In the Valley of the Shadow of Death

A lesson from Martin Luther on walking in faith during pandemics.

By Scott Church – Guest Blogger

After decimating nearly one-third of Europe during the 14th Century, the Bubonic plague continued to ravage it in periodic epidemics before it was effectively eradicated in the mid-20th Century (White, 2014; Schiferl, 1983; Griggs, 2014). For the most part, these outbreaks were isolated to villages or regions, and it was possible to flee to safety elsewhere until they subsided. In August of 1527, one such outbreak came to Wittenberg while Martin Luther was at the university there, and Elector Johann Hess of Saxony ordered him and other professors to flee to Jena for safety.

Luther refused, choosing instead to stay behind with his wife Katharina von Bora and open their home as a ward for the sick, whom they cared for at great personal risk to themselves. He penned a letter to Elector Johann explaining his reasons (Luther, 2020). Five centuries later, in the age of COVID-19, his words and the testimony of his life show us what true God-fearing faith during pandemics is... and more importantly, what it is NOT.

In his words,

"[W]hoever serves the sick for the sake of God's gracious promise... has the great assurance that he shall in turn be cared for. God himself shall be his attendant and his physician, too. What an attendant he is! What a physician! Friend, what are all the physicians, apothecaries, and attendants in comparison to God? Should that not encourage one to go and serve a sick person, even though he might have as many contagious boils on him as hairs on his body, and though he might be bent double carrying a hundred plague-ridden bodies! ... Therefore, dear friends, let us not become so desperate as to desert our own whom we are duty-bound to help and flee in such a cowardly way from the terror of the devil, or allow him the joy of mocking us and vexing and distressing God and all his angels..."

True disciples don't deliberately put themselves in harm's way out of mere fealty to church doctrine, or to appease worldly narratives and political agendas others have tarnished it with for reasons that serve their own interests rather than God's. They do so in loving service to their neighbor. In the words of the apostle Paul, they offer themselves as living sacrifices, holy, acceptable to God, which is their reasonable service (Rom. 12:1).

Note the reference to reasonable service (from the KJV Bible)—Or as the Amplified Bible renders it, "rational (logical, intelligent) act of worship." Genuine faith sees the face of Jesus in the poor, the oppressed, and the sick, and with full rational knowledge of the risks involved, seeks to be His healing face in their lives. It is in THAT place that we trust God's Will for our best, and our neighbor's.

By contrast, Luther tells us, there are those who,

"Sin on the right hand. They are much too rash and reckless, tempting God and disregarding everything which might counteract death and the plague. They disdain the use of medicines; they do not avoid places and persons infected by the plague, but lightheartedly make sport of it and wish to prove how independent they are. They say that it is God's punishment; if he wants to protect them he can do so without medicines or our carefulness."

This sort of "faith" will have nothing to do with reason (logic, intelligence). It flies recklessly in the face of real-world facts, rejects medicine, makes no attempt to socially distance from the sick, and even goes so far as to make fun of those who do, simply to assert its independence... that is, freedom.

Sound familiar...?  ;-)

According to Luther,

“This is not trusting God but tempting him. God has created medicines and provided us with intelligence to guard and take good care of the body so that we can live in good health… If one makes no use of intelligence or medicine when he could do so without detriment to his neighbor, such a person injures his body and must beware lest he become a suicide in God's eyes. By the same reasoning a person might forego eating and drinking, clothing and shelter, and boldly proclaim his faith that if God wanted to preserve him from starvation and cold, he could do so without food and clothing. Actually that would be suicide.

It is even more shameful for a person to pay no heed to his own body and to fail to protect it against the plague the best he is able, and then to infect and poison others who might have remained alive if he had taken care of his body as he should have. He is thus responsible before God for his neighbor's death and is a murderer many times over. Indeed, such people behave as though a house were burning in the city and nobody were trying to put the fire out. Instead they give leeway to the flames so that the whole city is consumed, saying that if God so willed, he could save the city without water to quench the fire..."

