Coronavirus – A Challenge to the Christian Community
On March 20th, 2020, Andy Crouch and Dave Blanchard of the Christian theology and culture thinktank Praxis, published a provocative article on how Christians should respond to the coronavirus pandemic titled, ‘Leading Beyond the Blizzard: Why Every Organization Is Now a Startup’.(1)
They posed the question as to whether COVID-19 would be a blizzard, lasting days, a winter, lasting months, or a mini-Ice Age whose ongoing effects would be felt for many years to come.
Now, 15 months on, it is now evident that the coronavirus pandemic is neither a blizzard nor a winter but a mini-Ice Age.
When case numbers fell dramatically worldwide in July and August 2020 many felt that the world had overreacted to the threat, but the second and third waves over New Year which brought far greater numbers of deaths have largely dispelled that notion.
Now with over 2.5 million dead, this pandemic ranks amongst the worst eight in history, eclipsed in the last century only by HIV/AIDS and the Spanish flu.
Even allowing for inaccurate reporting in the developing world, the affluent West has suffered most in terms of lives lost. By the most accurate measure, deaths per million population, 17 of the world’s 20 worst affected countries are in Europe.(2)
A Multitude of Responses
One of the most striking features of this pandemic is the way that it has exposed the deficiencies of some countries’ public health responses and demonstrated the strengths of others.
The UK, with a population of 68 million, has had over 120,000 deaths and a death rate now approaching 2,000 deaths per million population. This makes it the fifth worst on total death toll (exceeded only by the US, Brazil, India and Mexico) and sixth worst on deaths per million population.
Why has the UK performed so poorly? It’s really quite simple. We failed to close our borders, we let the virus escape into care homes, we introduced lockdown and mitigation measures too late, we lifted restrictions too early and never managed to make ‘track and trace’ work properly. The result has been one of the worst fatality rates in the world.
By contrast other island nations like New Zealand, Taiwan, Singapore and Japan, closed their borders early, didn’t allow the virus into care homes, implemented mitigating measures and early lockdown along with effective track and trace systems resulting in the lowest fatality rates in the world.
While living in the UK, I come originally from New Zealand, an island nation of just five million people which has recorded only 26 deaths at 5 deaths per million population. I have on my phone a photograph of our extended family group enjoying my uncle’s 90th birthday during the New Zealand summer with a complete absence of social distancing. Taiwan, with 23 million people, has done even better with 9 deaths in total and 0.4 deaths per million population. In other words, the UK death rate from COVID-19 is almost 400 times that of New Zealand and 4,000 times that of Taiwan.
Attempts to slow down the spread of the virus and protect health systems and the vulnerable population have had devastating effects on health and the world economy and aroused much controversy and debate. Lancet Editor, Richard Horton, put it starkly in July 2020:
This pandemic is dismantling the foundations for protecting and advancing health. […] Global health has entered a period of rapid reversal. De-development is the new norm. Yet no plan is in place, or even being proposed, to address this global regression in human health.(3)
He argued that coronavirus has ‘accentuated inequalities on all continents, across all societies’ with horrifying direct effects especially for the elderly, ethnic minorities, migrants, refugees, and health workers. But the indirect consequences of the pandemic will take longer to manifest.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has calculated that COVID-19 will dislocate health systems to such an extent that an additional 1.4 million deaths from these three diseases will follow.
The World Bank has revised its estimates upwards of those likely to be tipped into extreme poverty by COVID-19 to an additional 71–100 million people living on less than $1.90 per day.(4) The World Food Programme chief warned that 265 million people would likely face starvation by the end of 2020 because of COVID-19.(5)
The WHO Director General suggested that the number of children dying from missed vaccinations is likely to far outpace the numbers of people dying from COVID-19.(6) UNICEF warned about threats to unwind decades of progress against vaccine-preventable diseases like measles, polio, typhoid, yellow fever, cholera, rotavirus, HPV, meningitis A and rubella.(7)
A WHO survey from 155 countries suggested that because of the pandemic there would be huge effects on the management of non-communicable diseases: 53% would suffer partial or complete disruption for hypertension treatment, 49% for treatment for diabetes and diabetes-related complications, 42% for cancer treatment and 31% for cardiovascular emergencies.(8)
A large study has found that 20% of those infected with the coronavirus are diagnosed with a psychiatric disorder within 90 days. Anxiety, depression and insomnia were most common among recovered COVID-19 patients.(9)
The Center for Disease Control (CDC) in August 2020 reported that a quarter of young Americans had serious mental health issues.(10) There had been an increase in drug overdose deaths,(11) amid lockdowns and economic uncertainty, and a tripling of the number of young people developing symptoms of anxiety within the United States over the previous year.(12) 25.5 percent of Americans aged 18 to 24 had seriously considered suicide during the COVID-19 pandemic, in part due to stay-at-home orders. The prevalence of depressive disorder was also approximately four times that reported in the second quarter of 2019.
