Dr Sarah Masterton, CMFnz Board Member | Apr 27 2020
A milestone was reached as CMFnz hosted our first online forum/webinar on Tuesday 7 April 2020. It was not something we had planned to do a long time ago, rather, it arose from an acute yearning to connect with our community during the lockdown. Indeed, it was wonderful to be able to meet with colleagues from all around the country, especially given that we were no longer able to gather together at conference.
So, what did we talk about?
Professor Steve Chambers (an Infectious Diseases Physician who is currently working in Occupational Health in the Canterbury DHB, and as part of the national Technical Advisory Group for COVID-19) and Dr Graham Mills (an Infectious Diseases and General Physician in Waikato DHB) begun by summarizing the current situation. They explained that COVID-19 is a coronavirus, probably derived from bats and possibly via an intermediate animal vector, which spread from Wuhan, China, to the world. It is highly infectious, transmitted by droplets and has an incubation period of 3-14 days. Immunity to the virus is yet to be determined but will probably develop. Treatment options are under investigation as the World Health Organisation looks into randomised controlled trials involving 70 countries, but it will likely be at least 18 months until vaccines are available. In the meantime, testing criteria and New Zealand’s national response continues to be adapted to protect the health system and wider community, and mathematical modeling suggests that we are in a much better position than we would have been without lockdown.
In regard to how our faith speaks into our practice and response, there is a heavy responsibility for health professionals as evidenced by the experiences in China, Italy, the United States of America and other European countries. There is also a lot of talk and thinking about death, which is unusual in our culture. As a result it can be easy to become extremely and irrationally fearful when instead we should be taking time to step back and put our trust in Him who cares for us (Psalm 91:1, Romans 8:38-39).
Ethical issues have come to the fore. In many countries this has ended up with questions about access to life saving treatment and broader questions of inequity between communities and countries. At times it is difficult to think beyond the patient in front of us and consider the implications for the wider community, especially when it comes to resource allocation. A lot of thinking has been done around ventilator allocation which should not be on a ‘first come, first served’ basis. A recent New England Journal of Medicine article (March 24, 2020) addressed some of the ethical principles in making difficult choices around ventilators and life support. From quite a different angle, Dr Amanda Landers, a Palliative Care Physician, stressed the importance of pausing to check what the goals of treatment are for the patient in front of you before launching into treatments. The reality for many people in New Zealand who are likely to contract COVID-19 is that many of them are not appropriate for life-prolonging interventions. Little work and public discussion have happened about the ethics of supportive care only; and palliative care has rarely been mentioned as an important partner in this ‘fight’ despite the majority of deaths occurring in frail elderly who have not been offered intensive therapies.
In regard to our social response, many people have found it very encouraging to meet neighbours and create new connections while walking around their neighbourhoods. However, many others, especially those who live alone, are unwell, have limited access to transport and/or are naturally much more communal (for example, Pasifika communities), are facing challenges and isolation. Consequently, it is important that we are generous to others and this may mean we need to be proactive and creative (for example, by making phone calls or delivering online messages).
Sadly, xenophobia has reared its ugly head at times with respect to groups being blamed for virus transmission, and we have a role to try to de-escalate these sentiments. Dr Kaaren Mathias, an International Public Health Physician who works in North India, also highlighted the importance of meeting people where they are emotionally, and addressing their immediate needs and concerns before providing education about how to respond COVID-19. Jesus demonstrated this when he asked Bartimaeus, “What do you want me to do for you?” (Mark 10:51). She went on to say that people in the majority world are likely to be most affected by food insecurity during the lockdown, so governments need wisdom and the international community (including us personally) need to consider our part in supporting others from other nations whose needs are greater than our own.
Inevitably the virus triggers many different personal responses in us. Some people have wrestled with the desire and/or expectation to do what they have been trained to do as medical professionals when they have been sick during the lockdown. They have desperately wanted to help and yet opted to stay at home in order to protect their community. All of us have been guilty of ‘presenteeism’ on occasion, and this is one of those times to serve in a different way. Being at home requires adaptability to other roles and new ways of working, as well as the handing over and passing on of some things. Nevertheless, as with many past challenges, we can remain hopeful that “this too will pass”.
As Martin Luther once wrote to the Reverend Dr John Hess in 1527 about ‘Whether one may flee from a deadly plague’: “I shall ask God mercifully to protect us. Then I shall fumigate, help purify the air, administer medicine and take it. I shall avoid places and person where my presence is not needed in order not to become contaminated and thus perchance inflict and pollute others and so cause their death as a result of my negligence. If God should wish to take me, he will surely find me and I have done what he has expected of me and so I am not responsible for either my own death or the death of others. If my neighbor needs me however I shall not avoid place or person but will go freely as stated above. See this is such a God-fearing faith because it is neither brash nor foolhardy”.
It can be difficult to maintain perspective during such times but as C.S. Lewis, in response to another threat – of nuclear war, once wrote (here paraphrased, and edited to our current threat): “If we are all going to be destroyed by [coronavirus], let that [virus] when it comes find us doing sensible and human things – praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts – not huddled together like frightened sheep and thinking about [viruses]. [It] may break our bodies but [it] need not dominate our minds.”
Thank you to Dr Steve Withington (Rural Hospital Specialist and Senior Lecturer at the University of Otago with a special interest in Infectious Diseases) who coordinated this webinar.