Dear CGS Family,
Below – in a FAQ format – are representative examples of some of the “point-counterpoint” discussions that occurred among the elders, pastors, and members of the Re-Gathering Team. These discussions were part of an extensive consensus-building process leading to a “masks-optional” opportunity in 2022 for our CGS church family. The types of questions we asked of each other were relatively rigorous, and the answers provided here share that tone. We trust these will provide you with insight into our process and our rationale…
FREQUENTLY ASKED QUESTIONS:
1) We did not “mandate” masks during our 2021 worship services: we simply made a “strong, humble ask” towards that end, and our people have been gracious and charitable towards each other in that regard. Why don’t we just continue a “masking strongly advocated” posture until the virus is no longer a part of our environment ?
Compelling evidence strongly suggests that such an option is not actually available to us, for the following reason:
The SARS-CoV-2 virus which causes COVID is becoming endemic in the US, and will almost certainly – along with its mutated offspring – become an enduring part of our public health landscape going forward, just as (for instance) malaria has been endemic to India and sub-Saharan Africa for centuries.
2) What are some of the specific implications for CGS of the terms “endemic” and “enduring”, as we deal with COVID as a church family?
Our relationship with COVID as a church family is evolving from a status of acute invasion (pandemic) into a state of chronic coexistence (endemic).
As a point of reference, it is estimated that the 1918 Spanish Flu infected about 500 million persons worldwide (~ one-third of the world’s population at that time) and killed more than 50 million persons (~ 650,000 persons in the US). Yet the viral offspring of that pandemic persist among us today here in Durham – 100 years later – as a part of the accepted fabric of our everyday life.
The descendants of that same 1918 viral family (formally referred to as Influenza A, subtype H1N1) cause a disease that we in our casual conversations today refer to as “the flu”. Those types of viruses are the reason that annual “flu shots” are seasonally available each autumn at our corner drugstores and health clinics.
It is exceedingly likely that the family of coronaviruses that is causing COVID will persist and evolve among us, as has the “flu” virus. As such, our approaches to ordering our own daily lives in dependence upon God – including our approach to worship at CGS — must of necessity evolve as well.
3) But even if the SARS-CoV-2 family of viruses is destined to dwell among us indefinitely, a new variant – Omicron – has now emerged. Perhaps we should defer making additional decisions about masking until such mutations have ceased to occur ?
Again, compelling evidence regarding the history of SARS-CoV-2 over the past 2 years strongly suggests that this option is not available to us.
This virus continues to mutate – as has the analogous H1N1 viral family that causes “the flu” (see above) – and there is no clearly identifiable “end point” for this process. Prudent decisions going forward need to incorporate these realities.
4) But the numbers of current infections (including the Omicron variant) — though decreasing rapidly — are still substantial. Shouldn’t this inform our masking decisions now ?
Yes, it is appropriate for us to track current infection rates, and yes we should continue to exercise caution. Viral testing remains an important aspect of our public health response to COVID.
But the rate of “positive tests” in our community – like most public health tools when used in isolation – doesn’t provide all of the important information for making prudent decisions. Test-positivity tends to identify viral presence in the community as a function of test-seeking behavior, rather than providing direct information about significant illness and/or viral impact.
This is particularly the case now that both natural immunity and vaccine-mediated immunity have become more widespread in Durham and Chapel Hill. Such immunity (however acquired) greatly diminishes the consequences of becoming infected by the virus.
Knowing the extent of viral spread within a community is of importance primarily as it relates to the development of serious disease within that community. If a virus infects 100% of the population but results in significant consequences for no one, that virus is of little concern. If viral infection only infects 1% of a population but kills everyone it infects, that virus would cause 3.3 million deaths in America.
Wisdom requires us to discern carefully between viral prevalence (viral “spread” or numbers of viral cases) versus viral consequence.
5) What then is generally meant by the terms “serious consequences” or “serious disease” with respect to COVID?
