Church Responses to Swine Flu

A couple of folks in our church went down with suspected swine flu' at the weekend (update: both back at work today, so it may not have been), so I had a quick peek round the blogosphere to see what other people are doing. Good discussions happening at most of these sites:

The Ugley Vicar has just had guidance from Chelmsford Diocese, which seems pretty thorough, though I sense he's not entirely impressed with it. They recommend antibacterial gel for anyone celebrating communion, carry on with a shared cup, but throw out the holy water as people come into church (drat). There's a useful checklist, and advice on hygiene, flu buddies etc. There are several other posts on his blog on the same subject.

Here's a snapshot from New Zealand, where some churchgoers have ignored advice to stay at home to avoid passing on the disease.

Prison Planet is thoroughly opposed to plans for a mass vaccination programme, and wonders how the government would enforce it. There's probably some comparisons to be drawn here with MMR, but not right now.

PaxtonVic is waiting for advice from Ely Diocese and trying to keep things in perspective. Thanks to her for the pic, which is Ship of Fools take on new clergy vestments. Discussion also here on her blog.

After a Nottingham church closed its Sunday service following some of the staff catching the bug, Phil Whitehead asks 'should swine flu close churches?'

OneTimothyFour has defended the possibly OTT 'common sense' advice being issued by churches, and looks forward to the abolition of the Peace.

Latest news here.

Swine Flu - Planning Ahead

It seems more and more likely that, when churches gear up again after the mellow month of August, swine flu will have taken hold in a big way. So I'm wondering if as a church we need to work out now how we're going to manage in the autumn.

Basic advice for individuals is here on the NHS site, very clear. Basically: have a 'flu friend' who can pick up antivirals for you, wash your hands regularly and use tissues, and ring your GP from home if you think you've got the symptoms. Health Protection Agency FAQ's on swine flu here.

Advice from the government for faith groups, issued in May, is here.

Lancaster Diocese (RC) has a helpful booklet.

Key things seem to be:

- vigilance over hygiene: washing hands etc. and encouraging folk in the church to do the same. In that regard, Dave Walkers cartoon may not be that far off. Cleaning door handles and surfaces, and then drying them afterwards, gives the virus less chance to hang around.

- plan for key services to be continued. Churches need to decide what their core activities are (worship, visiting, outreach) and how to maintain them if, say, 10-20% of key people are off with H1N1 at any stage. How will we let people know if services are cancelled? Could there be a prayer/service leaflet for people to use at home if this happens? Is there a publicly known phone/email contact for people to find out what you're doing? How will you communicate with people midweek if key events need to be changed/cancelled?

- how to support the community. Church folk could offer to be 'flu friends' for people who are isolated or who aren't sure who to ask. There may also be key local services (post office, shop etc.) which might need voluntary help to keep going if staff are ill.

- coping with extra demands: e.g. for funerals, pastoral care, home visiting etc. I'm guessing that some of this will look after itself - various meetings and appointments will be cancelled if swine flu really takes hold, and that will free up some clergy time for funerals. However, in my experience a funeral can take 4-5 hours to prepare and do, and it's quite exhausting, so it's not just a matter of doing a funeral rather than going to the Gutters Subcommittee. There's probably other things to look at, e.g. can Readers (CofE) be trained up to take funeral services? Can there be more support between churches if leaders are off sick?

- children: if local schools close, should Sunday school close too? Under-5's are both more infectious, and more vulnerable, so at some point we'll need to make the call over toddler groups etc., and to alert people to that as a possibility.

- Communion: thanks to Richard Frank for this 1-page summary from London Diocese, which points out that, in a mild pandemic, the chalice can be shared in communion if you follow the proper hygiene rules. However the Catholic church has been advising some of its churches just to use bread for communion, and to put it in people's hands, rather than on the tongue (as happens in some churches). Our advice from the council is not to share communion from the same cup. That means Free Church individual cups will be ok. We might also need to rethink sharing the peace, and the vicar/pastor/etc. shaking hands with everyone as they arrive/leave.

The CofE website has a swine flu page, with links to prayers, and a couple of other links - unfortunately the one to the NHS is broken!

We've started discussing all of the above this week, it would be helpful to know if anyone else is further down the tracks than we are.

Bono on Swine Flu (nearly)

'Breathe' from No Line on the Horizon

Every day I die again, and again I'm reborn
Every day I have to find the courage
To walk out into the street
With arms out
Got a love you can't defeat
Neither down or out
There's nothing you have that I need
I can breathe
Breathe now

16th of June, Chinese stocks are going up
And I'm coming down with some new Asian virus
Ju Ju man, Ju Ju man
Doc says you're fine, or dying
Please
Nine 0 nine, St John Divine, on the line, my pulse is fine
But I'm running down the road like loose electricity
While the band in my head plays a striptease

The roar that lies on the other side of silence
The forest fire that is fear so deny it

Ok, 'Mexican' wouldn't have scanned, but if you read it and imagine it was composed this week....

New single, U2's worship anthem Magnificent is out on May 4th.

Bad Joke

The European Commission wants to rename swine flu "novel flu" to prevent an adverse effect on pork sales. But what effect will that have on authors?

Wakey Wakey

There may be a media frenzy around swine flu, but the Church of England is making up for it by saying virtually nothing. No kind of statement on the national site (not even a special prayer, which is normally what they put up for this kind of thing), and the following (slim) pickings from Diocesan sites:

Manchester: keeping an updated section of the site, not telling people too much, but at least advising on the flow of information - that more guidance will come out when it's needed.

Bath and Wells: general advice on what to do in a flu pandemic, posted on the site at the beginning of 2009.

Update 30/4: Oxford too, and other dioceses are issuing advice through the normal channels via area deans etc. (see comments)

Hopefully there's more and Google have missed some, or perhaps they censored them, who knows? Or perhaps the CofE is being wisely chilled about it all and the media and bloggers like me will all look a bit silly in a couple of weeks when it all blows over.

I was going to cite an action plan by a district council in the Midlands as an example of good practice, but unfortunately it got posted with a number of 'confidential' pages about vaccination centres, so I've just rung them to let them know. Hopefully that's saved the webmasters job!

Here's the question: will there be a co-ordinated national information centre from the CofE for this, or will it happen piecemeal diocese by diocese? You'll see the reason for this question tomorrow...

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.

Flu Pandemic: There is a Plan

Hopefully the situation in Mexico won't turn into a flu' pandemic (though the news this morning isn't encouraging), but just a couple of weeks ago we had a briefing email from our Diocese on what to expect if one happened, and how we might respond to it. Good timing, the CofE right on the button as usual....

I won't post all of it, as we're not in a pandemic situation and pray God we won't be, but the opening couple or paragraphs are quite sobering:

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.

So basically a pandemic is, according to the experts, inevitable sooner or later. If it's not the Mexican strain, it will be something else. There are all sorts of consequences to this, from Alastair Darlings budget calculations being even further out (a pandemic will hit the economy hard), to the need to suspend church meetings to avoid passing on the bug - that's already happening in Mexico. It's not something my generation has ever experienced: suddenly the world seems a more precarious place.

Government info here. Helpful BBC Q&A on swine flu here, which suggests that the deaths in Mexico may be down to local factors, and that cases found in other countries have milder symptoms.