the person wearing it and more importantly due to constant touching & fiddling with potentially contaminated hands increasing the chance of self-inoculation.
- Having said that a simple surgical mask could prevent direct droplet inoculation fro somebody coughing or sneezing on your face.
What is the most important preventive measure?
- Wash your hands frequently with soap & water for at least 20 seconds each time, 70% alcohol based wash or wipes also may be useful as hands contaminated with infected droplets can spread infection.
- Wash them multiple times especially if you are travelling or working in an institution or office with lot of people.
- Most importantly do not touch your eyes, nose or mouth: the entry points for the viruses.
- Wipe down objects and surfaces with household cleaner.
- Maintain a distance from people who are sick.
Is there any treatment for COVID-19?
We do not yet have any drugs or vaccines approved specifically for the new virus. There is a race to develop a vaccine and hopefully we should have one in the next few months.
Regarding drugs, a few antiviral drugs used for other infections are being trialled in COVID-19 patients. There are a few clinical trials in China evaluating remdesivir, an antiviral drug that was also tested for Ebola. A class of HIV drugs called protease inhibitors have been used in COVID-19 patients in China. Combination of Lopinavir/Ritonavir is the drug under scrutiny. It was also used to treat MERS in Saudi Arabia few years ago. As of now, we only have case reports and no clinical trials to guide treatment. China is conducting a clinical trial using the combination of these two HIV drugs and we hope this will shed more light in this area.
Dr Santhosh Daniel MD, FRACP
Infectious Diseases Consultant
Flinders Medical Centre
Adelaide, South Australia
A Tasmanian Christian Church
Coronavirus response - March 5, 2020
You will keep in perfect peace, him whose mind is steadfast, because he trusts in You Trust in the Lord for ever, for the Lord, the Lord is the Rock eternal (Isaiah 26:5)
As the coronavirus outbreak develops further, we need to consider, as a church, how best to:
- Continue to live and preach the gospel grace and be salt and light in our community
- Look for ways to show God's love to our community (particularly the elderly, the sick, the isolated, the vulnerable, the fearful)
- Protect and care for our members and visitors at our gatherings and in our networks
While currently the number of cases in Australia is relatively low, the developments around the world during February 2020 show how quickly the situation can change. Until recently, all cases in Australia were the result of infection from overseas. Several cases have now occurred in Australia in people with no travel history or no proven contact with a known case, which indicates person-to-person transmission within Australia and the beginnings of spread within the Australian community.
For most, the illness is mild and there will be full recovery. Some will have sickness requiring hospital treatment. Mortality rates are 2-3% overall. The data so far suggests that people most at risk are the elderly and those with pre-existing health conditions. In contrast, children and pregnant women do not have the death rates we would normally expect from a respiratory virus. However, even though children have a much lower risk of death, they still have a risk of spreading infection to others.
Table 1. Death rates reported by the Chinese CCDC released on Feb. 17, which is based on 72,314 confirmed cases. Note that in reality death rates are probably lower than this as this study likely missed many infected people who had mild or asymptomatic disease (http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51)
If this progresses as a large health crisis, it's likely it will continue for a long period of time. Our society and it's functioning will be impacted, by the illness itself but also by the various levels of risk management. And, as the usual respiratory illnesses of a Tasmanian winter develop in May-September, life may become quite complex for most of 2020.
There will be much for us to learn, as we seek to live with faith, hope and love, amidst a community experiencing fear, confusion, frustration and inconvenience. May the Lord enable us, as followers of Jesus, to be full of confidence in Him, and to bring His peace to our families, neighbourhoods, schools and workplaces. Our brothers and sisters in Wuhan have set an inspiring example for us in this!
Organisational responses - first level measures to implement immediately:
- Educate all church members with reliable information about Coronavirus (COVID-2019)
- Fact Sheet - "Coronavirus diseases 2019 - Facts made simple"
- Tasmanian link - https://www.dhhs.tas.gov.au/news/2020/coronavirus_update
- If you develop flu like symptoms (sore throat, cough, fever, body-aches)
- Self-isolate at home - do not attend work or school or church or other public gatherings
- Phone Tasmanian Public Health Hotline for advice - 1800 671 738
- Follow instructions for testing or further medical assessment
- Remain at home until result available
- Request that the following categories of people not attend church activities:
- Those who are unwell (e.g. fever, cough, sore throat) - until well
- Those who are contacts of a known COVID-2019-positive person - until 14 days
- Those with a relevant travel history (return from China or Iran) - until 14 days from departure from high-risk country
- For other relevant travel history (ie returning from countries of high risk but not China or Iran - eg South Korea, Italy, Singapore, Thailand, Japan, Indonesia) - home isolation is not enforced but should be considered
- Emphasise importance of handwashing for all attendees
- Particularly welcoming, coffee/food prep roles
- Maintain clean facility
- Ideally, have alcohol-based hand cleanser (though is and will be in short supply)
- Ensure that soap and paper towels are kept well stocked in bathrooms
- Introduce regular cleaning of surfaces e.g. handrails, door handles
- Encourage opportunities for spiritual growth - see below
Other measures - consider implementing when needed:
- Behaviour changes - eg non-touch greetings
- Minimise or cancel handouts - Leaflets, Bibles, Comment Cards
- Roster shortages at short notice or for prolonged periods
- Developing systems of care for:
- Various church members on home-isolation for up to 14 days
- Various church members unwell or in hospital for prolonged periods of time
- The elderly, the isolated, the vulnerable, the fearful
- Consider - food/essentials; phone support; other support
- Opt for food options that have less cross-contamination risk
- Live-stream church for those who are ill and can't make it to church
- If widespread sickness
- Not provide food/coffee/drink and not offering Lord's Supper
- Cancelling various gatherings - GG's, Sunday gatherings, other midweek meetings
Opportunities for spiritual growth
- Rest confidently in our Father's care and His capacity to achieve eternal good in the midst of evil
- Develop and demonstrate peace and trust in the face of widespread fear and uncertainty
- Overcome our independent spirit as we develop flexibility in our patterns of life (personal, family, work, church, social) - lovingly accepting inconveniences for the sake of serving individuals or community-at-large
- Develop empathy with our neighbours as we face this aspect of the world's broken-ness together
- Care for the elderly, the isolated, the sick, the vulnerable, the fearful
- Develop a personal theology of risk, suffering, mortality and apply faith and wisdom in daily life