Especially in developing countries where lockdown measures have been most draconian, where health and transport systems are most vulnerable and where many live hand-to-mouth under a cash economy, the dangers of poverty leading to hunger and famine, family breakdown, domestic abuse and stigma, and crucial medicines becoming less accessible are so much greater.
The initial first wave COVID-19 morbidity and mortality is being followed by three as yet unmeasured waves in non-COVID-19 morbidity and mortality – the impact of resource restriction on urgent non-COVID-19 conditions, the impact of interrupted care on chronic conditions and the mental health sequelae of psychological trauma, mental illness and burnout.
I have concentrated on health-related sequelae but the economic effects from the shutdown of businesses and the cost of supporting workers made redundant has led to levels of international debt not seen since World War II. The economic situation is unlikely to improve anytime soon. Falling revenues combined with costly pandemic relief measures have increased global debt by $20 trillion since the third quarter of 2019. By the end of 2020, economists had anticipated global debt to reach $277 trillion, or 365% of world GDP.(13)
Overall, the last year has also resulted in a widening gap between the rich and the poor – those with savings, investments and property have grown richer and those without have grown poorer. Some of the biggest beneficiaries have been the owners and shareholders of big technology companies (FAANG).(14)
The world has been left between Scylla and Charybdis, not knowing which was worse: the disease itself, or the health and economic consequences of trying to control it.
Not surprisingly this has led to great controversies about how the crisis should have been managed with opinion often divided often along party political lines. Should we prioritise protecting the vulnerable or protecting the economy? Should it be full lockdown or intermittent release? Should we seek to eliminate the virus completely or instead aim at moderate control? Should we go for ‘focused protection’ (of the vulnerable) and ‘herd immunity’ (for everyone else) or try instead to suppress and control community spread?(15)
There have also been arguments about the science itself. What was the real IFP? (Infection Fatality Proportion).(16) Is seroprevalence a reliable measure of immunity or have we underestimated it by ignoring the possible contribution of IgA, BCG and T cell immunity? Might drugs like hydroxychloroquine or ivermectin play a role in treatment, or perhaps post-convalescent plasma?
The debates over these issues have often generated more heat than light with groups of professionals aligning themselves on one side or other with coalitions and petitions such as the ‘Great Barrington Declaration’(17) and the ‘John Snow Memorandum’.(18) Respective proponents have rarely changed sides.
Vaccines – the Great Game-Changer
Much of this has been rendered irrelevant as vaccines, developed at truly astonishing speed, have been the great game changer.
Several vaccines are now in use with the big five in the developed world being Pfizer, AstraZeneca, Moderna, Janssen and Novovax. The first mass vaccination programme started in early December 2020 and by February 15th, 2021, 175.3 million vaccine doses had been administered, using at least seven different vaccines.(19)
Israel has been the first country to see the impact of its vaccination programme after vaccinating 80% of its over-60s. The data show that the biggest falls in hospital admissions and deaths have been in this age group, who were vaccinated first.(20)
By January 14th, 2021, Israel had administered 72 doses per hundred people, followed by UAE (50), UK (23) and US (15) – these four leading countries were way ahead of Germany (4.7), China (2.8), Russia (2.7), Brazil (2.4) and India (0.4).(21)
The speedy rollout of the vaccine to all vulnerable people globally will be critical to reducing the pandemic’s death toll, relieving pressure on health services, and reversing lockdown and its societal and economic sequelae.
The impact of COVID-19 vaccines on the pandemic will depend on several factors. These include the effectiveness of the vaccines; how quickly they are approved, manufactured, and delivered; the possible development of other variants and how many people get vaccinated.
But things could have been so much worse. The Serotracker website,(22) which tracks antibody studies worldwide, has now documented 826 seroprevalence studies in 73 countries, and shows that even in the heavily affected countries of Europe, immunity levels from infection alone are only about 10-15%, which means that, had vaccines not arrived when they did, we would have faced being locked down and/or suffering many more deaths for much longer.
Whilst mitigatory measures – social distancing, hand hygiene and masks – are extremely effective in suppressing viral spread, and therefore limiting deaths and protecting healthcare delivery systems, they only slow down the inevitable advance of the virus.
Challenges with Vaccine Rollout
Vaccine inequality is a huge challenge. The World Health Organization chief on January 18th, 2021 lambasted drug makers’ profits and vaccine inequalities, saying it’s ‘not right’ that younger, healthier adults in wealthy countries get vaccinated against COVID-19 before older people or health care workers in poorer countries and charging that most vaccine makers have targeted locations where ‘profits are highest’.
