Guidance for Churches and Clergy in case of a Flu Pandemic

The following advice has been up on our Diocesan website for a while, and was mailed out to Bath and Wells clergy at the beginning of April. I posted an excerpt a few days ago, and as things are moving on a bit, here's the whole thing. Hopefully it's just 'for information', and nothing more!!

NOTE: this advice was all prepared before the swine flu outbreak began in Mexico, and so it's likely to be updated. It may also pan out that swine flu doesn't become a pandemic, so what follows relates to a possible scenario, rather than being a prediction.

I'm in two minds over this: part of me thinks there's enough media hysteria already about swine flu - it's a good story, and one the media will happily run with for ages. However, the World Health Organisation is already talking about increased levels of risk, and being a pragmatist I'm a big fan of forward planning. So here you go.

The advice is based on local conversations in Somerset and some national guidance, so it may need adapting for local context. It also assumes that a pandemic would be avian flu, and needs reading with that in mind!

The following guidelines are based on those issued by the Church of England and the government. They will be revised in detail as further information becomes available. Please ensure that clergy and lay officers are familiar with them so that you can act appropriately when the outbreak occurs. Below is information on the following:

· Why be prepared
· What scenarios to expect
· What medical response will be available
· How clergy and church members can respond
· The additional impact of funerals and bereavement
· The impact of avian (bird) flu on rural communities

Why be prepared
An epidemic of seasonal flu is statistically overdue in the UK. So too is a world wide “pandemic” where a fresh strain of flu breaks out in one country, and spreads through various means to others. They have occurred (with devastating effects) in the past, including 1918 and 1957. In the 1918 “Spanish flu” outbreak, an estimated 100 million people died directly or indirectly from it.

Either event could have a major impact on local churches and church members:
· Key personnel will become ill and may act as carriers, limiting their pastoral availability;
· Services may be cancelled at short notice because of lack of personnel or as a precaution against spreading the virus;
· There will be a major strain on medical services and hospital facilities;
· There will be a higher than normal number of deaths (and hence of funerals);
· Many people will be off work because of their own illness or by caring for ill dependants;
· There will be severe disruption to normal social and commercial activities, causing considerable inconvenience, and probably frustration, anger and even violence.

A pandemic could be especially devastating if a strain of avian (bird) flu which cannot currently be passed from human to human mutates to join with a strain of human flu forming a new strain against which we have no protection. Experts say it is simply a matter of time before this occurs.
What scenarios to expect (DK note, this is in a pandemic, so it's not necessarily what's going to happen with swine flu', as it's too early to tell)
1. At least 25% of the population is expected to be infected, including people of every age.

2. Between 15% and 30% of any given group of people (company, shop, service agency, hospital, school, church) could be absent through illness at the peak time; the figure could be up to 50% in small businesses. (This will be catastrophic for farmers who have few or no support staff; livestock may suffer through reduced care.)

3. An unknown additional number will be absent while they care for sick children or other relatives.

4. School closures are extremely likely, adding to the pressure on working parents who have to take unscheduled leave to care for well children.

5. Most people who fall ill will be off work for about a week or ten days. However, the after-effects of flu can last for several weeks, leaving people feeling drained and sluggish, and unable to return to “full speed” for some time. This will add to the general disruption.

6. Government estimates suggest that anywhere between 54,000 and 350,000 more deaths than normal for the time of year will occur. This will put added strain on funeral directors, cemeteries, crematoria and clergy of all faiths who themselves may be under strength through illness. Although the elderly and the very young are the most vulnerable, deaths are likely to occur across the age range.

7. The government will consider banning gatherings of people over a certain number in a worse-case scenario, in order to limit the spread of infection. This might include some larger church services.


What medical response will be available

Vaccines
Until the exact strain of flu is identified, no vaccine will be available. It will take 4-6 months to develop and begin to manufacture a vaccine in the event of a world wide pandemic of a mutant form of avian flu. Until a vaccine is available, the only counter-measure will be anti-viral drugs, which mitigate the effects of flu but do not prevent it or cure it. The UK government is currently stockpiling 14.6m courses of anti-viral drugs.

Key worker protection
The plan at present is that anti-viral drugs will be given only to front-line medical workers, members of the emergency services and other key workers, and then, if available, to those members of the public who are most at risk for medical reasons.

The Church of England is currently in discussion with government officials about including clergy (of all faiths) in this category as their pastoral ministry will be an important part of the national response to people’s needs. The government does plan to vaccinate the entire population if a vaccine is produced and there is time for it to become effective before a pandemic elsewhere spreads to the UK. (Good idea, though I'd rather take my place in the queue behind those who are most at risk.)

How clergy and church members can respond

Take sensible precautions
During an outbreak, everyone should take sensible precautions to avoid infection, and to avoid passing the virus to others unwittingly (you can be a carrier without being ill). The virus spreads in minute water droplets in the air. Precautions include:

· Avoid unnecessary contact with people who are ill. This may require clergy to weigh up the benefits of “sick visiting” against the possibility of becoming ill or unwittingly acting as a carrier.
· People who become ill are asked by government to “take social responsibility to lessen the spread and thus protect others”. This suggests that anyone “under the weather” should not work or attend meetings. Clergy especially will need to resist the temptation to work until they drop.
· Anyone who becomes ill is advised to stay at home, keep warm, and drink plenty of fluids.
· Don’t rush back to work too soon.

