COVID-19: Methodist Hospital Update for Pastors with Texas Annual Conference UMC


Dr. Marc Boom, CEO of Methodist Hospital System,  Bishop Scott Jones, and Mary Lou Reece hosted a webinar for all clergy of the Texas Annual Conference on June 25th. This webinar addresses the 600 churches in the Texas Annual Conference on the current COVID-19 spike, how that affects the church and its programming.

Discussion Questions:

1. 0:00:43 - Where are we in our battle against Covid-19?

2. 0:03:38 - If you haven't started in-person worship, should you delay farther, and if so, how long?

3. 0:06:43 - If we were to say we are going to give up on the second Sunday in July option, what's a fallback. When might we think about it actually being okay to reopen with all the precautions we're talking about?

4. 0:11:30 - If a church is worshiping in person, what are the things that you think they ought to be making sure of in order to be as safe as possible given that decision that they've made?

5. 0:18:05 - What about congregational singing? Is that even something that could be thought about, or should we just abandon it for a while?

6. 0:19:41 - If there is a single performer singing from stage, how far away should they be from the audience, and should they be masked?

7. 0:22:50 - What do we know about herd immunity associated with COVID-19 right now?

8. 0:30:23 - We hear a lot about symptomatic and asymptomatic people, but is there much in between? Can a person be mildly symptomatic with just one small symptom, or is that unlikely? If one of my team members is mildly symptomatic, do we keep them at home?

9. 0:33:00 - What factors do you attribute to African Americans dying at disproportionately higher rates than other ethnic groups? Additionally, does the Texas Medical Center and Houston Methodists have a plan to address these healthcare inequities and disparities?

10. 0:38:25 - Is there something about Type A blood being worse in terms of impact? Is that another genetic or biological factor that makes some people get a more serious case than others?

11. 0:40:01 - What if the pastor of a church is the one who's over 60? What advice do you have for those of us who are in that 65 and older group?

12. 0:42:54 - What are your insights about the Beaumont area of Tyler or College Station communities that are in the 40 to 120 thousand population range?

13. 0:45:47 - We previously gave congregants the choice to wear a mask. Should we begin to either ask people to wear masks as they enter or leave worship, or should we begin asking people to wear masks for the entire worship service?

14. 0:47:49 - What about taking people’s temperatures before they come in the building? Is that something that ought to be done, or is that sort of over the top?

15. 0:49:16 - What are the rationale for getting tested for COVID or for antibodies? Under what circumstances should somebody go to get a test?

16. 0:56:33 - What about resuming children's and youth ministries and especially preschools?

17. 0:58:58 - Does being outdoor for worship lower risk factors that all that would allow for singing, or other things or do we still need masks even in an outdoor environment.


Transcript:

Bishop Scott Jones (00:00:00):

Well, we do appreciate all that you've been doing, and we are proud to be associated with you. I told some people in a few minutes ago who got on the call a little early that at the board meeting yesterday we paid great tribute to you, but you also said your staff who are running the hospital while you're getting the messaging out. So, thank you for making time for this conversation today. Obviously, we have a lot of United Methodists on. I extended the invitation to many of our ecumenical partners as well. So, this is really aimed at church leaders for, you know, how to cope with this. And let me just start off with a question. Where are we in our battle against COVID-19? Can you give us a general summary of what things look like at this point?


Dr. Marc Boom (00:00:51):

Sure. And I, I have slides at some point that can show you some of the data around that, but, you know, right now is a challenging time. There's no question. And that's why, you know, as we were talking briefly, things have been a little crazy, you know, the hospital. So, you know, there's a lot of very conflicting messaging happening right now, and it's very frustrating for everybody. I get it and believe me, it's frustrating for us. So, you know, you get the kind of, Oh my gosh, the sky's falling down this instant sort of, you know, theme and you get others who still are, Oh, this isn't that big a deal. And of course, neither one of those are right. It’s in between those, although frankly, it's more towards the, level of concern than, you know, the people who are saying, well, this is, this is nothing we're seeing this ramp up very significantly.

