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From Luke’s Journal February 2024 | Vol.29 No.1 | Missions and Sacrificial Service

Preparing for the unexpected

When calamity strikes, I sometimes remind patients that, “We never know what is around the corner.” In early January 2020, when the first reports of an unusual pneumonia being diagnosed in China started to trickle through, no-one knew what was around the corner. The World Health Organization (WHO) itself did not know whether the disease was transmissible from human to human even by 12^th January 2020, despite it having been identified as a coronavirus.¹

Even when it was declared a pandemic by the WHO in late January 2020, we hardly took notice. After all, our personal experiences of pandemics included the influenza pandemics of 1957 and 1968: the latter having a case mortality rate of about 0.2% (mostly in people with pre-morbid conditions) and resulted in no particular restrictions to daily life. Influenza was a disease well known to us all and since most of us had experienced it first-hand, it did not provoke a great sense of concern. After all, we had influenza vaccines and antibiotics to deal with any secondary infections and all general practices in Australia had been required to have ‘pandemic preparedness’ plans as part of accreditation.

As Christians too, we need to be prepared for the unexpected. We have the Bible, prayer and the Holy Spirit to guide us through difficult times, but we actually have to study and know the Word of God to be forearmed. We need to pray through the issues as they confront us and be attentive to the leading of the Holy Spirit. Knowing one’s Bible is paramount in times such as this, particularly because of the multitude of misguided theories that circulate whenever worldwide disasters strike – theories such as the pandemic being the wrath of God or it being one of the events listed in Revelations.

Good information is paramount

The COVID 19 pandemic was different to the 1968 influenza pandemic from the onset.  The causative agent was initially unknown and news feeds from China showed large numbers of people dying despite China’s heroic efforts to contain the disease. There were photos of people dead in the street, unable to obtain medical help. In less than a month, COVID-19 had spread to many countries and by 25^th January it had reached Australia shores, simultaneously being diagnosed in Melbourne and Sydney.

Adding to public concern were the stories of the pandemic in Lombardy, Italy. The first patient was diagnosed on 20^th February and the disease seemed to rapidly escalate to the point of overwhelming the medical resources. Unknown at the time, the disease had spread widely through the community before the first case was diagnosed,² hence the apparent rapid escalation. Again, the news media were showing pictures of patients lined up on beds in corridors and they reported high case fatality rates. There was significant anxiety in the minds of the Australian public, even before anyone had any local experience of this strain of coronavirus.

The initial experience of the pandemic was characterised by lack of knowledge. It was not known how the virus was spread, what the incubation period was, for what period patients remained contagious, how many people would catch the virus, and what percentage of people would become sick and/or die. Without good data it was impossible to make good decisions. Many people were very anxious.

This was an opportunity for Christians to be a calming voice in our communities. Jesus told us not to worry (Matt 6:25-34) and so we ourselves should not be anxious about events like these. Being calm sets a good example and also gives us an opportunity to help others with their anxiety.

Prevention vs Control

On 2nd March 2020, Australia had its first documented case of local community transmission. It soon became apparent that many people with COVID-19 had only mild symptoms and some people without symptoms still spread the disease. Bans were instituted to prevent travel from ‘high risk countries’ as the COVID-19 numbers increased in those countries. This included Iran on 2^nd March, South Korea on 5^th March, and Italy on 11^th March. A 14-day period of self-isolation for all arrivals from overseas was implemented on 15^th March. Not everyone did as they were told. Some of the more obvious absconders were heavily fined for their conduct and the cases made public through the press as a deterrent to others. Contact tracing was ramped up to cope with the small but growing numbers. In the middle of the month there were 300 confirmed cases, but as we did not know the duration of the incubation and the percentage of asymptomatic carriers, there was concern that this number was just the ‘tip of the iceberg’. This cohort of 300 required tracing and testing of perhaps 3,000 to 6,000 people, each within a couple of days of contact. This meant rapidly escalating the normal contact tracing staff in the Population Health Units (PHUs).

After some time, there was the realisation that it was unlikely that Australia could stop the spread. The public health response moved from trying to prevent the spread of the disease to trying to ‘flatten the curve’, i.e. ensure that the pandemic could only spread slowly and hence not overwhelm health resources.

