For centuries, Christian pastors have pondered myriad ways to deal with communities that have become increasingly sick of church. This fall they may need to turn their attention inward to those who are sick in church, thanks to an expected widespread breakout of swine flu or H1N1.
"Church leaders are frequently one of the most credible sources of information for their flocks," said Dr. Donald Thompson, senior medical and public health program director for the Center for Infrastructure Protection at George Mason University School of Law. "Leaders and workers in churches need to be up to speed. People will look to them as a trusted agent. They can't just say 'I'm just an authority of this Book.' Church leaders are authority figures. They need to know the landscape in which their sheep are grazing."
The retired Air Force Colonel, under the direction of the Department of Homeland Security, is developing policy to help contain the influenza. His experience has included policy development related to bioterrorism and public health threats, including early disease detection.
Thompson is also a member and spokesman for the Christian Medical & Dental Associations, which is in the process of developing its own paper on how to minimize the spread of the virus in different situations, including churches, public places, work and school environments.
"This is something newer that is hitting public health officials," Thompson said.
Part of the problem for public health officials is getting to know the personality of the H1N1 virus. How aggressive is it? Who is most vulnerable? How is it best managed? What are the clinical symptoms? How is it is transferred from person to person?
Thompson said because there were so many unknowns last spring, officials responded conservatively with swift and decisive action, in some instances closing schools following the report of even one case.
"At the time it wasn't overreacting because very little was known about the virus," Thompson said. "As more is learned, more information and more recommendations will come out."
Dr. Wilma Wooten, the public health officer for the county of San Diego, has been monitoring the local situation since the first case emerged here in April. Since then just over 1,000 confirmed cases have been reported in San Diego County, with 22 deaths and nearly 275 hospitalizations.
"We have no idea what to expect, but we can plan for the worse," Wooten said.
Help or hindrance?
Churches bring an interesting dynamic to the equation because they can become rampant germ centers, while also offering a variety of resources in the event of a pandemic, including use of their large gathering areas for vaccine depots or isolation centers. Church networks can also be tapped as quick information hubs.
For now, Wooten said, churches are not being asked to take extraordinary steps beyond planning and diligence.
"We are not advocating any social distancing," she said. "We don't want to encourage people to stay away from church. Nobody wants that. If you are sick, stay home. That is voluntary isolation."
If a breakout produces epic numbers, then churches and other larger gatherings such as malls and sporting events could be forced to shut down.
In addition to gathering in close quarters, churches can make their members vulnerable through corporate communion.
"There is the potential of spreading infections with that," Wooten said.
Of particular concern are churches whose tradition is to share the wine using a chalice. Earlier this year, some Catholic dioceses recommended alternatives to its tradition to help thwart the spread of H1N1.
"The sharing of the cup is very sensitive," Wooten said, adding that churches need to best decide how to handle the issue.
Thompson recommends prudence.
"It will be more important not to share things," he said. "Avoiding person-to-person contact in the thick of things is going to be really important."
Meeting physical needs
Churches, Thompson said, need to be proactive in protecting the most vulnerable, which includes pregnant women. Although they account for just one percent of the general population, statistics show they represent 6 percent of the H1N1 deaths to date.
Others who are vulnerable are those aged six months to 24 years old, and those with existing medical conditions such as diabetes, asthma, kidney disease and immune disorders.
"It's finding people who are at high risk and making them scarce," he said of prevention measures.
Logistically, Thompson said he believes the biggest challenge for churches will be the nursery areas and then protecting pregnant members.
"If H1N1 is burning through someone's community, the church has several options," he said.
One approach churches should consider, the disease expert said, is breaking down large classes and gatherings into smaller units so an outbreak would be confined to just that small cell.
"Don't allow mixing between the groups," he said.
For instance, a nursery of 30 children could be broken down into five cells of just six children. In the event of an outbreak, that cell could easily be isolated. Doing so, though, requires more staff. Churches could also limit all gatherings to just small groups, canceling worship services until the threat has waned.
"Instead of having 300 people in a building, you have 30 people in a home group," he said.
He also recommends that churches assign each family to an elder and have the lay leader be responsible for assessing needs and finding ways to help parishioners. Although a visitation program sounds irresponsible in the wake of a pandemic, Thompson said, it's important that isolated members are not left alone. Immigrant populations are also at risk since they often don't have established networks.
"When you have a few hundred people who are sick, that's when you need (visitation programs) the most," he said.
At a Sept. 15 meeting of the San Diego VOAD, an acronym for Voluntary Organizations Active in Disaster, a representative from the county suggested to those attending that churches, schools and other organizations with regular meetings should consider how they might respond to a major outbreak, perhaps holding services online or as Webcasts.
Because the at-risk group differs from seasonal flu, health experts are concerned the virus could be more widespread. Seasonal influenza, for instance, is generally more risky to people 65 and older and children under 5. Both these groups tend to be less mobile, meaning exposure to others is limited. Not so with swine flu, which targets young adults and pregnant moms.
"The vectors of transmission in this illness are much more active and they live with people who are the backbone of society," he said. "This one is changing the rules."
One university in Washington reported 2,500 cases of the flu within the first few weeks of school, with the number of cases increasing by 100 percent in one week.
"That's huge," the doctor said.
In addition to the physical aspects of a large outbreak, churches will also need to deal with the repercussions for parents who may need financial assistance if an outbreak requires them to spend an extended time at home taking care of sick children.
"Then it goes right back to the church, providing for needs," he said.
While signs abound that the outbreak could be severe, Thompson said most Americans will fare well with the virus, adding that recovery is usually within three to five days. In most of the cases of death, the patient had underlying medial problems.
The retired colonel said he is also confident in public health officials' ability to deal with the issue because many agencies were already prepared in anticipation of an Avian flu scare.
So, it boils down, he said, to being prepared and sensible.
"Our Lord is still on His throne," Thompson said. "There are no molecules or bacteria out there that the Lord doesn't know about."