How can we safely worship at church in a pandemic?

Many types of gatherings are important for civic and economic well-being; religious worship has particularly profound significance to communities and individuals, including as a right protected by the First Amendment.

in whom the whole structure, being joined together, grows into a holy temple in the Lord.  In him you also are being built together into a dwelling place for God by the Spirit.

Ephesians 2:21-22, ESV

The Holy Bible, English Standard Version. ESV® Text Edition: 2016. Copyright © 2001 by Crossway Bibles, a publishing ministry of Good News Publishers.

(Although this post addresses the Christian faith, I hope other communities of faith find this useful.)

update November 30, 2020

“As an association of Christian healthcare professionals, CMDA urgently requests that churches strongly consider taking their services online and cancel in-person gatherings until this current surge of COVID-19 cases passes.”

quote from “A Plea to Our Churches”, CMDA

IMG_2629.jpg
San Fernando Cathedral, San Antonio, Texas

 “Closing” our churches

Many of us have not attended a religious service in person since March, when almost every activity outside our homes ceased in order to limit spread of SARS CoV-2 infection.

Unfortunately churches were lumped into the category of “non-essential”, although we all realize how essential our religious establishments are. But in the context of a serious viral pandemic, our public health professionals believed it was necessary to prohibit all large public indoor gatherings.

Of course, the “Church” never closes; people who consider themselves the Church practice their faith in places other than a designated building-in their homes, in a park, at work, online. My local church already had an online presence so we’ve never missed a week of having teaching and prayer.

My state opened relatively early, and my church reopened soon after. They arranged the sanctuary for social distancing, performed extra cleaning, and now require masks. However, due to our age, my husband and I have chosen to continue worshiping from home.

St. Hedwig Church in Chicago Illinois
St. Hedwig Church in Chicago Illinois

“Reopening” our churches

The CDC, state, and local health departments have issued guidelines for reopening public facilities of all kinds, including churches, and I encourage you to consult those. A private association of Christian physicians and dentists also developed guidelines specific to the needs of churches. (Although these guidelines are directed toward those who practice the Christian faith, I believe that others can apply them to their worship practices.)

7 recommendations for church gatherings during COVID-19
7 recommendations for church gatherings during COVID-19 from the Christian Medical and Dental Associations

The Christian Medical and Dental Associations, CMDA, had a specific purpose in writing their guidelines. As stated-

Part of the mission of 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.

Members of the association are all physicians and dentists-students, residents, clinicians, teachers, missionaries, and retired. And they are active members of churches all over the world. So they are in a unique position to consider both the needs of the Church and the needs of public health and safety.

CMDA Guidelines For Reopening Churches

  • Consider size of the area for enclosed gatherings to accommodate social distancing.
  • Offer communion using single use, prepackaged supplies.
  • For baptism, use heated and disinfected water .
  • Limit choir participants and assure adequate social distance , especially if unmasked.
  • Use extra precautions for congregational singing if not done outdoors.
  • For instruments, ensure social distance and limit sharing of equipment.
  • Social distancing, hand hygiene, and masks are recommended for all attendees.

I encourage you to follow the link to the full document which explains the reasons for the recommendations and includes links to pertinent references.

a simple white church flanked by autumn trees
a church in Talulla Falls Georgia

There is no guarantee that even with these measures cases of COVID-19 will not occur due to transmission at a church. Ohio has had several COVID-19 outbreaks recently, many of which the Ohio Department of Health traced to bars, restaurants, churches, and day care centers. Outbreaks in other states have been linked to attendance at church events, including weddings and funerals.

the purpose of these guidelines is to provide evidence-based recommendations for Christian communities who wish to reopen safely.

Though evidence-based, however, these guidelines are not intended to replace government ordinances or health regulations and should be considered in light of local guidance which account for the community prevalence of SARS-CoV-2/COVID-19 and available resources.

CMDA

 

The Constitution and the CDC

Does closing churches for health reasons violate the Constitution? According to the First Amendment (the first ten amendments are called the Bill of Rights)

Congress shall make no law respecting the establishment of religion, or prohibiting the free exercise thereof; …

Amendment 1, the U.S. Constitution

I suppose it depends on your definition of “the free exercise” thereof.