True disciples are rational (logical, intelligent). They embrace science, medicine, and socially responsible behavior—not out of license masquerading as "freedom," but because they are responsible to God for their own health, and... [wait for it] ... their neighbor's. To do otherwise—to reject their reasonable service, which is holy, acceptable to God—is to tempt Him rather than trust Him, and in so doing, become a murderer plain and simple.

In summary, he tells us,

"No, my dear friends, that is no good. Use medicine; take potions which can help you; fumigate house, yard, and street; shun persons and places wherever your neighbor does not need your presence or has recovered, and act like a man who wants to help put out the burning city. What else is the epidemic but a fire which instead of consuming wood and straw devours life and body? You ought to think this way: Very well, by God's decree the enemy has sent us poison and deadly offal. Therefore I shall ask God mercifully to protect us. Then I shall fumigate, help purify the air, administer medicine, and take it. I shall avoid places and persons where my presence is not needed in order not to become contaminated and thus perchance infect and pollute others, and so cause their death as a result of my negligence. If God should wish to take me, he will surely find me and I have done what he has expected of me and so I am not responsible for either my own death or the death of others. If my neighbor needs me, however, I shall not avoid place or person but will go freely, as stated above. See, this is such a God-fearing faith because it is neither brash nor foolhardy and does not tempt God."

Nor is this restricted to personal faith only. It is a calling to the church and community as well,

“'Whoever loves danger,' says the wise man, 'will perish by it' (Ecclus. 3:26). If the people in a city were to show themselves bold in their faith when a neighbor's need so demands, and cautious when no emergency exists, and if everyone would help ward off contagion as best he can, then the death toll would indeed be moderate. But if some are too panicky and desert their neighbors in their plight, and if some are so foolish as not to take precautions but aggravate the contagion, then the devil has a heyday and many will die. On both counts this is a grievous offense to God and to man..."

To these ends, Luther’s exhortation to “make use of medicine and intelligence” is particularly timely for us. When diseases broke out in his world, one had only two options—do your best to avoid them; and pray for a healthy recovery if you don’t succeed. We, on the other hand, have been blessed with five centuries of advances in virology, immunology, and medicine his world didn’t have. And of all the blessings at our fingertips in the age of COVID-19, one stands out more than any other—the one that allows us to arm ourselves against it, and possibly even eradicate it… vaccines. Unfortunately, many people still aren’t getting them, which is keeping widespread herd immunity out of reach. In the United States in particular, many are flat-out refusing vaccination for ideological reasons, not the least of which is a general hostility toward science and public health measures that from all appearances, no amount of evidence or logic will ever be able to penetrate. Many others, however, are hesitant due to concerns about how safe and effective COVID vaccines are (especially considering public health recommendations to continue masking and social distancing even after vaccination) but can otherwise be reasoned with if these concerns are addressed. They can be.

COVID vaccines are effective

As of this writing, three COVID-19 vaccines are in general use in the United States: The messenger RNA-based (mRNA) vaccines manufactured by Pfizer and Moderna, and the Johnson & Johnson adenovirus-based "one-shot" vaccine. All three have been thoroughly tested and approved by the FDA (Tanne, 2020; Oliver, 2020). The AstraZeneca adenovirus-based vaccine has also been approved for general use in Europe (EMA, 2021). Demonstrated efficacies of mRNA-based vaccines against infection or symptoms requiring hospitalization from the original wild strains of SARS-COV-2 are 95-97% for the Pfizer–BioNTech BNT162b2, and 92-95% for Moderna mRNA-1273. Corresponding figures for the Johnson & Johnson [J&J] Ad26.COV2.S and AstraZeneca–Oxford ChAdOx1 nCov-19 vaccines are around 67-72% (Haas et. al., 2021; Tenforde et. al., 2021; Callaway, 2021; Noor, 2021; Polack et. al., 2020; Mahase, 2020; Olliaro et. al., 2021; Mallapaty & Callaway, 2021).

As of Sept. 2021, these figures are still holding up well, even against recent variants such as B.1.617.2, or Delta. Per multiple studies in Europe and North America, effectiveness of the Pfizer–BioNTech vaccine against the more robust and transmissible Delta variant ranges from 79% to 88% for infection and symptomatic illness, and 89% to 100% (!) for hospitalization (Tregoning et. al., 2021; Lopez Bernal et. al., 2021; Baraniuk, 2021; CDC, 2021).