We at the hospitals had been trying to find the right messaging and the TMC, the Texas medical center took a little misstep last night and ended up kind of messaging that, you know, we're full. And we're about to be out of control when really that wasn't the case. It was really intended to rally people and then they kind of miss messaged it. So, this morning, actually four of us did a press conference to talk about hospital capacity. I'd say that the key messages from that, if I was to summarize is we all have hospital capacity and have lots of creative things we can do. So we are not in a today shortage of hospital capacity. We have creative things we can do, but those creative things only last so long. So, you know, in two to three weeks, if we stay on a trend line, we're going to start to have some real challenges.

We know that we can change things in the community with a two to two week or so lead time and bring the curve down. And so, the time now is to start taking much more definitive actions, all of us as citizens, and other things that we need to do. And that's the time, you know, to do that now. So that was a second big message. And the third is really everybody personally, individually needs to do the social distancing, the hand hygiene, you know, this is not the time to advance through the society, new things and new openings, because right now this is going up very rapidly.


Bishop Scott Jones (00:03:03):

Let me just sort of launch in with what some pastors want to think about as we lead congregations. And one pastor I talked to earlier today had this question. He had led a rather large church, one of our largest United Methodist churches into a slow response and they have not yet started worshiping, in person reopening is sort of the catchphrase for that, but they were looking at doing so the second Sunday in July, if you haven't started in-person worship, should you delay farther? And if so, how long?


Dr. Marc Boom (00:03:44):

Well, I, well, unequivocally, you know, I don't think now is the time to march forward. So, you know, think of where you are, think about whether you need to go backwards. And I'll talk about that in a second, but definitely I would say now is not a time to move forward with loosening of any sorts of behaviors or restrictions or practices or, you know, worship services, anything that you're planning. So that second Sunday in July, that's within about a two-week time period of now right into two and a half weeks, I guess. And that's really within, I mean, the way things are looking right now, best case scenario we're at peak, then we may still not be quite peak. So we're on the way up. We haven't gotten back to the way down. I, you know, even if somebody is planning that and going through all the, you know, the details of planning that now I would find it hard to believe that when that date rolls around, they're going to go ahead and execute on that plan just from the numbers I'm seeing right now.


Bishop Scott Jones (00:04:41):

Wow. Okay.


Dr. Marc Boom (00:04:42):

And now I'm talking, you know, now let's keep in mind. I know this is a broad based group. So let me, let me clarify. I'm talking about, you know, an urban area, like the Greater Houston area, where we're seeing a major outbreak. Obviously some people may be in different towns, smaller towns, where they're not seeing that outbreak. So they need to be paying attention to what's happening in their area. But if, if you're talking somebody kind of in this Greater Houston area right now, you know, we are seeing very, very significant community spread. We've seen hospitalizations triple since Memorial Day. We're in control. We can handle it. We have some runway to continue to increase probably at least double if we need to, without, you know, really having to turn everything else off that's happening at the hospital. Like we did last time, but you know, that's two weeks to three weeks out.

So, we need to be careful that if there's something planned in that near term, not to go there and we're, you know, we've seen messages, as I said, swing a little too far, both ways. But you know, if you're, if you're sort of thinking of the pendulum of, I don't need to be concerned at all, and you know, maybe this is mid-May and things seem to be going well and things, you know, haven't been increasing in your, towards there. Or if you're thinking about how you felt kind of around the beginning of April and March, you should be feeling a more like end of, I mean, end of March, beginning of April, you should be feeling a lot more like end of March, beginning of April, right now we're, we're at a much higher peak than we were then, and we're not peaked yet.

The people who are in the hospitals tend to be younger. They are staying a shorter time. They're not dying as much. They aren't needing as many ICUs, which are all wonderful things. And I'm happy to talk about why that is, but the bottom line is, you know, for example, take Methodist, we got 330 something patients in house right now. We peaked at 207 in April. And across the Texas medical center, we're probably in the 1600, 1700 patients. You know, back in the mid may, we were at 500 so way more than triple at this point in time. So again, now's the time where really things are at risk of slipping out of our control.


Bishop Scott Jones (00:06:43):

So, if we were to say, okay, we're going to give up on the second Sunday in July option. What's a fallback? When might we think about it actually being okay to reopen with all the precautions we're talking, about?