  • Have we been told to renounce our faith?
  • Are we prohibited from owning or reading our Bibles and other spiritual writings?
  • Can we watch or listen to religious programs on television, radio, and the internet?
  • Can our clergy and teachers continue to preach and instruct?
According to the Centers for Disease Control and Prevention

“This guidance (about church activity during a pandemic) is not intended to infringe on rights protected by the First Amendment to the U.S. Constitution or any other federal law, including the Religious Freedom Restoration Act of 1993 (RFRA).

The federal government may not prescribe standards for interactions of faith communities in houses of worship, and in accordance with the First Amendment, no faith community should be asked to adopt any mitigation strategies that are more stringent than the mitigation strategies asked of similarly situated entities or activities.

while many types of gatherings are important for civic and economic well-being, religious worship has particularly profound significance to communities and individuals, including as a right protected by the First Amendment.

State and local authorities are reminded to take this vital right into account when establishing their own re-opening plans. “

Here’s another post you may enjoy reading

San Fernando Cathedral

San Fernando Cathedral was founded on March 9, 1731 by a group of 15 families who came from the Canary Islands at the invitation of King Phillip V of Spain and is the oldest, continuously functioning religious community in the State of Texas.

 

 

 

 

 

 

 

sharing the HEART of health, faith, hope, and love

I took all of the photos in this post on vacations over several years. They are for illustration only, and do not represent CMDA or the guidelines described in this post. I am a member of the Christian Medical and Dental Associations but had no part in writing the guidelines,with which I agree.

 

 

FAITH LOVE HOPE- words created with letter tiles
These three remain, faith, hope and love, and greatest of these is love. 1 Corinthians 13:13
Dr. Aletha

Using double duty drugs-COVID-19, migraine, and shingles

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

In this post I’m reviewing some drugs that treat multiple conditions. This post was updated August 5, 2020.

Many drugs originally developed to prevent or treat one condition can be “repurposed” to treat another.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

Please do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with your physician or other qualified healthcare provider.

Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates.
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates credit James Gathany, public domain

Treatment options for COVID-19

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

Chloroquine, an old malaria drug and its cousin hydroxychloroquine, used for rheumatoid arthritis and lupus received EUA, Emergency Use Authorization, from the FDA for use against COVID-19. At first it looked promising; President Trump even took it for prevention. But analysis of treatment results did not show fewer deaths but did find adverse heart effects so the EUA was withdrawn. However clinical trials using the drug can be continued.

In early July a hospital in Michigan released statistics showing more patients treated with hydroxychloroquine lived that those who weren’t, surprising other medical centers who did not find the same results in their patients.

As of August 2, 2020, the White House coronavirus task force member charged with coordinating the U.S. testing effort said that the nation needs to “move on” from the debate over hydroxychloroquine.  

Adm. Brett Giroir, assistant secretary of health and human services, said on NBC News’ “Meet the Press” that “from a public health standpoint, at first, hydroxychloroquine looked very promising” but at “this point in time, there’s been five randomized control, placebo-controlled trials that do not show any benefit to hydroxychloroquine.” 

“So, at this point in time, we don’t recommend that (hydroxychloroquine) as a treatment. There’s no evidence to show that it is,”

Adm. Brett Giroir

Another old drug however did reduce deaths in severely ill COVID-19 patients. Dexamethasone, a steroid, reduced mortality in patients who needed oxygen, either alone or by a ventilator and is now recommended for use in all such patients. Steroids treat a variety of conditions including severe asthma, rheumatoid arthritis, gout, lupus, autoimmune diseases, and multiple other inflammatory conditions.

illustration showing the coronavirus which causes COVID-19

 

Avoiding surgery for ectopic pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. As the fertilized egg begins developing into an embryo, it will eventually outgrow size of the Fallopian tube, and rupture, causing hemorrhage (bleeding) in the pregnant woman.

Ruptured ectopic pregnancies cause about 2.7% of pregnancy-related deaths. Ectopic pregnancy is a true medical emergency and usually requires surgery to prevent death. But another old medicine can in some cases spare a woman from losing her tube to either rupture or surgery.