For all vaccines collectively, one recent study in New York found overall age-adjusted effectiveness against new COVID-19 cases and hospitalizations to be 75% and 89.5% to 95.1% respectively (Rosenberg et. al., 2021). A similar recent study in England found 50-60% effectiveness against infection by Delta (symptomatic or otherwise), including the less effective one-shot ones such as J&J (Smout, 2021). Even a single immunization has been shown to boost neutralizing titers against all variants and SARS-CoV-1 by up to 1000-fold (Stamatatos et. al., 2021), and one study of new COVID-19 cases in Kentucky during May and June of 2021 found that those who were vaccinated were 2.34 times less likely to be infected than those who had previously had COVID-19 and survived but weren't vaccinated (Cavanaugh et. al., 2021). One recent study in Israel did find an effectiveness of only 64% for Pfizer–BioNTech BNT162b2 against infection and symptomatic illness (Hass et. al., 2021). However, it was based on incidence rates in subjects who were considered fully vaccinated one week after receiving their second dose, whereas per U.S. CDC guidelines, one isn't considered fully vaccinated until two weeks after their second dose (CDC, 2021b).

If one does contract COVID-19 after vaccination, severe symptoms, hospitalizations, and deaths among breakout cases are almost an order of magnitude lower than those among the unvaccinated. Even in the case of the more vaccine-resistant Delta variant, the Pfizer–BioNTech BNT162b2 and Moderna mRNA-1273 vaccines reduce risk of hospitalization after four months by 93% and 91% respectively, and by 92% and 77% after six months (Scobie et. al., 2021; Self et. al., 2021).

But of course, if in doubt one could simply check the trended data on new US cases and deaths vs. vaccination rates since mass distribution of these vaccines began in earnest last January (JHUM, 2021). The dramatic declines in COVID-19 with rising national vaccination levels reflected in these datasets are self-evident. The spike in new cases after July 11, 2021 was almost entirely due to the Delta variant spreading among the unvaccinated, who as of July 30, 2021 comprised 96-99.8% of all cases (Kates et. al., 2021). And among the rising percentages of breakthrough cases (thanks to the unvaccinated Petrie dish), severe illness, hospitalizations and deaths are clearly a fraction of those for the unvaccinated (CDC, 2021c; Evans & Wernau, 2021).

By the numbers and the extensiveness with which they've been tested, the effectiveness of these vaccines in preventing infection, hospitalization, or death from COVID-19 is beyond reasonable dispute. But that said, it's important to be clear about what we mean by effectiveness and efficacy (there's a difference). When we say, for instance, that the Pfizer–BioNTech vaccine has an efficacy of 88% against infection, we mean that in controlled studies where a random sample of subjects received the Pfizer vaccine and an identical (or as similar as possible) control group of subjects received a placebo, 88% fewer subjects in the vaccinated group contracted COVID-19 during the trial period than the unvaccinated group--that is, if 100 COVID-19 cases turned up in the unvaccinated group, twelve did in the vaccinated group, and likewise for efficacies against hospitalization and death. On the other hand, vaccine effectiveness generalizes these comparisons to wider vaccine use in the general public. Since vaccine distribution and use may differ regionally and/or demographically from controlled laboratory studies, vaccine effectiveness may differ somewhat from efficacy.

In both cases, what we are NOT saying is that an efficacy/effectiveness of 88% against infection means that vaccines only work for 88 out of 100 people, nor that they will only work 88% of the time for you. Likewise, 93% efficacy/effectiveness against hospitalization does NOT mean that seven out of every 100 breakout cases will be hospitalized, and the rest will be asymptomatic. It isn't hand grenades. :-)

It simply means that there will be 88% fewer infections and 93% fewer hospitalizations in a vaccinated population than an unvaccinated one. But everyone who is vaccinated still has some level of protection from vaccines that they wouldn’t otherwise have. [The WHO Vaccine efficacy, effectiveness and protection page has a very readable and informative overview of all this.]

All other factors held constant the bottom line is that vaccination protects everyone and does so in at least three ways.