Dr. Marc Boom (00:06:59):

You know, Bishop, I wish, I, I wish I knew the answer to that. You know, this, this curve is different than the last curve, because of all those things I just said, in terms of the number of people getting hospitalized, the age range, it's happening, shorter lines of stay. So, there's a lot of good things happening there, but it's also different in that we are seeing far more people diagnosed in the community. So I mean the bad news, that's bad news. The good news is even with far more people that diagnose, we're not seeing, you know, that big of an increase, we're seeing a big increase, but not proportionate in terms of hospitalization. So clearly a younger group they're not doing as poorly. You know, some people ask, well, did the virus change? We don't find any evidence of that. I mean, the jury's out on that. I can't give you a definitive answer. We know treatments improve.

There's a lot of other things going on like that, but this is a different curve. And so, we don't understand it as well, it's going up very rapidly right now, again, not with the kinds of mortality risks that we saw. I mean, now keep in mind, you're still seeing patients die, but not quite at the rates we saw before. And so I'm just not sure exactly, but I think, if you went back to kind of where we were at the end of March, you'd be sitting there, you know, saying, you know, don't know when this peaks going to end. And it ended up at two weeks later. I think that's probably our best-case scenario right now. You know, we're not, we haven't done anything as a community, nearly as definitive as last time. We've been trying and trying to figure out how to do this without that, because frankly, if we can do this at hospitals throughout the community for months and keep patients safe and keep our employees safe, it is doable.

So, in theory, the things you're talking about in a church setting are very doable and safe, but you know, at a point where things are going down, not where things are going up, you know, would be my advice. So, you know, if you'd asked me four weeks ago, we just said, yeah, you know, and actually I had that conversation with number of, of your, your local ministers here to say, yeah, you know, start easing things. And a number of them started to do that in July. And that was, or June, that was perfectly reasonable. It's just a different scenario. Now, as we look at the numbers, did I understand you to say you don't think we should be going backwards though? Well, I think that's a, that's a, a congregation by congregation kind of choice. You know, obviously let me put it this way.

So, the governor gave the authority to the County judge now to limit gatherings of anything greater than a hundred. It's not clear to me, honestly, if that's gonna apply to houses of worship or not but you know, that, that that's a distinction politically, not a distinction, you know, in virus terms. You know, certainly if you've eased to the point that you're doing large gatherings that are much bigger than that. Yeah. I think you should be thinking about whether you back off now, you know, if you've got 1500, 2000 person, you know, church and, and, are able to, you know, have in your sanctuary that, you know, people really spread out there, you know, that may be more equivalent to having, you know, a group of 20 and another group of 20, if you think about how some of those people arranged.

So, I don't say that with a hundred percent, but, by and large, I would say if you're, if you're getting into those numbers, you need to be thinking about ramping back. I mean, within the hospital, we still don't let anybody gather in a group greater than 10. You know, unless it's a clinical situation where they have to, but certainly no business administrative nonclinical situations where people are get getting together and gathering like that because we're being extra safe and extra cautious. I know this isn't the news. Everybody wanted to hear today, but unfortunately the virus has had some different ideas right now and is going a little bit the wrong direction in greater Houston again, and in Dallas and in Austin and in San Antonio. And what we saw this morning was the governor started to restrict elective surgeries again in Austin, Travis, Bayer, and Harris County. So the core counties of each of those urban areas now have some restrictions going into effect on Friday night. They're different than the last we'll be able to still do some outpatient procedures and other things that don't hurt our ability to take care of COVID patients. But there will be some things that we will have to start turning off in order to handle the volumes of COVIDs.


Bishop Scott Jones (00:11:14):

If a church is worshiping in person, what are the things that you think they ought to be making sure of an order to be as safe as possible, given that dispersion that they've made?


Dr. Marc Boom (00:11:31):

Sure, you know, I'll start with highly discouraging, anyone with a vulnerability from being one of those worshipers, in-person worshipers. They need to worship virtually. So, you got to look at it. You know, I know that this is a tough one to talk about, but you gotta look at age and you gotta say, you know, at some threshold of 60 or 65, the start to go up in terms of risk. And, you know, we really should try to keep those individuals from coming in, particularly those individuals who have underlying medical conditions, and those don't have to be dramatic medical conditions. They may be hypertension. Hypertension has been a big one, some heart disease, lung disease, you know, many other things, and younger people who have some of those conditions. So if you've got a 45 year old diabetic, they probably shouldn't be coming to in-person worship service at this point.