Create contingency plans for church service provision
A proportion of clergy and licensed lay ministers will fall ill and be unable to take scheduled services, perhaps with little notice. To mitigate the effects of this deaneries, benefices and individual churches could consider such things as:
· Providing suitable training now for church wardens or other responsible lay people so that they could lead a simple Service of the Word in the event of the last-minute illness of the minister;
· Creating an “emergency service pack” with a suitable liturgy, a selection of prayers, and perhaps two or three brief homilies, which could be used in the event of a scheduled minister falling ill;
· Creating a telephone or email “chain” (much as some prayer chains operate) so that information about services available or cancelled in the area can be passed down the line quickly. This may help people discover alternatives if “their” service is cancelled, and avoid wasted journeys.
· Discuss in the PCC the balance of risks between holding services (where coughs and sneezes can spread diseases) and cancelling them, especially if your congregation is quite large.
· During a major outbreak, the Chapter Clerk, Deanery Synod secretary, Rural Dean or other suitable person could keep a daily-updated list of retired clergy and other licensed ministers willing to give emergency midweek or Sunday cover and who are currently fit.
· When a service is cancelled and no-one is able to lead an alternative service, ensuring that a clear notice is put on the door, or (preferably) that someone is available to give worshippers information and keep the church open for private prayer for a while.

NOTE: Currently it is considered that there is no health risk involved when people share the same communion cup so long as it is made of silver or gold, and alcoholic wine is used (these have a disinfectant effect) and the cup is carefully wiped after each communicant. There is apparently more risk in sharing the peace! (The virus can be spread in sweat droplets on hands.)

Be open to offer support to the community
While we may ourselves be stretched, others in our communities may be too. If Christian love means anything, it means not walking by on the other side. The list is of possibilities is almost endless:
· Farmers working on their own with little assistance may need volunteer help to feed livestock.
· Small shops may need voluntary assistance to remain open.
· Elderly people may need drivers or shoppers when their normal helpers are unable to attend.
· Care homes may be short staffed and welcome volunteers.
· Neighbours without friends or family close by may need assistance.

Be patient with “central services”
It is likely that bishops, archdeacons, and national and diocesan officers and staff will also fall ill. This could create delays in dealing with administrative and financial matters, and in responding to letters, emails and telephone calls. Please be patient, and encourage patience in others as the whole community grapples with “circumstances beyond our control”.

The additional impact of funerals and bereavement
In even a moderate outbreak, funeral directors, cemeteries and crematoria will suffer staff shortages at a time of increased demand, and the system could become quickly over-loaded. Families will have to wait longer for funerals, adding to the strain and stress they are already under.

Clergy, licensed lay ministers and other volunteers who engage in bereavement support may need to be prepared to deal with increased anger and hurt caused by such delays.

In addition, clergy are likely to find that an unusually high number of funerals (and the visits and preparation associated with them) will lead to disruption of their normal every-day ministry. This may need to be explained to the PCC and congregation who may not realise how much time can be involved in this part of clerical ministry.

The impact of avian (bird) flu on rural communities
Much of our diocese is rural, and if there is an outbreak of bird flu the government will immediately put contingency plans into action, building on lessons learned during the foot and mouth crisis. These may include culling of flocks and restriction of movement. (DK not sure if this would apply with swine flu?)

Among the effects may be serious financial hardship faced by people who depend on flocks for all or part of their income, and the emotional and psychological stress caused by the contingency. Free range chicken farmers especially would be badly affected: by complying with advice to house their flocks, they then cease to be “free range” and lose their potential market value.

The Farm Crisis Network provides a help line for members of the farming community facing such stresses. It can be contacted on 07002 326 326 7.00 am to 11.00 pm.

Advice to clergy and churches on making appropriate pastoral and practical responses can be given by Rural Deans and Archdeacons. The office of the Church’s National Rural Officer at Stoneleigh will also be issuing advice (024 7685 3060; www.arthurrankcentre.org.uk).

There was some extra guidance for clergy, which included (my summaries):

- The Government’s Risk Register has pandemic flu as the number one threat to the UK, above terrorism or flooding. This is because it is high impact, and strong likelihood. (It can happen as easily in summer as in winter, because it may come in through migrating birds or people from affected countries)

- Those involved no longer talk in terms of flu vaccinations. They will use ‘anti-viral’ tablets, which strictly speaking are not anti-viral, though if taken in the first 48 hours will reduce symptoms and length of being ill.

- The national plan is for people to ring a national flu line run by NHS Direct who will organise distribution of tablets. Somerset and Avon have their own plan built around collection points from local NHS sites. There will be local numbers to ring and people will be given a code number to authorise them to collect a supply of tablets.

- If there is a second wave of flu, and it is more than 4 months after the first one, a vaccine can be developed. If there is time to do this, they will put into a place a plan to vaccinate the whole population.

Further information
Government information about pandemic flu is available on the web at www.cabinetoffice.gov.uk/ukresilience/pandemicflu.aspx
The Somerset Pandemic Flu Plan is available at http://www.somerset.nhs.uk/ – search for ‘pandemic flu plan’ or click here.