If the manifestations of COVID remain limited to discomfort and/or other moderate symptoms which are nevertheless manageable at home – and from which one recovers uneventfully after a brief interval – such episodes do not warrant classification as “serious disease”. And — most importantly — such episodes do not create a burden upon the healthcare system…
6) How useful are positive COVID tests (alone) in helping us judge our community’s risk of “serious consequences” or “serious disease”?
They’re not very useful (alone) at all, actually.
Perhaps this analogy may be useful: If it were your responsibility to reduce the number of annual deaths on American highways, would you give primary attention to reducing the number of licensed drivers in America?
Probably not.
It is of course true that there is a relationship between the number of drivers and the number of traffic fatalities – after all, if no one drives then no one will die while driving…
But to effectively reduce annual driver-related fatalities, we would want to focus primarily upon such interventions as seat belts and airbags, signage and traffic lights at intersections, discouraging impaired driving, and enforcing safe speed limits. We would not focus primarily upon the number of drivers…
Similarly, there is of course a relationship between the amount of virus present in our community and the risk of disease: if there is no virus present, no one will be harmed by the virus.
But even if substantial virus is present in our community, the more relevant question over time — particularly as both natural immunity and vaccine-mediated immunity become more widespread – is principally this: is viral presence in our community causing high degrees of serious disease?
The elders and pastors – in addition to rigorously tracking viral prevalence – are closely following the other important indices of serious disease in our community.
7) If the daily number of positive COVID tests in our community — and even the numbers of persons with mild viral disease – are not (by themselves) sufficient indicators upon which to base our decisions, what other types of information are the elders and pastors considering ?
There are two metrics that North Carolina and the CDC provide to us daily that are perhaps among the most useful in our current moment:
i) the degree of immuno-protection (against COVID, specifically) existing among the people within our local population, and
ii) the numbers of persons locally who are requiring hospitalization due to COVID:
8) Why do you consider these two parameters to be of value in our current moment ?
Firstly, because the effectiveness of our immune systems in combatting future viral disease is generally enhanced by past exposure to the wild-type virus and/or by exposure to vaccines. This type of enhanced protection (immuno-protection) – though imperfect – reduces the severity of disease. This reduction in disease severity is significant, whether that benefit is conferred by acquiring a previous natural infection or acquired by virtue of vaccination.
And secondly, because the numbers of persons requiring hospitalization due to COVID is a concrete and ascertainable quantity: all persons presently admitted to US hospitals are universally tested for the SARS-CoV-2 virus.
So those two metrics allow us to:
1) Assess the actual acute (immediate) medical burden of the virus (reflected by current hospitalizations), and
2) Project the potential future vulnerability of our Durham-Chapel Hill community to serious disease (reflected in the degree of immune-enhancement present locally).
9) To what extent have the people living in our local community acquired degrees of protection against serious COVID disease ? Is it even possible to estimate the extent of enhanced immunity that currently exists in Durham or Chapel Hill ?
In general, Durham and Chapel Hill are extremely fortunate. Although we can’t quantitate our local degree of protection with precision, we can make two sets of useful observations:
1) The presence of naturally-acquired enhanced immunity (i.e. acquired by infection with the SARS-CoV-2 virus) can be crudely estimated based upon the total number of confirmed positive cases within the community. As of February 14th, 2022, at least 20% of Durham residents are confirmed to have been infected since the onset of the pandemic, and thus have degrees of residual immune benefit from that exposure.
2) Extensive vaccine records are kept at local and state levels, and are reported nationally. As of February 16th, 2022 95% of Durham County’s total population above the age of 5 years has received at least one dose of vaccine. The figures for Orange County are virtually identical. Furthermore, ~80% of the adults in both counties are fully vaccinated. You can follow this data on a daily basis here, by clicking on “Your Community: County View” on the left side of this webpage, and then entering our state and county in the designated search area:
Although additional doses of vaccine confer higher degrees of effectiveness, immuno-protective mechanisms are substantially enhanced beginning with even one dose of vaccine. And the clear majority of individuals over 5 yrs of age who have begun a vaccine series in Durham/Orange have already completed the series (~ 70%). It is reasonable to assume that most persons who begin a vaccine series will complete it.