Those are the people we need to be, you know, isolating and protecting at home, and then reaching out to them spiritually and emotionally and as friends and, and colleagues and loved ones, you know, through other means virtual means and helping them in other ways. So that'd be step number one. Step number two, you know, for a younger, healthier crowd. Now the flip side there is, you know, what we've seen is I think a large part of what we're doing while it is getting blamed, at least politically on one side, you know, and all the reopenings and, you know, let's face it, the reopenings clearly did allow the virus to increase. We know that, but I think to me watching the data the biggest uptick really came around timing where personal behaviors really started to slip people. They saw three or four weeks of, "Hey, this wasn't so bad. We've been reopening. The data's not going up in May. Oh, hey, now it's Memorial Day. Let me crowd into a pool and let me go to a party and, you know, it's summer and lets let the kids all start having their parties." And we've seen all of those kinds of things. I think start to bite us and start to get us and are starting to bump things up. Some of that was compounded by, you know, obviously very understandable, but nonetheless from a virus perspective, troublesome large protests because you know, in a viral time we're talking about a hundred or even 25 here, you know, to put 60,000 people together, you know, is, is a real challenge from this virus time. I don't, I mean, looking at the data and nobody can prove what I'm saying, okay. This is my take on the data.

I don't think that was, you know, the major factor. I was a factor. I think that was 60,000 people. We have 7 million people in Houston. And I think it's pretty fair to say from the behaviors and the things I've seen when I'm out in the community, I don't go out much, but if I've driven by and looked at things, I haven't been a restaurant picked up. I haven't gone out to a restaurant yet, but when I see some of those behaviors there, you know, I got to figure 20, 30, 40% of the population has been too lackadaisical. So that's, you know, a couple of million people, and doing that day in day out. So at the end of the day, I think those were a bigger impact than the marches. So what I was gonna say is keep in mind that some of your younger people that have been some of the people who may not have always been the ones following guidance is as clearly.

And I'm getting kind of countless stories from people who contacted me, needing testing of, "Hey, my kids who are 25, we're in a party. And then this kid infected that kid, or, you know, exposed to that kid. And then they came home to my house." So we're seeing a lot of those kinds of things. So just be mindful of that. So you really need to think about the messaging that says, if there's a shadow of a doubt, you've had any sort of potential exposure, you don't feel well, you feel a little run down, you have a scratchy throat, you know, you are having a cough, you've started having a fever. You know, whatever those things are. If in doubt, just stay home this morning, worship with us virtually. Don't come. So you want to have people come, you know, that's not a perfect measure by any stretch.

You know, I think you should ask people that very firmly, you know, these are houses of worship. I hope people would, you know, obviously follow that. And also you could look them in the eye and say, yup, I'm following that. So I don't think you need to put temperature screening in. You can, but I don't think you need to do that. I do think you should bring people in through one set of, and one entrance probably through another exit. So you just kind of don't have all that traffic and those people getting too close. You need to focus on social distancing, you know, in a Sunday school class, which might be a pretty small, you know, classroom, right within a church slash school setting or something like that, you know, be really mindful of the size of those. Cause those are pretty small rooms.

So, you know, you need to really think about, can you take those outside? It's hard in Houston this time of year. Is there a bigger setting those could meet and meet, you know, with some distancing, everyone wearing a mask from, you know, the actual, a worship service standpoint, how do you keep it down and, you know, keep a family unit together and then keep great distance between them enhance cleaning protocols. I mean, all of those would be the things to continue on. If you've been doing it safely. I mean, you've now got a few weeks of experience and you've not been having congregants call you and say, "Hey, I came to church and I was sick", and you've not been doing a bunch of tracing of other people or someone calling or the County health department calling and saying, "We think this person might've gotten this there," you know, that, that, that says you've probably been able to do it safely.