Director-General Tedros Adhanom Ghebreyesus kicked off WHO’s week-long executive board meeting, virtually from its headquarters in Geneva, by lamenting that one poor country received a mere 25 vaccine doses while over 39 million doses had been administered in nearly 50 richer nations.(23)
It is hoped that COVAX will change all this. As none are safe until all are safe, global equitable access to a vaccine, particularly protecting health care workers and those most-at-risk, is the only way to mitigate the public health and economic impact of the pandemic.
COVAX is a collaborative international initiative working towards the development, purchase and delivery of vaccines to more than 180 countries. It was launched in April 2020 and is led by the World Health Organization (WHO), together with the Global Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations.
There is now growing support for the scheme from both the G7 and the British government,(24) both of which will have large numbers of surplus vaccines to give to low- and middle-income countries (LMICs).
But international roll out is not straightforward. Once vaccines are demonstrated to be safe and efficacious, they must be authorized by national regulators, manufactured to exacting standards, and distributed. Some countries will find this extremely challenging.
SARS-CoV-2, the virus that causes COVID-19, keeps changing, generating new and more transmissible versions, as the world scrambles to stay ahead of the pandemic.(25) First, last September, a UK variant caused an explosion of new cases, then two more emerged in South Africa and Brazil.
The UK variant (B.1.1.7), which is about 50% more contagious than SARS-CoV-2 and accounts for more than 60% of positive tests in the UK, has spread to over 75 countries. The Brazil variant caused an explosion of cases in Manaus, the province’s capital, causing a dire oxygen shortage.(26) The South Africa variant (B.1.351) has been found in 32 countries and is now dominant in Zimbabwe.(27)
The RSA variant (B.1.351), also known as 501.V2, includes the E484K spike protein mutation, which could explain why some vaccines are less effective against it.(28) A non-peer-reviewed study reportedly showed that the AstraZeneca/Oxford jab appeared to offer only limited protection against mild disease caused by this variant.(29) Similarly, protection against mild and moderate cases dropped from 66% to 57% for the Johnson & Johnson one-shot vaccine and from 89% to 60% for Novovax.
The Moderna and Pfizer/BioNTech vaccines, while still effective, were less effective against this variant than they were against other strains in the UK. But these latter two vaccines use mRNA technology, which allows for reconfiguration to transmit different genetic instructions more easily.
There are many strict protections in place to help ensure that COVID-19 vaccines are safe. Like all vaccines, COVID-19 vaccines are going through a rigorous, multi-stage testing process, including large (phase III) trials that involve tens of thousands of people.(30)
Whilst trials have shown several COVID-19 vaccines to have high levels of efficacy, like all other vaccines, COVID-19 vaccines will not be 100% effective, but they are already having a spectacular effect on reducing serious illness.(31)
Vaccine hesitancy is fuelled both by misinformation and by genuine fears people have about whether corners have been cut in vaccine production, whether vaccines are safe and whether vested financial or ideological interests have distorted vaccination agendas.
Many countries have very low proportions of people who believe vaccines are safe, according to analysis published by The Lancet.(32) In Lithuania, the proportion is just 19% but in countries such as Finland, France, Italy, Ireland and the UK confidence levels have increased steadily and by last November 52% of Britons agreed vaccines were safe.
These fears have been fuelled by quasi-scientific websites spreading misinformation, often attractively and persuasively presented and then propagated and promoted by friendly mainstream media journalists and ‘influencers’ on social media.
Professor John Wyatt of CMF UK has published a helpful blogpost on the ICMDA website on frequently asked questions about COVID-19 vaccines.(33) Also helpful on countering misinformation is his review of the conspiracy theories about COVID-19 vaccines which are currently trending(34) and advice from the World Health Organisation about how to assess and verify potential misinformation found online.(35)
A new website (Anti-Virus: The COVID-19 FAQ) run by clinicians and researchers debunks COVID-19 scepticism and tackles some of the more prominent COVID-sceptics head-on.(36) The editors are systematic in referencing the current peer reviewed literature and in refuting arguments line by line, rather than ad hominem.
How Should the Christian Community Respond?
How should the Christian community respond at this stage in the crisis and, specifically, what role might Christian doctors play?
