Stay-at-Home Orders and the Common Good

Abstract

COVID-19, also known as SARS-CoV-2, began in Wuhan, China, late November or early December, 2019 and has since spread rapidly throughout the globe, being declared a health emergency of international concern a month later and a pandemic on March 11, 2020. It is highly contagious with a death rate up to twelve times that of the flu, even higher where the healthcare systems have been strained. To reduce the spread, states have implemented stay-at-home declarations, limiting social gatherings, and closing churches. However, some have argued that churches are an “essential service” and should be reopened in order that the faithful to be able to receive the sacraments, in particular the Eucharist. I will argue that this goes against the Catholic doctrine of the common good and care for the poor and vulnerable.

Summary: COVID-19 has caused a pandemic strained health care resources. In response, the US instituted stay-at-home orders which included the closing of places of worship. Within reason, this falls under the Catholic doctrine of the common good and caring for the poor and vulnerable.

On December 31, 2019, China reported to the World Health Organization (WHO) the existence of the novel coronavirus 2019 or COVID-19 (Anderson et al. 2020; “Cases in the U.S.” 2020; “Rolling Updates” 2020; Guo et al. 2020), also known as SARS-CoV-2, first identified in mid-December after physicians saw a cluster of patients with pneumonia in the city of Wuhan (Guo et al. 2020).

It spread person-to-person and mainly affected the respiratory tract. People complained of fever, cough, and fatigue. A few had vomiting and diarrhea. Most cases were mild. However, some were more likely to progress to respiratory distress combined with an overreaction of the immune response known as cytokine storm (Guo et al. 2020).

It spread rapidly worldwide. By January 30, it was declared by the WHO as a health emergency of international concern (Guo et al. 2020; “Rolling Updates” 2020) and a pandemic on March 11, 2020 (“Cases in the U.S.” 2020; “Rolling Updates” 2020). It is the greatest healthcare crisis that the United Nations (UN) has faced in its seventy-five-year history. It is not only a health crisis but an economic and humanitarian crisis as well. As the UN Secretary-General Antonio Guterres declared, it is “attacking societies at their core, claiming lives and people’s livelihoods” (Goal 2020). It has been compared to the Spanish Flu of 1918 when up to a third of the world’s population was infected with a 2 percent death rate (Terry 2020).

We know that COVID-19 is highly contagious with a low infective dose, especially for at-risk persons. The virus is optimized for binding to angiotensin-converting enzyme 2 or ACE-2 receptors found in the lower respiratory tract (Anderson et al. 2020; Guo et al. 2020). It is spread mainly through respiratory droplets, respiratory secretions, and direct contact, though some patients have it in their feces (Guo et al. 2020). This means that while the Centers for Disease Control and Prevention (CDC) mentions talking (“How COVID-19 Spreads” 2020), simply breathing has the potential to spread the virus (Fineberg 2020). The incubation period is 1–14 days (Guo et al. 2020) with a latent contagious phase of 2–3 days (Cai et al. 2020; Li et al. 2020). Some may have no significant symptoms at all or are asymptomatic (Bai et al. 2020; Li et al. 2020). When severe, respiratory distress develops rapidly (Guo et al. 2020).

The overall death rate in China was 3.5 percent (Guo et al. 2020); in South Korea, it is 1.7 percent (Le Page 2020) which still makes it 12 times deadlier than the flu (Disease Burden of Influenze 2020). Those at highest risk are over age 65 and/or have severe heart disease, diabetes, kidney disease on dialysis, chronic lung disease, moderate-to-severe asthma, immune-compromised, obesity with body mass index over 40, or liver disease (“People” 2020).

Children are less susceptible. In a Chinese study, children were one-third less likely than adults to be severely or critically ill (Dong et al. 2020). Most had only respiratory symptoms (Cruz and Zeichner 2020). The US experience is similar with less than twenty-five total known COVID-19 deaths under age fifteen as of May 30 (“Deaths” 2020). In the United States, minorities have been hit the hardest in proportion to the population. They are more likely to live in densely populated areas, in multigenerational households, or be incarcerated, all increasing the risk of person-to-person spread. They are more likely to work in the service industry and less likely to be able to work from home. They have less access to paid sick leave which may cause them to go to work when ill, infecting others. They are more likely to have chronic underlying illness and chronic stress that makes them more vulnerable. Finally, they are less likely to be insured and more likely to be distrustful of the healthcare system in general (“COVID-19 in Racial and Ethnic Groups” 2020), which can lead to delays in getting care.