You've been doing it safely point where the virus was at a lower level in the community, and now it's at a higher level of the community. So there's a caveat with what I'm saying here, but you've been doing that safely. You know, I think you've gotta be extra vigilant, but I think without like, if you don't let your guard down, I think it would not be unreasonable to say, let's try to do similar things. Now, you know, there's very active discussion and there's a lot of politics, but very active discussion, you know, between local health officials and state health officials. And this whole question of, do we need another shutdown? Will there be another shutdown? What else does it need? It needs to be ramped back. I don't have any idea, frankly, where that will go. But it is distinctly possible in some timeframe, you know, anywhere from soon to the next three weeks that we end up in a shutdown or an effective shutdown in Houston. I don't know that for a fact. I really personally think that if everybody did their part, we could avoid that. But, you know, we as a, we as a people, we, as you know, the 7 million people in greater Houston have not shown that we're able to do that. I mean, it's just be blunt. Know we have not shown that to a T everybody can look each other in the eye link arms and say, we got you and do it correctly and do it together. And it doesn't take a lot of kinks in the armor to, to, to, to sort of blow that up for the whole community. And that's really frankly, where we are today.


Bishop Scott Jones (00:18:05):

What about singing congregational singing? Is that even something that could be thought about or should we just abandon it for a while?


Dr. Marc Boom (00:18:15):

You know, that's always part of my favorite part of the service. So, after the sermon of course, you know, that is, yeah, it took me a second and that's a no, I'm sorry, but you know, the data that's out there, you know, says that when we are speaking loudly we are projecting and there is a greater force. You're going to probably spread some of the droplets farther, even with a mask, a mask helps tremendously, but the idea of having a bunch of people there singing is just, I just don't think it's a good idea. I mean, I, you know, a performer upfront, you know, one individual who's well, well away from everybody, I mean, well away from everybody probably masked, which is hard if you're singing you know, is an option, obviously, you know, people playing musical instruments, but I know there's some, some issues where you can put too many people with a wind instrument together and those kinds of things, but, you know, a string quartet or things like that. If that's something that's in a budget enable, there may be some other ways to worship, obviously the organ. But the actual singing of hymns and things I think is a bad idea. And choirs are a terrible idea. I mean, I just don't think we, but no one believes that it's safe right now. It's just, just is I'm so I'm sorry. I don't like the message, but it's, don't shoot the messenger.


Mary Lou Reece (00:19:33):

No, no. I'm going to interrupt a minute now and ask, because you said something there that really ticked me, not, you know, just really tickled my brain. When you said a single performer well away, what do you mean by well away? And masked? Well away and masked?


Dr. Marc Boom (00:19:54):

Well, okay. If we think about the six-foot six-foot rule, we have for kind of normal interactions is pretty well. Data-driven nothing. I mean, let's be clear. We still don't know everything about this virus, not everything's known. But we do know that most droplets would drop out of the air before six feet put a mask on, of course, and you've cut the number of droplets pretty dramatically, but there's still some getting through. Okay. I mean it's and the virus itself does not generally get blocked by, you know, non-N95 masks. It's the fact that matters is the virus is in droplets and droplets are easy to, easy to catch. And I don't mean droplets as in, you know, I'm talking and I see spindle flying. I'm talking much smaller than that, but still being very microscopic actually, but much bigger than the holes in the masks. So they get caught by the mask, but things can bend around the sides of the mask. So you're not perfectly protected, but masks are also then something that help us get a little closer to each other. I mean, you know, clinical environment, right? We know that we need to care for patients and to care for someone, we need to be very close to that many times. So, it protects the patient, it protects the caregiver. So, it's not a license to get close together, but it, it, it certainly helps. So with those moments of time. That's why particularly when people are walking through a supermarket and you know, they're going to pass by each other in an aisle and all those kinds of things, you really, really want those masks on.

