The spreading outbreak of the COVID-19 coronavirus (initially called the Wuhan coronavirus) is having a global impact, but has not yet developed into a pandemic, according to the World Health Organization (WHO). (UPDATE: The WHO reclassified the condition as a pandemic on March 11, 2020.)
“Our decision about whether to use the word ‘pandemic’ to describe an epidemic is based on an ongoing assessment of the geographical spread of the virus, the severity of disease it causes and the impact it has on the whole society,” WHO director-general Tedros Adhanom Ghebreyesus said during a press briefing with reporters on Monday.
“Using the word ‘pandemic’ now does not fit the facts, but it may certainly cause fear. We do not live in a binary, black-and-white world. It’s not either-or,” he added. “We must focus on containment, while doing everything we can to prepare for a potential pandemic.”
As the threat of COVID-19 increases, Christians are finding it increasingly necessary to form an opinion and discuss the topic. But how do we do that in a way that fits the demands of biblical ethics?* Here are four suggestions.
1. Distinguish Levels of Information
As epidemiology professors Bill Hanage and Marc Lipsitch say, we “should distinguish between at least three levels of information: (A) what we know is true; (B) what we think is true—fact-based assessments that also depend on inference, extrapolation or educated interpretation of facts that reflect an individual’s view of what is most likely to be going on; and (C) opinions and speculation.”
Category A would include such facts as where the cases of the infection are reported and that human-to-human transmission happens frequently, while category B would include the true number of cases in any location and the degree to which presymptomatic cases can be transmitted. In category C would be such issues as the effects of extreme social distancing (limiting large groups of people coming together, closing buildings, canceling events, and so on).
In talking about this issue, we should make every attempt to base our opinion on category A, be hesitant about putting too much weight on category B, and be clear when we are referring to category C.
2. Understand the Key Terminology
For basic information and background, see also: The FAQs: What Christians Should Know About the Wuhan Coronavirus.
Is COVID-19 an epidemic? A pandemic? An outbreak? While the answer depends on which public-health official you ask, there are four interrelated terms—endemic, outbreak, epidemic, and pandemic—that are commonly used to describe how a condition (such as a viral infection) has changed geographically (i.e., through space) and chronologically (i.e., through time) relative to an expected number of cases.
An endemic condition currently has a stable and predictable rate of occurrence among a specific geographical location and can always be found in the population that lives there. For example, imagine that every year about one-third of the population in the region of Ontario, Canada, contracts the Martian Flu (n.b., a made-up disease). We would thus say that Martian Flu is endemic to Ontario.
An outbreak is when there is a sudden increase in the number of people with a condition greater than is expected. This can mean that there are either more cases of an endemic condition than expected, or the condition is found somewhere it has not been before. Outbreaks are limited to relatively small areas, and can consist of a single case. For example, if a single year, two-thirds of the population in Ontario contracted Martian Flu, it’d be considered an outbreak, because the levels were higher than under endemic conditions. Similarly, if the neighboring province of Manitoba normally had zero cases of Martian Flu but now has three cases within its border, we would be described as an outbreak.
An epidemic is an outbreak that spreads over a larger geographical area. If after having spread to Manitoba, the Martian Flu spreads to North Dakota, Montana, and Idaho, the condition would be considered an epidemic.
An epidemic that spreads globally is a pandemic. If after having spread from Canada to the United States the Martian Flu if found in countries across the globed, we’d classify the condition as having become a pandemic.
The use of the terms endemic, outbreak, epidemic, and pandemic do not denote the severity, or how serious the condition has become. For instance, influenza (flu) is endemic to the United States, though the severity changes from year to year. The severity of the flu in 2019–2020 is classified by the Centers for Disease Control (CDC) as being “high.” According to CDC estimates, from October 1, 2019, through February 15, 2020, there have been 29 million to 41 million flu illnesses, 13 million to 19 million flu medical visits, 280,000 to 500,000 flu hospitalizations, and 16,000 to 41,000 flu deaths.
In contrast, the COVID-19 has (as of February 24, 2020), resulted in 51,838 currently infected patients (40,271 in mild condition; 11,567 in serious condition), 25,271 recovered cases, and 2,698 deaths. It’s currently unclear what level of severity we should expect if COVID-19 becomes a pandemic.
