Courage in the Crisis
CMDA and COVID-19
Care for the Frontline Healthcare Worker as the Coronavirus Progresses
Are you worried about spreading the disease to your family? Are you ramping up to fight the virus or being placed on standby because much of your work is elective or “noncritical?” Are you fearful for the future, whether your health, your finances or your job?
If you’re asking yourself these questions and more, remember that you are not alone! CMDA is here for you for such a time as this. As a ministry for Christians in healthcare, we stand ready to pray for you, to assist you in any way we can and to offer resources to help you sustain the onslaught of extra work.
We are going to be here with you every step of the way, so check back often for the latest information and resources to help you as you fight against COVID-19.
Part of the mission of Christian Medical & Dental Associations (CMDA) is to glorify God by caring for all people and advancing Biblical principles of healthcare within the Church and throughout the world. With that in mind, CMDA has enlisted several expert members to provide guidance to church leaders as they wrestle with the problem of re-opening their services within the ongoing COVID-19 pandemic.
Statement of the Problem
Religious involvement correlates with the following health benefits through various pathways:
- Decreased overall mortality
- Improved outcomes with chronic conditions such as diabetes
- Increased ability to cope with stress
- Decreased depression, suicide, and anxiety
- Some evidence of decreased blood pressure
- This has been shown to be especially true for vulnerable sub-groups in the African American community
However, attendance at religious services has been labeled “high risk” for SARS-CoV-2/COVID-19 exposure due to “enclosed space, prolonged close contact, potential clustering of people, high-touch surfaces, singing, and projection of voice”. Thus, many congregations in the United States have gone through a period of not gathering in person because of state restrictions. As the pandemic continues, churches have been placed in the unfortunate position of having to weigh the risks of reopening with the benefits of gathering in person amid conflicting interstate and intrastate guidelines.
Thus, the purpose of these guidelines is to provide evidence-based recommendations for Christian communities who wish to reopen safely. Though evidence-based, these guidelines are not intended to replace government ordinances or health regulations and should be considered in light of local guidance which accounts for the community prevalence of SARS-CoV-2/COVID-19 and available resources.
Summary of Recommendations[1]:
Critical Question 1: How many people can safely gather in a given area for worship services?
Recommendation: The number of people that could gather safely for worship should be determined by the type of space (enclosed or open-air), size of meeting area, and safety measures enacted. Such gatherings should avoid having a large number of participants, unmasked, in closer proximity than 6 feet between households for a prolonged period of time in an enclosed space without hand sanitizer or hygiene measures.
Critical Question 2: Is it safe to practice the sacrament of communion?
Recommendation: Communion can be safely done using single-serving, pre-packaged communion.
Critical Question 3: Is it safe to practice the sacrament of baptism?
Recommendation: Baptism may be safely done with clean water. For serial baptisms in the same baptistry, the baptismal should be heated above 23oC and treated with chlorine to decrease the risk of transmission of SARS-CoV-2/COVID-19. We recommend that the person performing the baptism wear a mask, practice hand hygiene prior to the baptism, and defer to someone else if he/she has any symptoms compatible with SARS-CoV-2/COVID-19 infection.
Critical Question 4: Is it safe to have a choir performance/practice?
Recommendation: Choir practices or performances that have a large number of participants, unmasked, in close proximity to one another for a prolonged period of time in an enclosed space with shared food, commonly touched items, and non-socially distanced interactions before and after will increase the risk of transmitting SARS-CoV-2/COVID-19 infection if one of the participants is infected. Therefore, choir rehearsals and performances should avoid these factors to decrease the risk of spreading SARS-CoV-2/COVID-19 infection.
Critical Question 5: When can congregational singing be done safely?
Recommendation: Alternatives to congregational singing likely have the least risk for SARS-CoV-2/COVID-19 transmission. With the uncertainty regarding congregational singing, we recommend thoughtful consideration of alternatives. If congregational singing must be done due to specific faith convictions or practices, we recommend the following to decrease risk of SARS-CoV-2/COVID-19 transmission:
- Singing outdoors rather than in an enclosed space when possible,
- Maintaining a minimum distance of 6 feet between congregants, and
- Wearing masks while singing, and
- Singing in a quiet, subdued voice.