This was a difficult time for the state governments as each had to make important decisions based on limited information. Christians were in a good position to support their decisions and encourage others to do the same. Without good community support, pandemic management would fail.

A pandemic requires coordination and co-operation on many levels

Navigating through any pandemic requires good leadership and the trust of the people so that they will follow what may have been tough decisions by the government. Some of these decisions, made early in the pandemic when there was limited data about the pathogen, erred on the side of caution and may have appeared to be ‘overkill’.

In late March, Australia announced a number of measures

• Full shutdown of overseas arrivals.
• Social spatial distancing.
• Mask wearing.
• Travel bans.
• Quarantine of fourteen days for anyone who contracted the disease.
• Bans on large community events.
• The establishment of a National Cabinet to coordinate strategies across all the states and territories. It consisted of the prime minister, the state premiers and chief ministers.

As the COVID-19 case numbers increased, restrictions were increased. Community gatherings were initially limited to 500, but this was later brought down to 100 and yet later to 10 people (if indoors) and later again to 2. Non-essential services were required to shut down and people were required to stay at home. Exceptions included health care workers. These restrictions, of course, meant that people were not allowed to gather together in church to worship God and to fellowship with one another face-to-face. Since there is no legalistic requirement for Christians to meet weekly at church, this should not have been an issue.  However, the lack of fellowship was problematic for some, particularly those who were single and/or had limited social networks. A partial solution was taken up by many churches, and that was to host church services online using video-conferencing platforms. Numerous churches have since continued the practice, or have at least kept video records of their weekly sermons on their church websites. Those in home study groups were able to keep in contact with each other via telephone.

As Christians we are told to respect authorities (Rom 13:1-5, Tit 3:1, 1 Pet 2:13-17). We can be thankful, in Australia, for governments that are held responsible by the populace for their actions. We do not live in a totalitarian society. Short of something which clearly contravenes what the Bible says, we are bound to obey the law. It was sad to see that some churches disregarded the edict relating to large gatherings. These were made examples of by the press and some people in our communities would have interpreted this as Christians thinking that they are above the law. We should always set good examples and not provide opportunities for some people to denigrate God’s church.

Misinformation is problematic

The news media, eager for newsworthy stories, soon acquainted the general public with terms normally used only in public health units. The term ‘reproduction rate’ was foremost among them. From the initial observations in China and Lombardy, it seemed that the reproduction rate was high, perhaps as high as 6. This forecast a hyperbolic rise of cases for Australia. Based on pure maths only, and not considering real life situations such as the widely distributed nature of the Australian populations, the case numbers could have gone from 300 individuals to 25 million (the population of Australia) in less than two months, with even a modest reproduction rate of 3.

News stories discussed various theories as to the origin of the pandemic, including that the virus was engineered as a weapon or an experiment in genetic engineering at the Wuhan institute of Virology. This was readily accepted given that the Institute had been studying coronavirus in bats. It was not helped by rising tensions between China and other countries and the perception by the West that China heavily censored news leaving the country and hence may have been hiding something.

Once vaccines became available, the rumour mill went into overdrive. This was made worse by the fact that these were a new type of vaccine (mRNA) and the fast-tracking of approvals saw people labelling the vaccines as being untested. Conspiracy theories included views that the vaccines contained tracking devices or nanobots and some went as far as saying the vaccine was the ‘mark of the beast’ (Rev 13:16-18) despite there being no resemblance to scriptural references. The occasional patient would ask to view the vaccine before administration to ensure there was no device in the syringe and more than one held a magnet to the vaccine to test for nanobots (I held my tongue and did not state that nanobots would not have been made of iron!). And these were patients who were accepting the vaccine! Who knows what some of the vaccine refusers believed (many would not give reason for declining the immunisation)? The most disturbing were those Christians who declined to vaccinate for ‘religious reasons’. Whilst many refused to discuss their reasons, it seemed that some saw it inherently wrong to inject the body with man-made genetic material. Some believed that God would protect them, and therefore they did not need to be vaccinated. It did no good to point out that the Bible makes it clear that Christians will not be completely protected from harm (1 Pet 1:6).