Nursing homes have also been niduses of infection due to their vulnerable population living in close quarters (“Preparing” 2020). Caregivers in those facilities must be in close contact with the residents for prolonged periods of time.

The first option for controlling the epidemic is isolation. Isolation separates those who are ill from a contagious disease from those who are not sick. Quarantine separates and restricts the movement of people who have been exposed to a contagious disease to determine whether they will become ill. Both isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease (“About Quarantine and Isolation” 2020).

Perhaps the best-known case of quarantine is Mary Mullen, also known as Typhoid Mary, a woman who was a healthy carrier of typhoid. She is probably the source of a typhoid epidemic in New York City in 1907 where 3,000 people developed the disease. Unfortunately, because she refused to stop working as a cook, she was quarantined twice for a total of twenty-six years and died in quarantine (Marineli et al. 2013).

The first case of the novel coronavirus in the United States was documented on January 16, 2020. The numbers accelerated rapidly in early March (“Cases in the U.S.” 2020). On March 16, the CDC announced its campaign “15 Days to Slow the Spread,” recommending social distancing (staying six feet apart), staying home if ill, especially for those elderly, or having an underlying condition that puts one at risk; and if someone in the household tests positive, then everyone stays at home as ways of decreasing the spread (“The President’s Coronavirus Commission” 2020).

Yet, even that may not be enough. A choir in Washington State an hour north of Seattle with no known community COVID-19 infections held a practice with sixty people. They practiced social distancing and cleaned their hands with sanitizer prior to entering. All were asymptomatic. In the end, forty-five of sixty came down with COVID-19 and two died (Read 2020). Thus, various states made the decision to limit the number of people who can congregate together and limiting business to only “essential services,” which has not included places of worship. The CDC recommended that everyone in public, whether ill or not, wear a covering over their faces (“Guidance Documents” 2020). Originally, these were called stay-at-home orders, but perhaps to make it more acceptable and less a command, it was changed to shelter-in-place.

The goal of all these interventions was to flatten the infection curve, decreasing the rate of acceleration so that healthcare services, including hospital beds, ventilators, and personal protection equipment, are not overwhelmed by demand for care. It also protects the finite number of healthcare personnel including physicians and nurses who can care for infected patients.

Following CDC recommendations, churches, mosques, and synagogues began to close (Burk 2020). The Archdiocese of Chicago and New York suspended public masses the weekend of March 14 (“Masses Canceled” 2020; “Statement” 2020). Others followed. There has been opposition. Some claim divine protection (Boorstein 2020). In Wisconsin, a state legislator sent a letter to the governor with concerns about infringement on the free exercise of religion (Wigderson 2020). A letter from a group of prominent Catholics to the bishops urged them to demand that church services be considered essential, imploring them “to do everything you can to make the sacraments more available to us during this crisis…(W)e must do everything we can to have access to what is essential for our spiritual lives. We should certainly not voluntarily deprive ourselves of the sacraments.” Among their concerns was the ability of priests to serve the dying, but the letter also included a demand that priests and bishops celebrate public Masses, especially for Easter.

The letter ends with “The Bishops, our Spiritual Fathers, must take active and public roles in bringing to our wounded world the sacramental graces needed to survive the COVID-19 pandemic” (“Message to Our Bishops” ²⁰²⁰). There is also a feeling among some Catholics that, as autonomous persons, they have the right to take the risk of dying in order to avail themselves of the sacraments, especially the Eucharist including personal conversations on Facebook March 26, 2020). But in view of how contagious COVID-19 is, what is our obligation as Catholics to the common good and the vulnerable?