Critical Question 6: Is it safe to have wind, percussion, and/or string instrumental accompaniment in worship?
Recommendation: The use of instrumental accompaniment in worship does not appear to increase the risk of spreading SARS-CoV-2/COVID-19 infection when appropriate distancing and hygiene measures can be followed.
Critical Question 7: What general measures should be considered for all worship gatherings?
Recommendation: Social distance (minimum of 6 feet between households) at all times including during entry and exit, wearing of masks, availability of hand sanitizer, and frequent hand washing should be done. Consideration should be given to vulnerable populations in the congregation as defined by the CDC. We recommend that masks be worn continuously unless you become short of breath, and then they may be removed for a brief 30 second interval. If you experience continued shortness of breath with a mask, it would be best for you to get up and go outside.
Further guidance regarding children will be provided in the near future.
Guideline Committee
Timothy Jang, MD, Professor of Clinical Emergency Medicine, David Geffen School of Medicine at UCLA, Associate Editor, Academic Emergency Medicine
Kristen Ojo, MHS CPH, Co-leader, Side by Side Twin Cities Chapter, A Ministry of CMDA for Medical Wives
Ifelayo Ojo, MBBS, MPH, Assistant Professor of Pediatrics, University of Minnesota Medical School, Pediatrician, Hennepin Healthcare
Amenah A. Agunwamba, ScD, MPH, Assistant Professor of Health Services Research, Mayo Clinic, Department of Health Sciences Research
Jeffrey Barrows, DO, MA, Senior VP Bioethics and Public Policy, Christian Medical and Dental Associations
Secondary Reviewers
David Kim, MD, MBA, Chief Executive Officer, Beacon Christian Community Health Center, Staten Island, NY
Janet Kim, MD, MPH, FAAP, MA, Chief Medical Officer, Beacon Christian Community Health Center, Staten Island, NY
[1] For the evidence and strength of each recommendation, please see the attached addendum which includes a description of the literature search, assessment of the data, and further discussion.
Virtual Doctoring, Virtual Church, Virtual Life
by Amy Givler, MD
When this pandemic started, I, at least, had heard of Zoom. My husband Don, also a family physician, had no clue. We’re both in our 60s and feel simultaneously confused and outdated whenever a new form of technology emerges. Picture a donkey leaning back on the rope held by someone trying to drag it forward. You get the idea.
When in a pinch, however, we are capable of learning. And COVID-19, if it is anything, is certainly a pinch. Within a week of Louisiana’s lockdown in mid-March, we were watching our church online, and within two weeks Don was leading Sunday School via Zoom. In fact, the first Zoom meeting he ever attended was one he led.
Two months later, Louisiana again allowed in-person church with reduced capacity, but I didn’t return. Being a physician puts me at higher risk of infection, and our church has many older adults. I didn’t want to unknowingly infect them if I was pre-symptomatic. Happily, they continue to live stream the service, so I have maintained a sense of connection. But I miss my church family—the people. I miss the gathering, the greeting, the hugging, the sitting next to people who are also focused on connecting with God.
CMDA's Position on Mass Gatherings:
Romans 13: 1, 2 gives clear guidance in times like these. “1Every person is to be in subjection to the governing authorities. For there is no authority except from God, and those which exist are established by God. 2Therefore whoever resists authority has opposed the ordinance of God; and they who have opposed will receive condemnation upon themselves. Christian Medical & Dental Associations endorses the efforts of state and federal government authorities to mitigate the spread of the coronavirus by limiting large gatherings. We believe that churches that ignore those instructions are placing their congregants at increased exposure and risk of SARS-Co-V-2 (Covid-19) infection and therefore we cannot condone such decisions or actions by churches.
Thomas Okamoto, PhD: Mental Health in the COVID-19 Pandemic