10) What do these observations mean in practical terms for Durham-Chapel Hill ?
The presence of enhanced immunity – though imperfectly protective – substantially reduces the severity of disease for persons with normal baseline immunocompetence. This is unequivocally the case, whether that benefit is conferred by acquiring a previous natural infection, or achieved by vaccination.
Overall, the Durham/Orange community is thus quite fortunate: as an entire community, we have had a very high degree of exposure to factors that enhance immune responses against COVID. Over the last year, our community has substantially diminished its future risk of serious COVID disease.
11) But data indicates that many hospitals around our country are operating at near-capacity, and we have many medical personnel at CGS who are affected by such conditions. Shouldn’t these realities influence our decisions ?
Absolutely yes. That is specifically why local hospital occupancy and the degree of immune-protection within our community have come under specific scrutiny by your elders and pastors. We want to be very cautious regarding these factors.
But it is also important to note that a nuanced relationship is in view here: If a hospital has 100% of its available beds occupied – yet only 15% of that occupancy is attributable to COVID patients – then the utter disappearance of all COVID patients still leaves that hospital operating at near-capacity (e.g. 85% occupancy).
Also, it is important to distinguish between being hospitalized because of COVID vs being hospitalized while COVID positive.
- By example: If the case positivity rate for Omicron in a community is 50%, one would expect that approximately 50% of patients admitted to the hospital for any other particular reason (e.g. a serious fracture, acute appendicitis, premature labor, concussion, etc) would also be positive for COVID simultaneously . But they would not have been hospitalized because of COVID.
It can be (and has been, in Durham/Chapel Hill) simultaneously true that i) Hospitals can be operating in tough conditions at near capacity, but also that ii) Patients hospitalized because of COVID represent a statistically modest proportion of the hospitalized patient load. Weighing the implications of these realities requires discernment from us all.
12) This discussion has only mentioned Omicron briefly, but Omicron’s emergence concerns me. And other future mutations are likely. How are the pastors and elders factoring this into their thinking?
The pastors and other elders are approaching this information in view of the types of considerations outlined above, with particular reference to Questions # 4-10. It is out of prudent respect for what is not yet known about the potential virulence of Omnicron that we did not opt to start a “masks-optional” approach for CGS in early January (which otherwise was our announced intent among the leadership).
Interestingly, at present it seems that Omicron will prove to be have been a strange ally of sorts…
13) What do you mean by raising the possibility that Omicron could be considered a potential ally in our community’s fight against COVID ??
“Amicus meus, inimicus inimici mei”. The enemy of my enemy is my friend.
Our understanding of the clinical behavior of Omicron is still quite limited, but if early trends prove to be predictive, this variant could become a modestly effective anti-Delta strain.
Omicron is much more extensively and rapidly infectious even than its predecessor (Delta). It has burned rapidly through communities here in the US and has quickly become – in less than 3 weeks after it “came ashore” – the dominant strain in our country.
However, Omicron appears to have been much less virulent (i.e. it appears to cause substantially less serious disease in those whom it infects than did Delta); thus the rapid spread of the Omicron variant (at the expense of continued spread of Delta) may cause less significant disease overall and may provide a naturally-induced degree of “immune-resistance” against more virulent future mutant forms of the SARS-CoV-2 family of viruses.
Nevertheless, we are absolutely not treating Omicron dismissively, because data analysis regarding this strain is still relatively meager. And there are two aspects of Omicron’s infectiousness that do concern us greatly (see below).
14) If the relative risk of serious disease from Omicron does in fact turn out to be substantially less than that associated with the Delta variant, are there nevertheless still aspects of the Omicron surge that concern our pastors and other elders?
Absolutely yes. There are two, principally.