So then you get to the singer. So the singer is going to, I've not seen data on this. I'm sure there is, but it's not going to be six feet, right? It's not, it's, they're projecting. I mean, a beautiful, beautiful voice is loud and amplifies it projects. And you know, I'm guessing total guests, you know, you're talking 2 to 3 times the kinds of distances in terms of potential droplets. You know, again, you can block the majority of that with a mask. So if I, I had an individual like that, that I wanted to have singing a worship service, you know, I'd figure out how to put them up on the, you know, right. Not, not, I mean, if you've got, you know, the preacher on one end at the pulpit, you know, whatever your room is, you've got, you know, your, your stairs up there for your tiers there for your choir. Go stick them back up there, you know, and have them breathe pretty distanced. I don't have a perfect answer for you, but most of those, you know, if you're not talking to tiny little church, you know, a good 20, 25 feet, something like that, if you're going to do something like that, obviously there's some smaller churches that may not be able to do that. In which case I probably wouldn't go with that. Again, I've not seen a study on that. That's really definitive. I'm just giving you some common sense advice based on what I know.


Bishop Scott Jones (00:22:31):

Well, we respect your advice, have a grateful for you sharing it, and we will not hold you accountable for that because we know you're giving us your best information in a rapidly changing situation. Let me turn to another question that's been sent in. What do we know about herd immunity associated with COVID-19 right now?


Dr. Marc Boom (00:22:51):

Yeah. It's a great question. There is lots we don't know yet that I'm going to give you, but I'll try and give you as much data as I can. So we do know that in monkeys when they study it, that you can, when you get the virus, you form antibodies and those antibodies neutralize the virus in a test tube kind of situation. We know that with monkeys, when we give them a vaccine, with a couple of the candidates, we can do the same. We give them enough antibodies and those antibodies will neutralize the virus. We know that in patients where we are trying to treat with convalescent plasma, that we, when we get somebody who has been, you know, cured of the disease, they're three, four weeks out. We draw their plasma. Their plasma has a bunch of antibodies in it. We take those antibodies, we put them in a test tube. We know they neutralize the virus. So we know the preliminary on several now of the vaccine candidates have been, you know, cause for optimism, they they've been safe in a very small population of people said the safety, you know, that's not answered yet. Um, but they have actually been appears effective at least in generating the antibody response. So we have reason to believe. I think with most evidence that says there is immunity. We have no idea how long that immunity lasts. Could it be three months? And there are some viruses that are like that. Could it be lifelong? I doubt it with this type of virus, but it's possible. Is it a couple of years? Some of the best guesses we're kind of hearing from some of the scientists and the vaccine companies, is that it's there thinking maybe every two, three year booster, but not annually, like the flu.

And we're not seeing this mutate at the rate like the flu where you would need something and something new evolves. So by and large herd immunity should be achievable. It may take, you know, every three year vaccinations till this thing's gone. I mean, if you've got one really good round of herd community, you could get rid of this thing. But you know, a lot of people think this may become more seasonal, but you know, okay, we do lots of things where we give boosters and things. So, then you get into the question of how does one develop herd immunity? There's two choices. There's really two choices. One is enough people get sick and they develop the antibody and they get herd immunity. The other is we give it to them through a vaccine. The vaccine is maybe we, maybe we end up having some vaccines in the fall that start getting going into large scale safety and efficacy trials.

So those will be volunteers who want to take them and first in line are gonna be a lot of healthcare workers for obvious reasons and so it's, it's not, it's not inconceivable that at least hundreds of thousands of people in the U.S. may get a vaccine, but of course, you know, there's what 300 million people in the Fall, but really the real amplification of that would be in Spring., The Trump administration has Operation Warp Speed. They are plowing money into this issue. Normally it's a very linear, sequential, you know, kind of Gantt chart approach where you, you know, you do this yes. And then do this, do this. And next thing you know, it's taken me 15 years and then they're parallel processing everything. The biggest one of those is actually building the manufacturing capacity now. So they're building manufacturing capacity that may never get used because those vaccine candidates fail.

So, it's a financial gamble now to try to obviously move this faster. It's the right thing to do. And that's the beauty of government, particularly the federal level stepping in is that's where you make an investment for the long-term. So, from a vaccine basis, we're talking well into next year, probably this time next year, at least before you could get to enough people immunized. It doesn't mean you might start not be able to start bringing it down and attenuating it, but to actually stop it. I think you're talking about a year to get to her community. Now, herd immunity can also be developed by getting the disease. And of course the combination of those two can help can work too. It could be that we have enough people who've gotten it. And then we have the vaccine and we have a shorter distance to go to get to herd immunity.

