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RPCNA Synod Paper on Pandemic Flu

   | | March 12, 2020 | Read time: 17 minutes



From 2008 Minutes of Synod of the Reformed Presbyterian Church of North America

Jon Adams presented the report of the committee to address issues concerning pandemic flu, Communication 08-3. The recommendation was adopted. The report as a whole was approved and is as follows:

Report of the Committee to review Paper 08-03

Recommendation:

That the Synod commend to the sessions of the RPCNA the information provided by the CDC (summarized in Appendix 8 of Paper 08-03) as helpful information in preparing for the possibility of pandemic flu.

Rationale:

1) Influenza pandemics have occurred on the average every 40 years over the last 400 years. The last pandemics occurred in 1918, 1957, and 1968. The last pandemic occurred 40 years ago.

2) Pandemic influenzas themselves vary greatly in severity. In a typical year, 10% of the US population is sickened with influenza; in 1918 25% of the population was sickened (25 million out of 105 million.) In a typical year in the U.S., 36,000 deaths occur due to seasonal influenza; during the 1918 Great Influenza 675,000 in the US died. World-wide, the 1918 pandemic infected over a billion people; over 50 million perished from it. Of all the American soldiers and sailors who died during World War I, 80% died from influenza.

3)    During most years 1 out of every 1000 infected people in the U.S. die from influenza; a death rate of 0.1%.  In 1918, an average of 25 out of every 1000 infected people in the US died, a death rate of 2.5%.  Death rates in the rest of the world ranged from 5-100%. In 1918 entire villages and towns were found to have been wiped out by the influenza. Currently, the avian influenza (bird flu) active in Asia has a death rate of over 60%; the death rate in Indonesia is 85%.

4)    The 1918 influenza pandemic occurred in 3 waves, each lasting 6-8 weeks over a period of 18 months. During these 6-8 week waves of illness, schools and churches were asked or ordered to close for public health reasons, and did so.

5)    The 1918 influenza virus was an avian flu virus, similar to what is circulating overseas.

6)    The exact strain of virus that will result in a pandemic is unknown; no effective vaccine can be prepared until the outbreak occurs and the virus is typed.

7)    By current technology, it takes a minimum of 6 months to manufacture sufficient quantities of a vaccine to meet current demand. There is currently not enough manufacturing capacity to make enough vaccine for the expected demand.

8)    The civil magistrate has asked for churches such as ours to assist in the tasks described in Appendix #8. Time will tell, but the work may be very great indeed.

Bill Weir | Scott Wilkinson | Jonathan Adams, chair

Communication #08-3

Dear Fathers and Brothers,

Our nation and the world face the possibility, and apparent probability, of another world-wide pandemic of influenza at some indefinite time in the future. In response to this threat, the Center for Disease Control (CDC) has developed a “Community Strategy for Pandemic Influenza Mitigation”: http://www.pandemicflu.gov/plan/community/commitigation.html which includes strategies for “faith-based organizations” and has issued a planning and management checklist for faith-based organizations at: http://www.pandemicflu.gov/plan/community/faithcomchecklist.html

Recommendation:

That this paper be endorsed by the Presbytery and passed on to the Synod for consideration. If approved by the Synod as a policy for the denomination, it could be disseminated to other NAPARC denominations for their consideration.

Appendix #8 of the first document deals specifically with “Faith-based organizations” and their part in preparation and response to a pandemic epidemic. The appendix is reproduced in its entirety:

Appendix 8

Pandemic Influenza Community Mitigation Interim Planning Guide for Faith-Based and Community Organizations Purpose

This Interim Planning Guide for Faith-based and Community Organizations is provided as a supplement to the Interim Pre-Pandemic Planning

Guidance:  Community Strategy for Pandemic Influenza Mitigation in the United States—Early, Targeted, Layered Use of Nonpharmaceutical Interventions.  The guide is intended to assist in pre-pandemic planning.  Individuals and families, employers, schools, and faith-based and community organizations will be asked to take certain steps (described below) to help limit the spread of a pandemic, mitigate disease and death, lessen the impact on the economy, and maintain societal functioning.  This guidance is based upon the best available current data and will be updated as new information becomes available. During the planning process, Federal, State, local, tribal, and territorial officials should review the laws, regulations, and policies that relate to these recommendations, and they should include stakeholders in the planning process and resolution of issues. Faith-based and community organizations (FBCOs) will be essential partners in protecting the public’s health and safety when an influenza pandemic occurs.  This Pandemic Influenza Community Mitigation Interim Planning Guide for Faith-Based and Community Organizations provides guidance for religious organizations (including, for example, places of worship—churches, synagogues, mosques, and temples—and faith-based social service providers), social service agencies, and community organizations in preparing for and responding to an influenza pandemic. When an influenza pandemic starts, public health officials will determine the severity of the pandemic and recommend actions to protect the community’s health.  People who become severely ill may need to be cared for in a hospital.  However, most people with influenza will be safely cared for at home.Community mitigation recommendations will be based on the severity of the pandemic and may include the following:

•    Asking ill people to voluntarily remain at home and not go to work or out in the community for about 7-10 days or until they are well and can no longer spread the infection to others (ill individuals will be treated with influenza antiviral medications, as appropriate, if these medications are effective and available).

•    Asking members of households with a person who is ill to voluntarily remain at home for about 7 days (household members may be provided with antiviral medications, if these medications are effective and sufficient in quantity and feasible mechanisms for their distribution have been developed).

•    Dismissing students from schools (including public and private schools as well as colleges and universities) and school-based activities and closure of childcare programs for up to 12 weeks, coupled with protecting children and teenagers through social distancing in the community to include reductions of out-of-school social contacts and community mixing.  Childcare programs discussed in this guidance include centers or facilities that provide care to any number of children in a nonresidential setting, large family childcare homes that provide care for seven or more children in the home of the provider and small family childcare homes that provide care to six or fewer children in the home of the provider.1

•    Recommending social distancing of adults in the community, which may include cancellation of large public gatherings; changing workplace environments and schedules to decrease social density and preserve a healthy workplace to the greatest extent possible without disrupting essential services; and ensuring work-leave policies to align incentives and facilitate adherence with the measures outlined above.

Planning now for a severe pandemic will help assure that your organization is prepared to implement these community recommendations. These preparedness efforts will be beneficial to your organization, volunteer and paid staff, and community, regardless of the severity of the pandemic.  The Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist (available at www.pandemicflu.gov/plan/community/faithcomchecklist.html) provides an approach to pandemic planning by FBCOs.  In addition, recommendations for implementation of pandemic mitigation strategies are available at www.pandemicflu.gov.  Reliable, accurate, and timely information on the status and severity of the pandemic also will be posted on www.pandemicflu.gov.  Additional information is available from the Centers for Disease Control and Prevention (CDC)

Hotline:  1-800-CDC-INFO (1-800-232-4636).  This line is available in English and Spanish, 24 hours a day, 7 days a week.  TTY: 1-888-232-6348.  Questions can be e-mailed to cdcinfo@cdc.gov.

Recommendations for Planning

1) Plan for ill individuals to remain at home

•  Plan for employee and volunteer staff absences during a pandemic due to personal illness.

o   Identify critical job functions and plan how to temporarily suspend non-critical activities, cross-train staff to cover critical functions, and cover the most critical functions with fewer staff.

o   Identify employees, volunteers, and members or clients that live alone or might need extra assistance if they need to stay home because they are ill.

o   Review Federal and State employment laws that identify your employer obligations and options for employees.

• Establish and clearly communicate policies on sick leave and employee compensation.

•  Encourage ill persons to stay home during a pandemic and establish return to work policies after illness.

•   Encourage leadership to model staying at home when ill as well as the use of proper cough and sneeze etiquette and hand hygiene.

• Where appropriate, align public health messages and recommendations with your organization’s values and beliefs.  For example, develop a culture that recognizes the positive behaviors of voluntarily staying home when ill to get well and avoid spreading infection to others.

•    Develop policies on what to do when a person becomes ill at the workplace.

• Advise employees, volunteers, and members or clients to look for information on taking care of ill people at home.  Such information will be posted on www.pandemicflu.gov.

2) Plan for all household members of a person who is ill to voluntarily remain at home

•  Plan for employee and volunteer staff absences during a pandemic related to family member illness.

o   Identify critical job functions and plan how to temporarily suspend non-critical activities, cross-train staff to cover critical functions, and cover the most critical functions with fewer staff.

o   Establish policies for alternate or flexible worksite (e.g., work via the Internet, e-mail, mailed or phone work assignments) and flexible work hours.

• Establish and clearly communicate policies on family leave and employee compensation, especially Federal laws and laws in your State regarding leave of workers who need to care for an ill family member or voluntarily remain at home.

• Establish and clearly communicate policies for volunteers to ensure that critical functions are covered.