Pandemics are costly

The Commonwealth made an uncapped health funding agreement with the states and territories on 6 March, agreeing to meet half the increased health costs of patients with COVID-19, with an initial Commonwealth commitment of AUD$500 million. This was quickly followed by a AUD$2.4 billion health package on 11 March, which provided funding to purchase more personal protective equipment (PPE) and for other measures such as telehealth (telephone and video-conferencing). This meant a significant flow-on effect to the budget in subsequent years, i.e. the government would be unable to fund all the services that it wanted for some years to come. A good prayer point would be to pray that budget cuts would not affect those disadvantaged in our communities.

Some Australian states were required to shut down all non-essential services for various periods of time. This meant that some people could not earn money. Some businesses closed for good. On 12^th March, 2020 the Commonwealth announced its first economic stimulus package of AUD$17.6 billion to support businesses and households. It did not include support for people who had lost employment because of business closures. This was a lifeline to many and was designed to foster existing employment relationships and to keep businesses afloat. Here were good opportunities to help our neighbours and to support church-run organisations that help the poor.

This was the church’s opportunity to shine

Christians are told to be the light of the world (Mat 5:14-16). Jesus taught us to love one another and to care for our neighbours (Luke 10:27-37). True faith was described as looking after orphans and widows (James 1:27).  Whilst orphans and widows might now be looked after on a state level better than when James wrote those words, the principle of looking after those in need still applies. The modern-day equivalent might be considered to be single mothers, the homeless, the unemployed, refugees, and those living on their own, particularly those with mental health, drug and/or alcohol problems. These people were particularly at risk when total shutdowns occurred.

Some church organisations regularly have outreaches to these people, for example, the Wesley Mission, Anglicare, Mission Australia, and the Society of St Vincent de Paul.  However, the increased need for social welfare and social justice during the pandemic created opportunities for more Christians to be involved with these organisations and/or to support them in various ways. Each church in Australia had the opportunity and, dare I say, the responsibility of looking out for those at risk within their communities. During the complete shutdowns this may have meant regular phone calls to these people to provide social contact as well as organising help as needed. Later, with the lessening of restrictions this allowed for the provision of food and supplies, including masks.

In past times of ominous pandemics such as the Black Plague, Christians stood out for their compassion in looking after the poor, the sick and the dying, despite great risk for themselves.

This was the chance for Christian doctors to shine

Christian doctors should ‘go the extra mile’ (Matt 5:41) in helping our fellow man. How to do this was not particularly apparent for those doctors working to their limits in hospital emergency departments, medical wards and intensive care units.  Nevertheless, there were opportunities for Christians to support doctors in various ways, including prayer. Stresses were felt throughout the health system and doctors needed to consider how they could help not only their patients, but co-workers, nursing staff, administration staff and ancillary staff.

Christian doctors were not immune from needing support. The Christian Medical and Dental Fellowship of Australia (CMDFA) held weekly Zoom meetings to provide support. Of course, there were many doctors who were not part of this association and there was a great opportunity for the CMDFA to reach out to other Christian doctors to help support them.

Christian doctors also played a role in educating their Christian patients regarding the Biblical perspectives of the pandemic. In particular, it was good to see that matters such as ethical considerations regarding vaccinations, were discussed in Christian journals such as Luke’s Journal.^{3, 4}

This was a time for doctors to show leadership

There are a number of general practice representative groups around Australia, many of which were part of the earlier Divisions of General Practice. Some of these were able to establish disaster management plans and determine how to support their local general practitioners (GPs), particularly with the early concern that COVID-19 would overwhelm the health resources and leave GPs to manage hundreds and thousands of sick and dying patients: a scenario that never eventuated because of good management at political and health department levels. Many GPs took up leadership roles, not just in these groups but by representing their fellow GPs in management discussion groups. Here was an opportunity for Christian doctors to serve their fellow doctors and their communities by being involved.