The Church and the Sacraments

The Eucharist is the source and summit (Catechism 1995, 1324) and sum and summary of our faith (Catechism 1995, 1327). By partaking of it, it unites us to Christ and the Church (Catechism 1995, 1396) and commits us to the poor (Catechism 1397 ¹⁹⁹⁵). It is not to be celebrated alone, but within the assembly (Catechism 1329 ¹⁹⁹⁵). Canon law states that “Any baptized person not prohibited by law can and must be admitted to holy communion” (Code of Canon Law 2000, 912). It is also “highly recommended” that the Eucharist be received during the Mass itself (Canon 918 2000). It cannot be denied to those who seek them at appropriate times, are properly disposed, and are not prohibited from receiving (Code of Canon Law 2000, 843). Thus, if there is a limitation to the number who can gather, it means that Catholic churches would have no option but to refuse the sacraments when the number of persons gathering exceeds the legal number or disobey a legitimate authority making a decision based on the advice of medical experts.

Considering the importance of the Eucharist in the sacramental life, it is not surprising that we keenly feel its loss. When we fulfill our weekly obligation to attend Mass, we are also urged to receive it every time (Catechism 1995, 1388), though under canon law it should be received at least once a year, preferably during the Easter season (Code of Canon Law 2000, 920).

When we are unable to receive the Eucharist for any valid reason, we may make a spiritual communion by expressing our faith in the presence of Jesus in the Eucharist and requesting to be united with Him. Many saints, including Padre Pio and St. Josemaria Escriva, practiced spiritual communion. John Paul II (2003) quotes St. Teresa of Jesus in his encyclical letter Eclasia Eucharistia: “When you do not receive Communion and you do not attend Mass, you can make a spiritual Communion, which is a most beneficial practice; by it the love of God will be greatly impressed on you.” Or perhaps be like the Japanese who kept the faith for over 200 years without priests or any formal linkage with the Church in Rome (Watkins 2020).

We must remember that the Church is not a building but an assembly (Catechism 1995, 752). It is not only a liturgical assembly but also a local and universal community, all three of which are inseparable from the others. It draws from the Word of God and the Body of Christ to become Christ’s body present here (Catechism 1995, 752). It is a hierarchical society, a spiritual community, and an earthly Church endowed with heavenly riches (Catechism 1995, 771), born of Christ’s total sacrifice instituted in the Eucharist and fulfilled on the Cross (Catechism 1995, 766). The Church therefore is the people of God (Catechism 781 ¹⁹⁹⁵) with Christ as our head (Catechism 1995, 792). We are the Church.

Although we tend to think of sacraments in terms of the traditional seven, a sacrament is an outward sign of inward grace. Therefore, the Church is also its own sacrament in her whole being, and all members are to bear witness (Catechism 1995, 738), the outward sign of the sacrament of the inner unity with God and unity of the human race (Catechism 1995, 775). We are therefore God’s instrument (Catechism 1995, 776) here on earth.

Common Good and Preferential Care for the Poor

One outward sign of the Church is a preferential love for the poor. Caring for the common good has a long history in Catholic history. St. John Chrysostom, in the fifth century, said “This is a rule of the most perfect Christianity, this is a landmark exactly laid down, this is the point that stands highest of all; viz. the seeking those things which are for the common profit: which also Paul himself declared, by adding, ‘even as I also am of Christ.’ For nothing can so make a man an imitator of Christ as caring for his neighbors” (“Homily 25 on first Corinthians”). When we act for the common profit (good), we imitate Christ. Usually thought of in terms of living wage, ownership of private property, and the responsibilities of workers, employers, and the State to each other, there is more to common good. Pope Leo XIII (1891) defined the common good as a sacred justice where the most vulnerable who are least able to protect themselves are protected (#36–37). Pope St. John XXIII (1961) reminds us “all life is sacred” and of immense worth. People are the foundation, cause, and end of social institutions, which must be respected (#192, 194, 219).

This is in keeping with our social nature, where the good of each individual is “necessarily related” to the common good, in turn defined in our relationship to others (Catechism 1995, 1905). This allows us as a people and as a community to reach our “fulfillment more fully and more easily” (“Gaudium et Spes” 1965, 26). It calls for prudence, not only as individuals but among those who govern us as well (Catechism 1995, 1906). This has three essential elements: respect for the person, promotion of the social well-being and development of the group, and peace and security (Catechism 1995, 1907–9). The common good involves providing for the different needs of each person (Catechism 1995, 1911) and is oriented to the progress of persons, founded on truth, built on justice, and animated by love for each other (Catechism 1995, 1912). Its basis is theological–moral, a guide to human behavior at the levels of motivation, societal norms, and conscience (“Compendium of the Social Doctrine of the Church” 2005, 73). The common good relates to every aspect of social life so that we may attain the fullest meaning due to our dignity, unity, and equality. It should be society’s primary goal to be at the service of human beings at every level for the good of all and of the whole person. No one is exempt from cooperating (“Compendium of the Social Doctrine of the Church” 2005, 164–67).