First, while it is true that in some cases the individual protection offered by vaccines may not be enough to prevent one from coming down with the disease or being hospitalized, they still reduce everyone’s risk for infection, and nearly all of those who do come down with a breakout case anyway will have less severe symptoms than they otherwise would have. How well vaccination protects you personally will depend on a wide range of factors including your age, your overall immune function, any comorbidities you may have, how much exposure you get from daily life (home, workplace, etc.), and more. But regardless, you will be more protected with vaccination than without it. And unless you have known life-threatening vaccine allergies or related immune function risks, getting vaccinated poses no risk compared to remaining unvaccinated since you would have to be infected and get sick to generate an immune response anyway, so there's no reason not to get one.

Second, if 88 out of 100 people who are vaccinated don’t contract COVID-19 when exposed to it, that means there are 88 fewer people spreading the disease before they develop symptoms, which in turn reduces everyone’s risk of exposure to it in the first place (more on this shortly). This is a key point, especially for those who intend to love their neighbor as themselves…

Choosing to be vaccinated doesn’t just protect you from infection, it protects your loved ones, your friends, and your community.

Finally, and most alarmingly, the vast majority of people filling hospital beds nationwide and around the world are unvaccinated COVID-19 patients, and the resulting burden is taxing healthcare workers and resources to the breaking point—so much so that in many regions, hospitals are literally having to resort to “death panels” to decide who gets care based on their likelihood of survival (Knowles, 2021; Hiltzik, 2021; Westneat, 2021). In other words, we have now reached a point in this pandemic where people are literally dying from preventable conditions because there are no hospital beds for them.

A month ago, my 89-yr-old father fell and broke his knee. He was left on a gurney in a hallway at Deaconess Hospital in Spokane, Washington for eight hours because there wasn’t a single bed available for him—all but a handful were being used by unvaccinated COVID-19 patients from Idaho who were seeking care in Washington because of the very Idaho hospital death panels discussed in the last two sources cited above. If he’d been in a car accident, needed an emergency appendectomy, or had a heart attack, he’d be dead… for literally no reason other than that all the beds in the nearest hospital were taken up by unvaccinated COVID-19 patients.

Choosing to be vaccinated doesn’t just protect you from hospitalization and death, it protects doctors, nurses, and healthcare workers struggling to save lives, and saves everyone from needless crippling or death due to lack of available care.

COVID vaccines are safe

As of this writing, nearly 6.3 billion COVID-19 vaccinations have been administered worldwide. More than 393 million have been administered in the United States, and 63% of the U.S. population have had at least one shot (Ritchie et. al., 2021; JHUM, 2021). Anaphylaxis adverse reaction rates have run around 0.0011% for Pfizer and 0.00025% for Moderna or roughly two to eleven adverse events per million vaccinations administered (Rutkowski et. al., 2021; Shimabukuro et. al., 2021; Banerji et. al., 2021). Corresponding figures for adenovirus vaccines such as Johnson & Johnson [J&J] Ad26.COV2.S and AstraZeneca–Oxford ChAdOx1 are around 0.0003% for blood clotting (Ledford, 2021; CDC, 2021d). Overall, as of Aug. 16, 2021, after administration of more than 357 million doses of COVID-19 vaccines, a grand total of 6,789 deaths had been reported, or 0.0019% of doses administered (CDC, 2021d), and few of these deaths have even been specifically tied to the vaccines themselves rather than extraneous factors or even coincidence. For these and many other reasons, as of Aug. 23, 2021, the Pfizer–BioNTech BNT162b2 has full rather than emergency FDA approval (USFDA, 2021).

For comparison, your odds of being struck by lightning once in an 80-year lifetime (believe it or not, the National Weather Service maintains stats on this!) are one in 15,300, or 0.0065%--more than three times the odds of a severe adverse reaction (SAR) from any COVID-19 vaccine (NWS, 2021). Apart from valid doctor-certified medical exemptions, it isn’t reasonable to refuse vaccination based on risk this low.