Two other important terms are containment and mitigation. Containment is measures taken to slow the spread of a condition, usually for the purpose of making preparations before it becomes an epidemic or pandemic. As applied to COVID-19, containment has included measures taken to slow the spread of the virus (a somewhat achievable goal) rather than intended to stop the complete spread of the disease (which may not be achievable, at least in the short term). Mitigation is efforts to reduce the severity or seriousness of the condition. In a pandemic, mitigation strategies may include a variety of approaches, from encouraging handwashing to the creation of new vaccines.
Some of the approaches that may be beneficial during the containment stage could become counterproductive during the mitigation of a pandemic. For instance, many airlines have been suspending flights or modifying service in response to the coronavirus outbreak. But if such measures were to remain in place indefinitely, they could become counterproductive. Shutting down commerce, for example, could affect a country’s economy, making it more difficult for their government to afford health measures. Some poorer countries might even be incentivized to downplay the spread of the disease in their country to prevent such economic repercussions. (Note: This paragraph is prime example of category C information.)
3. Recognize the Emotional Element
While we should make every effort to base our discussions on reliable evidence, we should remember that discussions of suffering, illness, and disease have a psychological element. Recognizing this can help us communicate in a way that is more loving toward our neighbor.
For instance, we may be inclined to communicate in a way that is either overly rational or overly emotional. Some of us are inherently prone to downplay the severity of such public-health threats (“We’ve seen this same scare-mongering with Ebola and SARS”), while others are inclined toward catastrophizing, believing a situation is far worse than is warranted by the evidence (“This is the most serious health threat we face!”). We should recognize our own dispositions and acknowledge that others may differ. We shouldn’t be dismissive of the young mother who earnestly inquires if we should consider canceling church services to avoid the spread of the disease, nor should we feel it is our place to “scare some sense” into the overly analytical optimist who thinks the threat is overstated.
While being deferential and respectful to those on either end, we must also be consistently biblical. We should, for instance, help others understand what Scripture says about how God is sovereign over illness and suffering, and that we serve the one who casts out all fear (1 John 4:18).
4. Remember There’s Nothing New Under the Sun
We should also recognize that we are not the first believers in history to struggle over how to deal with epidemics and pandemics—or how to talk about them. Throughout history, Christians facing plague and infectious disease have had to consider such questions as, “Is fleeing in the face of disease an act of faith or presumption?” and “How far does the duties of neighbor love extend, and when might they be disregarded?” Theologians in the 16th century often attempted to address these questions in texts that Spencer J. Weinreich has dubbed “flight theology.” As Weinreich says:
Without prescribing a course of action, theologians could provide tools for navigating the interrelations of conscience, Scripture and experience. At the same time, in priming readers to think, even in emergencies, in communal terms, flight theology conditions them as participants in the public sphere, participants who affirm the new moral ontology—in short, persuadable subjects.
We can learn from those who came before about deferring to individual conscience, and not placing burdens on people that exceeds the bounds of Scripture.
We can also learn from their example about carrying on with our lives in times of distress. As John Calvin noted, “Duty must not be neglected, no more in epidemic disease than in war or fire.” While the names of the epidemics may change, our duty as Christians to defer to the Word, to divine providence, and to the demands of conscience stays the same.
*Christians have a higher duty to the truth than our secular neighbors because of the ninth commandment (“You shall not bear false witness against your neighbor,” Ex. 20:16). This commandment, reiterated in the New Testament (Matt. 15:19–20; Eph. 4:25), bars us from committing any act that might bring undeserved suffering on another person, especially through speech. As the Westminster Catechism says, “The duties required in the ninth commandment are, the preserving and promoting of truth between man and man, . . . ; appearing and standing for the truth; and from the heart, sincerely, freely, clearly, and fully, speaking the truth, and only the truth, in matters of judgment and justice, and in all other things whatsoever; . . . discouraging talebearers, flatterers, and slanderers; love and care of our own good name, and defending it when need requireth; . . . studying and practicing of whatsoever things are true, honest, lovely, and of good report.”