We should therefore create and support institutions that promote the common good (Catechism 1995, 1922) including health (Pius XI 1931, 28) and health care (John XXIII 1961,61). While all contribute to the common good, the State, governed by right reason and natural law and for the benefit of all especially the poor, also is to serve the common good (Leo XIII 1891, 32). The State exists for the common good with a duty to balance different interests with justice (“Compendium of the Social Doctrine of the Church” 2005, 167–68). The Popes and the Church allow it to intervene (Leo XIII 1891, 36; “Gaudium et Spes” 1965, 75), even if means curtailing rights temporarily, though they must be restored as soon as an emergency is over (“Gaudium et Spes” 1965, 75). As a base and as a reflection on the problem of the COVID-19 pandemic, Catholic social teaching cthe an be used to evaluate our response according to faith and reason (Wright 2017). Thus, as long as it is acting according to natural law and with prudence, the State has an obligation to act for the common good. We must actively submit for the sake of conscience to legitimate authority (“Compendium of the Social Doctrine of the Church” 2005, 380), though it is legitimate to resist if it acts contrary to natural law, fundamental rights, or Gospel teaching (“Compendium of the Social Doctrine of the Church” 2005, 399–400).

This is not a utilitarian version of the common good where actions are to achieve the greatest good for the greatest number. The Catholic idea of common good goes against the individuality of our culture and its emphasis on autonomy. We are called, both individually and communally, to do what is best for everyone. We must constantly be on the lookout for the good of others (John Paul II 2005). It includes subordinating one’s particular good “if the common good demands it” (John XXIII 1961, 147). We must act in solidarity with others, which Francis (2013) says is a “word that bothers us…[b]ecause it requires you to look at another and give yourself to another with love.” In the end, the common good respects the dignity of the human person, advances prosperity for all, and pursues justice by protecting and defending others, especially those who cannot protect themselves, which in turn promotes peace. Finally, it forms the basis of a civilization of love where life-giving love is present and permeates every social relationship, making us more human and more worthy (Compendium of the Social Doctrine of the Church 2005, 581–83).

The Church’s love of the poor is part of her constant tradition (Catechism 1995, 2444). The works of mercy include caring for the sick (Catechism 1995, 2447). The Ethical and Religious Directives (ERDs) state that the Church has served the sick and the suffering throughout her history (Ethical and Religious Directives Introduction 2018). Part of Catholic health care is to provide responsible stewardship of available resources, including equity of care and promoting the good health of all (Ethical and Religious Directives Part 1, Introduction 2018). But in the tradition of the common good and care for the poor, this is an obligation not only for those in health care, but as an act of mercy for the poor and vulnerable, an obligation of every member of the body of Christ.

In this time of the COVID-19 pandemic, how can serving the common good and the poor best be achieved? Epidemiological experts tell us the combination of social distancing, masks, preventing the gathering of groups of people, isolating those who are ill, and quarantining those who have been exposed will minimize the effect of this disease on the healthcare system and allow it to provide equitable care for everyone. Unfortunately, this means as the body of Christ, at the height of the epidemic, to protect our brothers and sisters in health care as well as the general population, especially the poor and vulnerable, we avoided prolonged large gatherings such as Mass, especially because it is difficult to practice social distancing when receiving Communion. It also meant that we made this sacrifice in common because we cannot offer the Eucharist to all. Consequently, even when states such as Texas were reconsidering whether or not churches should be labeled essential services and opened, the bishops were reluctant to open (O’Hare 2020). As we “flatten the curve,” we need to rely on the actions of government—and ourselves—to act in a way that is prudent when reopening everything from churches to restaurants to bars to tattoo parlors.