That's a challenging one. There's been a lot of debate. There's been a lot of discussion. The country of Sweden has been held out by kind of both ends of the argument. If you look at the data, the country of Sweden did not shut down to the degree of the rest of Europe, although they did do many things like restaurants. And, you know, if you go to the vacation sites there, they, the hotels were down 95%. So people did a lot of the same things, even without a government order. Their mortality rate is markedly higher than their neighbors. Now it's not so much higher that it's, you know, New York. And so the challenge with that discussion is most societies, especially as politicized as they are, seem unable to have the decision and the discussion around those kinds of ethical and moral tradeoffs, which is, you know, at what point is there, I mean, I'm going to be blunt, but ethically and morally, what point can we accept a certain level of death and suffering an illness weighted against, you know, what happens to the rest of the population with the financial side and with health issues that happen because it was shut down and all of those. And so it's, it's tough to draw an absolute conclusion, but I can tell you it's been a disappointing experiment for them. I actually don't personally, I don't think it was a good way to go, but with them doing it, it's been a disappointing experiment because when they've looked at the number of people who have immunity, at least supposedly through antibodies, it's in the six, seven, 8% range. And yet they've already had very large number of deaths. And so you do the math and they're going to have to have a very high mortality rate. So put it another way, New York City. Last, I looked at a couple of weeks ago, they were over 260 deaths per a hundred thousand people who live in New York city to put that in perspective, the U S in 2017 had, I don't know, 850 ish deaths per a hundred thousand people for the year.

Heart disease was number one, right under 200. You've of course, got cancer, certain, a few other things kind of, you know, I think cancer's 150, 160. 260 for COVID in two months. So in two months it had a mortality rate that was well above the number one cause of mortality in New York. And if you're generous and do some of the studies, the absolute highest number of herd immunity, it's not heard yet, but immunity trying to work towards her, the best bet, the highest bet that you could get is about 20%. That's probably an overestimate, but the highest bet would be about 20%. To get to herd immunity you need 60%. So if nothing changed, you would need to triple 260 to, you know, that your math of tripling 260, which is 780, right. Or whatever, I'm doing 680, 780. I've got it.

That's almost a full year's worth of mortality from other things. Now they could probably do better than that because they were totally out of control and they could let herd immunity go. But when we did the analysis best case 450, 500 people per hundred thousand dead in New York City to get to a theoretical herd immunity, which would basically raise the death rate by over 50% in the city, you know, that's not ethically morally, you know, to me, a trade off that can be made. So it's a long-winded answer to a complex question, but to say our real hope for that is a vaccine. And I don't think practically we're going to get there. And if we have to get there by this, going through the community it's going to be because we never got a vaccine, or the vaccine proves to be more difficult. And a lot of people are going to suffer and die to get there. I think.


Bishop Scott Jones (00:30:23):

Here's a question about symptoms. We hear a lot about symptomatic and asymptomatic people, but is there much in between? Can a person be mildly symptomatic with just one small symptom or is that unlikely? Couple that with the question that as a senior pastor of a church or me at leading a conference staff, what if one of my team is mildly symptomatic, do we keep them at home?


Dr. Marc Boom (00:30:53):

So anyone with any level of symptoms at this point, you should assume COVID until proven otherwise. So yes, if you have some mild symptoms, stay home, get in contact with your physician, get some, you know, virtual urgent care, use some mechanism to be discussing that with a physician they may or may not decide right away to do a test. It may be, "Hey, let's just keep your home for a day or two, see where this goes and test you or they may do the test. The good news now is we have such, it's such significant testing capability. They'll probably do the test. That's what I would do clinically. And I still, I still see a few patients and I've, I had a bunch who've needed testing and a few who've been positive.

We think best guess, and the CDC uses this in their modeling, 35% asymptomatic. If you really drill into that, probably some percentage of those people are really very mildly, but if you really check, they might've had some mild, but very mild symptoms and some small percentage above that are mild. So yes, there is a full spectrum of disease from barely asymptomatic, barely symptomatic. So, "yeah, it was a couple of days of having a bad cold" to, "I felt like, you know, a truck ran over me for a few days, just like when I had the flu", to, "I couldn't breathe and it felt like somebody was squeezing my chest and I had high fever and I went to the hospital and, you know, they had to use every technique they could to keep me from getting intubated" to, "I got intubated and, you know, went through" or to, "I got intubated and my body went into this cytokine storm", that we talk about.