•    Advise staff and members to look for information on taking care of ill people at home.  Such information will be posted on www.pandemicflu.gov.

3) Plan for dismissal of students and childcare closure

•    Find out how many employee and volunteer staff may have to stay at home to care for children if schools and childcare programs dismiss students.

o   Identify critical job functions and plan for temporarily suspending non-critical activities and cross-training staff to cover critical functions with fewer staff.

o   Establish policies for staff with children to work from home, if possible, and consider flexible work hours and schedules (e.g., staggered shifts).

•    Encourage staff with children to make plans for what they will do if officials recommend dismissal of students from schools and closure of childcare programs.  Instruct staff and volunteers not to bring their children to the workplace if childcare cannot be arranged.

•    In a severe pandemic, parents will be advised to protect their children by reducing out-of-school social contacts and mixing with other children.  Although limiting all outside contact may not be feasible, parents may be able to develop support systems with co-workers, friends, families, or neighbors, if they continue to need childcare.  For example, they could prepare a plan in which two to three families work together to supervise and provide care for a small group of infants and young children while their parents are at work (studies suggest that childcare group size of less than six children may be associated with fewer respiratory infections).2 

•    Help your staff explore about benefits they may be eligible for if they have to stay home to mind children for a prolonged period during a pandemic.

  1. Prepare your organization

•  Consider potential financial deficits due to emergencies when planning budgets.  This is useful for pandemic planning and many other unforeseen emergencies, such as fires and natural disasters.

• Many FBCOs rely on community-giving to support their activities. Develop strategies that will allow people to continue to make donations and contributions via the postal service, the Internet, or other means if they are at home for an extended period.

•  Develop a way to communicate with your employee and volunteer staff during an emergency to provide information and updates.

•  Meet with other FBCOs to develop collaborative efforts to keep your organizations running, such as large organizations collaborating with small ones or several small organizations working together.

  1. Plan for workplace and community social distancing measures

•  Learn about social distancing methods that may be used during a pandemic to limit person-to-person contact during a pandemic and reduce the spread of disease (e.g., reducing hand-shaking, limiting face-to-face meetings and shared workstations, work from home policies, staggered shifts).

•  Use social distancing measures to minimize close contact at your facility.  Determine how your facility could be rearranged to allow more distance between people during a pandemic.      

• Develop plans for alternatives to mass gatherings.  Examples could range from video messages on the Internet to e-mailed messages, mailed newsletters, pre-recorded messages from trusted leaders on a designated call-in phone number, and daily teaching guides from trusted leaders.

•  Encourage good hygiene at the workplace.  Provide staff, volunteers, and members with information about the importance of hand hygiene (information can be found at www.cdc.gov/cleanhands/) as well as convenient access to soap and water and alcohol-based hand gel in your facility.  Educate employees about covering their cough to prevent the spread of germs (see www.cdc.gov/flu/protect/covercough.htm).

•  Identify activities, rituals, and traditions, such as hand shaking, hugging, and other close-proximity forms of greeting that may need to be temporarily suspended or modified during a pandemic.

•  Review and implement guidance from the Occupational Safety and Health Administration (OSHA) to adopt appropriate work practices and precautions to protect employees from occupational exposure to influenza virus during a pandemic.  Risks of occupational exposure to influenza virus depends in part on whether or not jobs require close proximity to people potentially infected with the pandemic influenza virus or whether they are required to have either repeated or extended contact with the general public.  OSHA will post and periodically update such guidance on www.pandemicflu.gov. 

  1. Communicate with your employee and volunteer staff and members

•    Share your organization’s pandemic plan, including expected roles/actions for employee and volunteer staff and members during implementation.

•  Suggest that all employee, volunteers, and members or clients prepare for a pandemic.  Resources are available at www.pandemicflu.gov/plan/individual/checklist.html and www.ready.gov/america/index.html. For example, individuals and families should have a reserve supply of food and water.  People with more resources might consider obtaining enough supplies to support 1-2 other families in an emergency.

•  Ensure that your organization has up-to-date contact information for employees, volunteers, and members or clients, including names of family members, addresses, home, work, and cell phone numbers, e-mail addresses, and emergency contacts.  

  1. Help your Community

•  Identify people who are vulnerable and may need assistance in your community (i.e., elderly people who live alone, persons with disabilities, people with limited skill in speaking English, low-income families, children, or teens who may lack supervision).  Designate people from your organization to be responsible to check on specific vulnerable people or families.