Your elders’ first concern in this regard is the potential impact upon availability of healthcare workers to staff our hospitals and medical clinics. Even if healthcare workers do not suffer significant illness from contracting Omicron, they will nevertheless be temporarily removed from their workplaces during their quarantine. Hence, Omicron’s infectiousness could radically disrupt hospital-based care without inundating our medical facilities with sick patients – merely by removing our healthcare workers from their posts.
Your elders’ second concern rests on the shifting relationships between infectivity and virulence among differing strains of COVID-causing viruses. Whether Omicron’s virulence will prove to be so modest that its infectiousness becomes an unintended advantage in reducing serious disease in our community remains unclear at present.
Your pastors and elders are considering such distinctions thoughtfully.
15) If you are willing to consider a “masks optional” opportunity in February – with Omicron lurking – why did you not make such an offer available earlier?
Our approach throughout these past 21 months has attempted to strike a nuanced and charitable balance – as Pastor Chuck explained in this letter to the congregation on December 23. And throughout this process we have deliberately been cautious on behalf of those with medical vulnerabilities – which group included all of us at the outset of the pandemic. In the early months, we lacked accurate knowledge of the clinical characteristics of the SARS-CoV-2 family of viruses, particularly regarding virulence and infectiousness. Appropriately, we adopted fairly broad and universal precautions then.
The virus has evolved, and so have our responses. We are now tailoring our worship options accordingly:
- Vaccines against COVID are now widely available now for those (above age 5) who feel that vaccination is the appropriate personal choice, and all among our congregation who are so inclined have had ample opportunity to avail themselves. Additionally, Pfizer received FDA approval on December 22nd for emergency authorization of its oral anti-COVID pill (which pill appears to be very effective at preventing subsequent hospitalization among unvaccinated persons).
Vaccine trials for those under age 5 are – disappointingly – not yet favorable, and await further investigation. Nevertheless, this is a precious population that we can well care for in safe, sequestered spaces within our Children’s Ministry and Nursery.
The last large group to be included in vaccine availability was that consisting of children aged 5-12. Access to vaccines in that age group was granted in November; the regimen consists of 2 doses given 3 weeks apart, with an additional 2 week “maturation” period for full immune responsivity to develop. That timeline carried us out into December, which informed our original intention to offer a “masks optional” opportunity in January. But Omicron’s arrival forced a brief re-evaluation.
The anti-COVID recourses that are likely to be available in the US for the foreseeable future appear to be fully in place, and are unlikely to change significantly in this next year. We feel – as Pastor Chuck alluded – that this seems now to be within “the fullness of time”…
16) Is it possible to share with us the main medical realities that will be informative for the pastors and other elders as they guide CGS forward into 2022?
I think “yes”, certainly. Those realities are pretty simple, actually, and were identified at the outset of these FAQs:
We are now in our 3rd successive calendar year in which COVID has been a part of the fabric of life in the US. The 1918 Spanish Flu pandemic killed an estimated 50 million people worldwide, and the offspring of those ancestral viral strains dwell among us today here in Durham – 100 years later – as a part of the routine rhythms of our daily existence. Yet we nonchalantly obtain annual flu shots – or not – and go about our lives…
The SARS-CoV-2 virus – like its 1918 predecessor – will almost certainly evolve globally from an acute pandemic invasion into a state of chronic endemic coexistence, becoming an enduring part of our public health landscape here in Durham-Chapel Hill going forward. Furthermore, vaccines against COVID are widely available now for those who feel that vaccination is the appropriate personal choice. And Pfizer received FDA an EUA on December 22nd for its oral anti-COVID pill
As such, our approaches to ordering our own daily lives in faithful dependence upon God must of necessity now evolve as well – beginning most prominently with our approach to gathering and worshipping at CGS.
These are among the straightforward realities that will continue to inform the pastors and elders.
We hope these FAQs have been informative and helpful. If you have additional questions, we encourage you to reach out and contact Glenn Jordan directly, at glennjordan@cgsonline.org
(Originally posted December 23, 2021)
(Re-posted with modest updates on February 16th, 2022)