Methotrexate is an old drug used to treat several forms of cancer as well as several inflammatory and autoimmune diseases, including psoriasis, multiple sclerosis, and Crohn’s Disease. Now, some patients can avoid surgery for an ectopic pregnancy by receiving one or two doses of methotrexate by the IM (intra-muscle) injection route.

The treatment is not 100% effective; patients must follow their doctor’s instructions for follow up carefully, as surgery may still be necessary.

https://medlineplus.gov/images/femalereproductivesystem.png

Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs much more frequently in them than men. For infrequent headaches,non opiate pain relievers are effective and recommended. But for severe, frequent, or persistent symptoms prevention is recommended to improve quality of life.

Botox, onabotulinumtoxin A, has been FDA approved for treating chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Yes the same drug used to treat wrinkles,Botox, can prevent migraine.

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

 

Preventing cancers with the HPV vaccine

Infection with the HPV, human papillomavirus, causes genital warts, an uncomfortable condition but not life threatening. However it can also cause changes in the cervix called CIN which can lead to cervical cancer.

According to a review of clinical trials by Cochran, vaccination against this virus effectively prevents infection and thus fewer cases of CIN. Since a significant percentage of CIN progresses to cancer, we can expect fewer women will develop invasive cervical cancer, the 4th most common cancer in women worldwide.

The vaccine, Gardasail 9, originally approved for use in females ages 9 to 26 years,received FDA approval for use up to ages 17 to 45 years in both males and females.

The vaccine is intended to prevent cancers of the anus, vulva, vagina, and cervix.

The American Cancer Society, ACS, recommends routine vaccination from ages 9-12 years, to prevent the greatest number of cancers, since the vaccine is less effective at older ages. The ACS encourages physicians to offer “catch-up” vaccination to people through age 26 years. For persons older than 26 years, the vaccine offers much less cancer prevention so the society does not recommend it.

HPV-16 E5 Oncoprotein
Description:
A koilocyte is a squamous epithelial cell that has undergone structural changes as a result of infection by human papillomavirus (HPV). This image of a koilocyte shows human ectocervical cells (HEC) expressing HPV-16 E5 oncoprotein, and immortalized with HPV-16 E6 and E7 oncoproteins. Formation of koilocytes requires cooperation between HPV E5 and E6 oncoproteins. The cell culture is stained with hematoxylin and eosin (H&E).

This image was originally submitted as part of the 2016 NCI Cancer Close Up project.

This image is part of the NCI Cancer Close Up 2016 collection.


Source:
National Cancer Institute \ Georgetown Lombardi Comprehensive Cancer Center
Creator:
Ewa Krawczyk
Date Created:
2006
Date Added:
April 11, 2016
Reuse Restrictions:
None – This image is in the public domain and can be freely reused. Please credit the source and, where possible, the creator listed above.

Stopping shingles-and strokes- with the zoster vaccine

Zoster is a reactivation of the varicella/zoster virus that causes chickenpox. It causes a painful rash known as shingles;the pain may continue after the rash is gone. It can happen at any age, but symptoms tend to be worst in older persons.

The new zoster (shingles) vaccine, Shingrix, prevents the painful rash much more effectively than the original vaccine Zostavax. It ranges in effectiveness from 91% to 97% at preventing shingles, depending on age. The first vaccine was 51% effective.

However, the original shingles vaccine may not prevent shingles as well, but it may prevent strokes due to inhibiting inflammation causes by the shingles virus.

Researchers at the CDC reviewed the Medicare health records of more than 1 million people age 66 or older who received Zostavax between 2008 and 2014, and 1 million people of the same age who had not received the vaccination. Researchers took into account age, gender, race, medications and existing health conditions.

Based on these records, the Zostavax reduced stroke risk by 18% for the most common type of stroke. During the years they reviewed, the Shingrix was not in use, so they couldn’t say if it would also show a protective effect.

Signs of Stroke
Signs of Stroke

Stroke is the fifth leading cause of death in the U.S. and causes more serious long-term disabilities than any other disease. Every minute counts, especially during the COVID-19 crisis. The best way to help someone having a stroke is to recognize the symptoms and call 9-1-1. www.stroke.nih.gov/index.htm
before you leave, here’s another post you might enjoy

exploring the HEART of health

Thanks for joining me to review some old drugs with new tricks.

Dr. Aletha

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