•  Determine ways your facility might be used during a pandemic, such as a temporary care facility or a central distribution site for providing meals, supplies, or medicine to those who cannot obtain them.

• Identify and meet with local emergency responders, health departments, and healthcare organizations to learn about their planning and educate them about your organization’s planning.

•  Suggest that each household maintain a current list of emergency contacts in your community.

•  Meet with other FBCOs to develop collaborative efforts to care for those in need, such as large organizations partnering with small ones or several small organizations working together.

•    Identify employee and volunteer staff in advance who would be willing to help others in need during a pandemic and help them to receive training through the local health department, emergency services, or other resources.

•  Designate an experienced person who can take calls and organize individuals who call spontaneously to volunteer during an emergency to facilitate the best use of their particular skills and experience.

•    Develop or identify an existing mental health or counseling hotline that people in the community can call during a pandemic or other emergency.

•  Participate in community-wide exercises to enhance pandemic preparedness.

  1. Recovery

•    Assess which criteria would need to be met to resume normal operations.

•  Plan for the continued need for medical, mental health, and social services after a pandemic.

References: 1. American Academy of Pediatrics.  Children in Out-of-Home Child Care: Classification of Care Service.  In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases.  26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:124.

  1. Bradley RH. Child care and common communicable illnesses in children aged 37 to 54 months. Arch Pediatr Adolesc Med. 2003 Feb;157(2):196-200.

The reason for this paper to the Presbytery is to address the possibility ahead of time that during a pandemic, the Federal Government may request or even require that worship services be suspended for an indefinite period of time. This paper addresses some of the issues involved in complying.

It is the recommendation of our session that the Presbytery, and ultimately, the Synod, issue a guidance that complying with a federally issued request or mandate to temporarily suspend worship and other services during a pandemic is altogether right and proper, and that such compliance may be agreed to in the local congregation with a clear conscience.

Reasons for complying are as follows:

1) In explaining the 6th Commandment, the Larger Catechism states, “The duties required in the sixth commandment are all careful studies, and lawful endeavors, to preserve the life of ourselves and others, …”  Not gathering together during a pandemic may well be life-sparing for some.

2) The Federal Government is not outlawing worship according to the dictates of our conscience, in support of a prescribed manner of worship or no worship at all. Families and individuals are free to continue to worship.

3) Not complying, if directed or requested to do so by the authorities, would likely be a poor witness to the unbelieving world.

4)  Historical precedence supports such a temporary suspension of services: Books dealing with the 1918 pandemic state unequivocally that churches were asked to, and did temporarily close during the outbreak.

Some of the objections to complying may tentatively be answered as follows:

1) “We should just trust God for our protection.” In response, yes, we should trust God, He has however placed us in the 21st Century where means to somewhat limit the dreadful effects of a pandemic are known and should be utilized. It is a matter of stewardship of the lives of ourselves and others.

2) “The Federal Government has no constitutional authority to limit the peaceful gathering together of healthy people for the exercise of their religious freedom.” In response:  Thus far, the limitations being described are only in the form of suggestions or a request that gatherings be temporarily suspended.

It should be stated that past experience with pandemic influenza showed that the worst of the outbreak in a given geographic area lasted some 12 weeks. The 1918 “Spanish Flu” lasted 15 months in this country. It is likely, that the Federal Government, State, county, or municipal governments could request, and possibly even require, as they did in 1918, that places of worship, schools and universities, sporting events, etc. close their doors for the duration of a pandemic, perhaps for up to 12 weeks. Some areas in 1918 had recurrent phases of flu activity, necessitating two or more periods of time where public meetings were suspended and/or forbidden. This is a very long time for congregations of God’s people not to gather. A marked increase in home visitations by the elders and deacons, presuming that they themselves are able, might be necessary or desirable during this time. Further, Christians who were able in the past, were among those in the forefront providing care to those outside the church who were in need of care.

Lastly, the Internet, and specifically as an example, Sermonaudio (http://sermonaudio.com/main.asp) provide a means for the gospel to be preached and heard in such times. Congregations not already purchasing this service, at which our denomination already has a presence, are advised to consider doing so.

Recommendation:

That this paper be endorsed by the Presbytery and passed on to the Synod for consideration. If approved by the Synod as a policy for the denomination, it could be disseminated to other NAPARC denominations for their consideration.

Jonathan D. Adams, MD

Assoc. Professor of Family and Community Medicine

Medical Director, University Physician