As the danger ebbs and flows, we need to use wisdom in determining where the dangers lie, and to depend on science, including the social sciences. These dangers are not only the effects of COVID-19 but also the physical effects such as delaying cancer treatments and screenings or heart surgery, the psychological effects of social isolation, especially among our elderly, and the economic damage to those who have lost their jobs or cannot work at home. We need a generous spirit toward those on whom this responsibility falls. The line between opening too soon or too late is narrow, and there will be mistakes. It is difficult, even in the best of times to balance these interests and even more so when we fear each other, seeing the other not just as a source of potential infection or death. In this atmosphere, it becomes even harder to trust. In a time when power has increased in our political systems, it can be hard for those in charge to give up their power and easier apply rules and regulations in an unjust way that reflects fears and agendas.

Conclusion: Social Distancing, Sacrificing the Sacraments, and the Common Good

Consider this scenario: at the height of the epidemic, the churches are open. Because the sacraments are to be made available to all, people come even when they are unable to maintain social distancing. Even in those where there is adequate social distancing, the virus is spread during communion, especially among priests. Thus, churches become a nidus of infection. The rate of infections increases. The healthcare system is overwhelmed.

At one parish, only those who are at low risk of severe disease attend. However, someone comes to Mass who is asymptomatic. The priest, Fr. James, is unknowingly exposed. A week later, before he becomes symptomatic, he exposes his parishioners to COVID-19, including Mark, a young healthy man with no risk factors. Later in the day, Fr. James goes to a hospice to give last rites to John Smith, age 80, who is dying of cancer and comforts his wife, Mary. A few days later, both Mary and Mark have COVID-19 and are seriously ill. Both of them present to the hospital. Unfortunately, due to the lack of ventilators and personnel who can run them, the hospital has to triage its resources. It is Mark who gets the ventilator, and Mary gets comfort measures only. She later dies, she who might have lived if there had been enough ventilators.

Even as the government yields, there are several ethical reasons why the churches should remain closed under circumstances of significant community infection and why when they reopen mitigating steps are needed. These mitigation steps have included the limitation of space. With social distancing, only a certain number of people can be admitted. Because the Church encourages that everyone who can receive communion during the Mass do so, this would be impossible to do and maintain social distancing between priest and communicant, thereby increasing the risk to the priest because of his role in distributing communion. During the reception of communion, both the priest and communicant are in close proximity, potentially passing the virus. The United States Conference of Catholic Bishops has issued instructions for the safe reopening of Churches, and individual bishops have adapted them for local concerns. There has been a debate, sometimes heated, on the propriety of restrictions that have been issued, from the mandating of masks to the prohibiting of singing and of communion on the tongue. The necessity of these instructions can be debated, but they all have their basis in attempts by the local ordinary to nurture the common good as best he can. If churches became niduses of infection, we would not be acting for the common good, increasing the spread of COVID-19 while the poor among us, the homeless, the elderly, and those with preexisting conditions would bear the brunt when our desire for the Eucharist is greater than our care for the life our neighbor.

In Matthew 25:31–46, we have the parable of the sheep and the goats. In it, we are reminded that, in the end, we will be judged on how we cared for the least of our brothers and sisters, the poor, and the vulnerable. We are called to do everything we can for the common good and to do what is best for everyone even if it means that we must subordinate our own needs and desires. As St. John Chrysostom said, we are called to follow “the highest point of all:” to imitate Christ by caring for others (Homily 25 on first Corinthians), even if we don’t know or even like them (Benedict XVI 2005, 18). In doing so, we are caring for Jesus Himself, even if we do not realize it at the time. By working for the common good under the social teachings of the Church, we can form a just society based on transcendent human dignity (“Compendium of the Social Doctrine of the Church” 2005, 132) and a true life-giving culture of love. The Eucharist is worth dying for, it is not worth sacrificing the lives of others.

Biographical Note

Cynthia Jones-Nosacek, MD, is a family physician, retired after being in practice for over thirty-five years. Her practice covered the full range from obstetrics and newborn care to hospice, inpatient, and outpatient care. She graduated from Loyola–Stritch School of Medicine. Her residency was at Resurrection Hospital in Chicago. She practiced at Ascension Columbia–St. Mary’s in Milwaukee, Wisconsin. She has written a wide range of articles in medical bioethics from beginning to end of life. Presently, she divides her time between mission work in Uganda, studying for a master’s degree through Ohio State University, and caring for her grandchildren.