In conclusion, it should be also noted that there is a flood of disinformation regarding vaccine safety and effectiveness circulating on social media and in online activist and news/op-ed forums. A detailed examination of the numerous claims and allegations being made is beyond our scope today but suffice to say that virtually none of it has any basis whatsoever in fact and it continues to spread only because it receives uncritical reception in these forums outside of the scientific peer-review process.¹ By the reliable data and numbers, the safety of these vaccines is also beyond reasonable dispute.

Do I still need to mask up and socially distance after vaccination?

In a word, yes… but only as the circumstances of your daily activities and regional safety guidelines dictate. Here are the things that need to be kept in mind…

As of this writing, 99% of all new COVID-19 cases in the US are the Delta variant (CDC, 2021e). As already noted, the existing Pfizer vaccine has been shown to be 79-88% effective against Delta for infection. That's tantamount to saying that it's 12-21% ineffective, meaning that even if you're vaccinated you still have roughly one chance in six of coming down with COVID-19 if exposed to it, perhaps asymptomatically.

What happens if you do...? It’s well known that breakout cases among the vaccinated can still carry viral load significant enough to be contagious even if they don't become symptomatic, and in some cases, they may even carry as much as those who aren’t vaccinated (CDC, 2021). Either way, if you do, how many susceptible people you pass it to while contagious will depend on a wide range of factors—your age and immune function, demographics of your daily encounters, behavior (including masking and social distancing), etc. Taking all these factors into account, given the average person infected with a disease, the expectation value for how many people he/she will spread it to in an unvaccinated environment while contagious is given by its base reproductive factor, or $R_{0}$.

As of this writing, Delta has an estimated $R_{0}$ of between 5 and 9.5, as opposed to that of chickenpox, which has an $R_{0}$ of 8.5 (CDC, 2021; UNSW, 2021; Liu & Rocklöv, 2021; Georgiou, 2021). As such, even if you are vaccinated, if you come down with a breakout case of Delta COVID-19 in an unvaccinated setting and don't quarantine or change your behavior, you will likely spread the disease to at least some people before recovering or dying. In most cases being vaccinated will reduce the likelihood that you will spread it, but it’s possible that you could spread it to as many as five to nine others. Each of them will then do likewise, and so on—more so among the unvaccinated. As successive generations of infection proceed through a given population, the number of susceptible hosts will be eroded by acquired immunity or death, and continued infection rates will to first order yield an effective reproductive factor, $R_{eff}$, given by,

$R_{eff} = R_{0}\left ( 1 - p_{1} \right )$

where $p_{1}$ is the percentage of a population that has acquired immunity either through infection or... vaccination. As can be seen, the key to reducing $R_{eff}$ is to increase $p_{1}$… And vaccination makes this possible at a much faster rate with orders of magnitude fewer casualties.

For Delta (or any other SARS-COV-2 variant) to be contained regionally or globally, $R_{eff}$ must remain less than 1.0 long enough for the virus to die out. So, given a median $R_{0}$ of 7.3 for the estimated range above, this means that $p_{1}$ must be greater than 0.86. As of Oct. 3, 2021, total cumulative U.S. COVID-19 cases were at 43.7 million and deaths at 701,000, or around 13.1% of its population that has acquired immunity, and concurrently, 54.9% of its population is fully vaccinated (JHUM, 2021; CDC, 2021). Conservatively assuming negligible breakout case overlap, and naively presuming a normalized overall vaccine effectiveness of 88% (per the upper range of Pfizer–BioNTech Delta variant effectiveness cited above), that works out to at most, a $p_{1}$ of 0.61—far short of the target needed for containment. And none of this accounts for the erosion of vaccine effectiveness by the evolution of increasingly vaccine-resistant strains, which once they break out of vaccinated hosts, spread most virulently among the unvaccinated.

What can we do? By my lights, there are three responsible options:

Whatever path we choose, let us examine our own hearts and remember that it’s not just we ourselves that we’re protecting, but our neighbors, our loved ones, and our communities. As the poet John Donne said,

“No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as any manner of thy friends or of thine own were; any man's death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.”