Good information flow is essential

One such group was the COVID-GP Community of Practice (COP), set up by the NSW branch of the Royal Australian College of General practitioners (RACGP) and consisting of GPs in representative positions from across the state. The chair of this group was able to relay issues to the state health minister. This enabled rapid responses to be made at a state level to combat the evolving nature of the pandemic. The COP also enabled the flow of information from the minister to the member doctors who could then disseminate it to their local GPs. One excellent method of connecting the grass-roots GPs was the use of internet mail groups. An example of this was one run by the Hunter General Practice Association. With 470 GPs on the mail group, most of the GPs in the Hunter Valley could discuss issues relating to them and their practices. Sometimes these issues could be solved locally with the assistance of other doctors (e.g. sharing of supplies) and sometimes these issues would be relayed to the COVID-GP COP and then to the Minister of Health. An example of this was the lack of personal protective equipment (PPE) early in the pandemic. With concerns escalated from grass roots members up to the state and then national level, the government was able to perceive the magnitude of the problem and source sufficient supply and then distribute them. Christian doctors on such mail groups have the ability to moderate and tone down criticism and negativity and be a positive influence.

One of the most valuable sources of information for the public was the weekly report by state premiers. These updates explained the status quo of the pandemic and the government response. It was reassuring to see that the government was aware of what was happening and appeared to be in control.

The 80:15:5 Rule

Not a rule, really, but just a personal observation. Most people (let’s say 80%) will do as authorities require. Some (say 15%) will ignore this if they think that they can get away with it. A few (say 5%) will do whatever they please. For example, when state borders were closed, most people respected the authority’s decision and did not cross state lines. One supposes that reasons included respecting authorities, understanding the reasons for the decision and perhaps fearing the repercussions of going against the law. Some people decided to sneak across the borders, in places where the authorities were not checking. One supposes that they thought that their own personal needs outweighed the needs of the community. A few decided simply to ignore the decision. One supposes that this group included anti-social people, narcissists and those who are anti-establishment.

Another example related to vaccinations. Most people accepted the recommendation to get vaccinated, despite initial concerns about the vaccines. They lined up, not just because they thought that they were protecting themselves, but because they understood the need to achieve ‘herd immunity’. They were prepared to do their part and saw that they were helping protect those who were vulnerable to the disease and at risk of dying. Some people were reluctant to be vaccinated, but with persuasion, typically from their GP whom they trusted, chose to be vaccinated anyway. The combined groups (80% + 15%) saw Australia achieve 95% vaccination rate for two vaccinations and hence sufficient community immunity was achieved to completely slow the spread of the virus. Vaccinations kept many people out of hospitals and prevented deaths. The remaining few refused to be vaccinated.

Roughly similar results were seen with mask wearing. Most people accepted the wearing of masks for their own safety and the safety of others. Some chose not to wear masks when they thought that they could get away from it. A few decided not to wear masks.

Nursing home residents are vulnerable

An early realisation in the pandemic was that residents in registered aged care facilities (RACFs) were at particular risk. Almost all of them were in these facilities because of age-related disabilities. Most had multiple health issues and were particularly at risk of dying from COVID-19 if infected. The early case fatality rate was 6.3% in these facilities. In 2020, 75% of all COVID-19 related deaths occurred in aged-care facility residents but fell to 17% in 2021.⁵

There was no easy way to isolate these people from COVID-19. Most were not spending time outside their communities, but their carers and families were. Most people kept away if they had a sore throat or runny nose, some exercised denial and tried to visit but were turned away and a few came to these facilities regardless of their symptoms insisting on their right to visit. Once COVID-19 was within the walls of the nursing homes (RACFS) it was extremely difficult to stop it spreading. As staff came down with COVID-19 they were quarantined, initially for fourteen days. This led to a large shortage of staff. Some of the gaps were filled by temporary staff, some of whom were working in more than one aged care facility. This potentially led to more spread of the disease.

One of the saddest parts of the pandemic was that some of the elderly died without their family around them because of quarantine requirements. One consoling thought is that few of these people in their twilight years would have wanted it any other way if the alternative was to risk spread of the disease to their own family. Technology was helpful in providing video conferencing with families.

As doctors looking after patients in the nursing homes, we provided a little extra social contact and could look for ways to help. One of my patients, who had been socially and geographically isolated from her church upon entering the nursing home, often talked about her church. During COVID-19, I was able to arrange for her to view the Sunday services via Zoom, which was wonderful for her.