Don’t Be Dismayed
Pandemics, like earthquakes, floods, wars and other disasters, should not surprise Christians. Jesus specifically warned of about ‘pestilences’ being one of the signs of His coming that would characterise the ‘last days’ between His resurrection and return.(37) Plagues, almost always in Scripture, are a sign of God’s judgement on groups, nations or empires.(38) The western world, in particular, with its flagrant idolatry, sexual immorality and shedding of innocent blood, bears all the signs of such an end-stage culture. Certainly, we are no better than the Babylonians, Greeks and Romans who preceded us and interestingly, this pandemic seems not to have led to repentance or revival but rather a heady confidence in human solutions. We see God’s extraordinary mercy given how much worse this pandemic could have been – imagine a virus with the virulence of Ebola and as easily transmissible as chicken pox. But judgement is surely coming.
Don’t Be Discouraged
We need to remember that God is absolutely in control. He is sovereign over every aspect of the COVID-19 pandemic. He determines the rise and fall of governments,(39) the decisions of political leaders,(40) the course of infectious diseases,(41) the development of vaccines and medical treatments and the mode and timing of our lives and deaths.(42) He weaves all life’s events into His tapestry and works in and through all things for the good of those who love Him.(43) He rules over everything and turns every evil intention of man for good.(44) His will shall be done on earth as in heaven.
Don’t Be Distracted
We need to guard against being distracted by what is going on around us from God’s purposes for this world. COVID-19 has changed many things, but it has not changed anything of lasting importance: Humanity’s need of the Gospel;(45) Jesus Christ’s Great Commission;(46) the certain growth of God’s Kingdom;(47) the call to His disciples to preach and to heal;(48) His imminent return once the Gospel has reached all nations;(49) the certainty of the coming judgement;(50) the new heaven and new earth.(51) If anything, the pandemic should serve to sharpen and clarify our true priorities.
Don’t Succumb to Disunity
It is distressing to see how responses to the pandemic have divided Christians often along political lines, rather like Trump and Brexit. We must be careful that we are not being drawn into sectarian echo chambers where everyone thinks the same about everything and those who do not hold to the prevalent groupthink are marginalised. This is why it is so important that we remain united on those things of primary importance, while remaining free to debate our disagreements, whilst maintaining fellowship with each other: ‘in essentials unity, in non-essentials liberty, in all things charity’. Let’s be careful to speak well of each other and not be drawn into public ad hominem disputes.
Don’t Surrender to Disinformation
Jesus prayed in the Garden of Gethsemane that His disciples would be unified, but also that they would be sanctified in the truth.(52) It does no credit to the church in the eyes of the world when we ourselves are responsible for spreading misinformation or speaking before we have verified our position. As doctors we have a major role to play here in countering conspiracy theories and untruths spread on social media that may have misled those in our congregations who may not have the background knowledge to evaluate fully what they are reading. If people choose not to be vaccinated, for example, because they have read something spurious on social media, and later catch the virus and succumb, we share the responsibility if we remain silent when we could have spoken out.
Don’t Be Dismissive of Real Concerns
While it is right to be cautious of conspiracy theories, we must not be dismissive about concerns about the loss of civil liberties fuelled by lockdowns. While we do not fight against flesh and blood,(53) we know that there is a cosmic conspiracy at work, whereby the god of this world (Satan) is seeking to deceive human beings into believing lies and drawing them into bondage.(54) The COVID-19 pandemic has accelerated the accumulation of power and information into fewer powerful hands – whether it is the coercive surveillance communism of Orwell’s 1984, seen in authoritarian states, or the seductive surveillance capitalism of Huxley’s Brave New World, seen in the West. Governments and multinational corporations have more and more power over us through the information they hold and the political and financial power that they wield to make us do what they want. We need to be aware how this could potentially be used against us in the future.
Finally, we must remember that behind the grey clouds of COVID-19’s threat, is a silver lining of opportunity for the church. We are called to be salt and light – to be ‘in the world’ but not ‘of the world’. As doctors we have the tools to serve on the front line in spreading good information, giving vaccines, treating and caring for the sick, comforting the anxious and bereaved and allaying fears. As Christians, we have a duty to exercise a prophetic voice, to challenge misinformation and hold out the Gospel of hope to those for whom the pandemic has raised serious questions about the meaning of life, death and suffering. Let us not be ashamed of Jesus Christ or of His glorious Gospel, which is “the power of God for the salvation of everyone who believes.”(55)
 Facebook, Amazon, Apple, Netflix, Google
 Luke 21:11
 Daniel 2, 4 & 7
 Proverbs 21:1
 Luke 21:11
 Psalm 139:16
 Romans 8:28
 Genesis 50:20
 Romans 1:1-5, 16-17
 Matthew 28:19, 20; Acts 1:8
 Matthew 16:18
 Matthew 4:23, 9:36; Luke 4:18, 19
 Matthew 24:14
 Hebrews 9:27; Revelation 20:11-15
 Revelation 21:1-4
 John 17:13-23
 Ephesians 6:12
 2 Corinthians 4:4
 Romans 1:16