As we face our own plague—As millions of our fellow citizens suffer under the iron fist of this cruel disease, hundreds of thousands die slow, horrible, intubated deaths, and doctors and nurses put in 70/80-hour weeks at the edge of their human reserves to save lives—Luther reminds us that we are all in this together, and we’ve been called to go forth into that Valley of the Shadow of Death hand-in-hand...

Not in brashness or foolhardiness… Not in willful rejection of science and medicine… Not in service to Self and license masquerading as "freedom…"

But as living sacrifices, holy, acceptable to God, in reasonable service to each other knowing that whatever may befall us, God is by our side completing the work he began in us. "Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me" (Matt. 25:39-40).

Or in the words of Paul,

"All things are lawful, but not all things are profitable. All things are lawful, but not all things edify. Let no one seek his own good, but that of his neighbor" (I Cor. 10:23-24).

"Do nothing from selfishness or empty conceit, but with humility of mind regard one another as more important than yourselves; do not merely look out for your own personal interests, but also for the interests of others. Have this attitude in yourselves which was also in Christ Jesus, who, although He existed in the form of God, did not regard equality with God a thing to be grasped, but emptied Himself, taking the form of a bond-servant, and being made in the likeness of men. Being found in appearance as a man, He humbled Himself by becoming obedient to the point of death, even death on a cross. For this reason, also, God highly exalted Him and bestowed on Him the name which is above every name, so that at the name of Jesus every knee will bow, of those who are in heaven and on earth and under the earth, and that every tongue will confess that Jesus Christ is Lord to the glory of God the Father" (Phil. 2:3-11).

Do nothing from selfishness or conceit… Regard others as more valuable than yourself, and look to their interests as well as your own...

Have this attitude (this mindset, this worldview, these values... not these parroted dog-whistles or party-line narratives) in you which was also in Christ Jesus...

Who although He was God Incarnate, with all the power, authority, and glory thereof, did not consider that august status a thing to be grasped (clung to, defended with bared teeth and narcissistic injury), but emptied Himself, taking on the role of a servant...

And being found in mortal human form, was obedient to the point of death—even death on a cross, which in New Testament times was a death of disgrace reserved only for the lowest of despised criminals...

This is the kind of discipleship we’ve been called to… And it’s a far cry from rugged individualism and idolatrous nationalism whitewashed with joyful hymns and inspirational bumper stickers.

Say what you will about his quaint puritanical language, his belief that "evil spirits" cause plagues, and other bucolic naivetes. But like us, Luther was a man of the age he lived in. His words were penned long before he or any of his contemporaries had access to modern epidemiology, immunology, or even knowledge of germs. To dismiss him for speaking from, and to the age he lived in would be at best anachronistic, and at worst, sanctimonious. Archaic or not, in this age of COVID-19, the example he left with us is as self-evident as it is timeless, and those of us who call ourselves Christians would do well to heed it—especially those who seem to think that trusting God means tempting Him by rejecting science and medicine and behaving recklessly in the name of “freedom,” and then expecting Him to clean up their messes without holding them accountable as His sons and daughters.

We can embrace a faith like his that "makes use of intelligence and medicine" and "serves the sick for the sake of God's gracious promise." We can offer ourselves as living sacrifices, holy, acceptable to God in reasonable service to our fellow human beings and put an end to this pandemic. We can reach for the best that is in us, the best that is in our souls...

Or we can set aside loving our neighbors as ourselves (Mark 12:31) and tempt God with a "faith" based on denial, recklessness, and idolatrous worldly narratives and spread this disease throughout the world, filling hospitals and graves in our wake.

In short, we can be salt and light to a world in need... or in Luther's words, murderers.

The choice is ours. But make no mistake... We're kidding ourselves if we think we can choose the latter and expect that outside of our own echo chambers, the world isn't going to notice the difference and judge our witness accordingly.

Footnotes

1)      A deeper examination of some of the most widespread anti-vax myths currently in circulation can be found at two public Facebook posts of my own titled Covid-19 Vaccine Whack-A-Mole and Covid-19 Vaccine Whack-A-Mole - Part 2.

2)      Likewise, a deeper examination of the most widespread anti-mask myths currently in circulation can be found at a public Facebook post of my own titled Anti-Mask Whack-A-Mole.

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