Not all apparent resources are actually available

The coronavirus in this pandemic did not discriminate. Many doctors and nurses caught the disease and were quarantined in the early days for fourteen days. This removed a large number of people from the workforce and this was problematic particularly within the hospital systems. The remaining doctors had to make up deficits with extra work under stressful conditions. The repercussions were long lasting as some junior doctors took a year away from full-time work to recover.

General practice was less affected, not because GPs were immune but because the workload early in the pandemic dropped considerably. Most preventative care matters like mammographies, cervical screening tests, surveillance colonoscopies, etc, were put off until lower risk times. The provision of electronic prescriptions was fast-tracked and so most prescription repeats could be managed over the telephone. This meant that many doctors in quarantine could still work from home using telephone and/or video conferencing.

When it came down to examining patients with respiratory diseases, there were more surprises. GPs were required to have adequate facilities and PPE. Most surgeries were able to set up drive-through clinics, but not all.  Some doctors refused to see patients with respiratory illnesses. Some of these doctors had young children or infirm relatives that they were protecting at home or elderly relatives living with them. A few doctors, mostly because of having at-risk illnesses, chose not to see patients at all.  The net effect was that at a time of increased need, there were fewer workers to do the work. Some compensation was made by the upstaffing of various ‘Respiratory Clinics’. These were clinics that the state government had previously funded and contained state of the art facilities including rooms with negative pressure airflows.

Another surprise came when it was time to vaccinate Australia. Not all GPs, possibly for the same reasons given above, decided to run vaccination clinics. Not all clinics were eligible, with vaccines only distributed through the 80% accredited practices.¹  This meant that those GPs who chose to vaccinate ended up seeing large numbers of new patients. Large vaccination clinics were set up around Australia, and these helped with those patients whose GPs were not vaccinating. These large clinics required a large number of staff. A few doctors were needed to cope with the small percentage of vaccine reactions (ranging from fainting to anaphylaxis), but a large number of nurses were required. A call was made for nurses who had retired or who were not working, to come back to the workforce and help. It was inspiring to see the number of nurses who responded. Many worked in the vaccination clinics, but some also put their hand up to work in hospitals because of the staff shortages that occurred there.

In a time of community need it was wonderful to see Australians ‘going the extra mile’ to help their fellow Australians.

Prayer

“Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Phil 4:6-7)

It is not surprising that people turned to God in prayer during the pandemic. What was surprising was the extent. According to a research paper by Bentzen, more than half the world population prayed for the ending of the pandemic!⁶ If prayer brings people closer to God then some good has come out of the pandemic. However, praying for an end of the pandemic is only one important part of prayer. Other important themes would include praying for individuals that we know, praying for support for those who mourn, praying for healing, praying for the church, praying for leaders, and praying for the strength to cope.

Prayer, of course, can be personal: between you and God, but also organised in groups. The CMDFA held weekly prayer groups through Zoom meetings. HealthServe Australia also held nightly Zoom prayer meetings entitled, “HSA Flattening the COVID-19 Curve Prayer Group”.⁷

The Outcome

We are often reminded that it is important to learn from our mistakes: that not doing so dooms us to repeat them. Equally important is to learn from our successes.  During the Spanish Flu, Australia was one of the safest countries in which to live, partly because of good management and partly because of geographic considerations. According to the Worldometer,⁸ during this pandemic Australia ranked 39^th in terms of reported cases per million of population (450,443) but 109^th in terms of deaths per million cases (913). Australia has been described as having better outcomes in this pandemic than all other large western countries.⁹

The Future

There are many take home messages from this pandemic. The important thing is that these lessons be remembered at the time of the next pandemic. Will there be another pandemic? With rising world populations and air travel comes the increased abilities for diseases to spread rapidly. Overcrowding increases the risk in big cities and there are now over eighty cities in the world with populations over five million.

From a worldly perspective we would predict more pandemics. From a Biblical perspective we have Jesus’s own words “There will be great earthquakes, famines and pestilences in various places, and fearful events and great signs from heaven” (Luke 21:11 NIV).

And then there are also the events of Revelation!

Therefore, we should always be prepared because we never know what is around the corner.

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