It's not well understood who goes where and how to predict that. I think we've gotten better at that with some of the inflammatory markers. So, you know, we have seen the outcomes improve dramatically at the hospitals. A big part of that may be some age shift, but I don't think it's all age shift. I think we've just, you know, our doctors are smart people and, you know, very academically oriented and, you know, have gained the experience of treating, you know, it's going to be 2000 people pretty soon in the hospital that we've had, you know, over the course of 100, 110 days, you know, learning matters. And at the beginning, everybody just, you know, had not ever seen a person with COVID before.


Bishop Scott Jones (00:33:00):

What factors do you attribute to African Americans dying at disproportionately higher rates than other resident groups? Additionally, does the Texas Medical Center and Houston Methodist have a plan to address these healthcare inequities and disparities.


Dr. Marc Boom (00:33:16):

A great question. So, we do see both socioeconomic factors and race as factors I'm alone in terms of, of risks. So the African American community has a higher burden of disease and therefore higher burden of death, you know, on a per capita kind of basis. It looks like. So initially we were hearing lots of data that it was both more people getting sick and people doing worse. I think most of the data is suggesting it's the first part, not so much the second part. So, there was a large study out of New Orleans at Ochsner a month ago, or so, looked at a couple thousand 1700, 2000 people saw no difference in mortality by race once people were in the hospital, which is obviously great news.

But if you took a thousand African Americans, you were having more African Americans die from the disease because a higher proportion of the African Americans were getting the disease. And therefore, even with the, the same death rate, of course, there are more deaths we've seen the exact same data, in fact, even lower mortality, but we've seen very similar data in Houston Methodist. So, if I went back kind of through wave one 34% of our admissions were patients who were African American. That's about 20% across the eight county, it varies by county, but roughly about 20% of the population. So that's a very disproportionate number. We actually saw significantly lower mortality. So at least in our number, if you did the math, it really wasn't too much extra depth, which obviously great. I don't have a great explanation for why that was, it could be that knowing that there was a lot of data out there and African Americans, we may have been more conservative in admitting some, very much our clinicians are obviously very sensitive to every potential risk factors and certainly socioeconomic factors, racial factors, and others that might play into a disease and cause a, a person, you know, there's drugs that work in whites better than blacks. There are diseases that happen, you know, in people have different genetic descent.

So, they're there, that's always part of what we think of as a clinician to help people. And so, I don't know if perhaps something like that happened. We've actually seen that come down. So what we're seeing now is our African American populations down about, I think the last number I saw was 27%, 28%, which means in this wave, it's actually been not quite, but almost down at sort of the expected number from the population. What we've seen is a marketed increase in people of Hispanic descent. It was about 25% in wave one. Now it's 55.0%. We're seeing a lot of those individuals who speak limited to no English. So, our caseworkers and people on the frontline are saying, we all need to work together to do a better job messaging in Spanish media and many, you know, Spanish churches many, many realms to get to people who don't have English as a first language or who don't speak English at all because we're hearing from some of those patients, won't, you know, no one told me I didn't hear these things. And you know, a lot of those community are been people. Sometimes we're talking to our caseworkers or social workers talking to them and they work two, three jobs and they're, you know, very frontline jobs where they're exposed to many other people. So, long-winded answer to kind of give you the scenario of where we are, whether there's genetic factors is very, very unclear. We do know that certain antihypertensives work differently across races and ACE inhibitors are actually one where, you know, kind of I'm an internist. So it's always on the boards in terms of different races, act a little differently in terms of how effective ACE inhibitors might be. And I raised that because the ACE two receptor in the lungs is actually where the virus binds.

So, it's possible, there may be some genetic differences that are explaining it, but honestly, I think most of it has to do with socioeconomic status across different communities. Probably not all, but, but I think most of it is that, so the next part of the question then is how are we all trying to work? So there's, there's a variety of things to that part of that is messaging, right? So, we need to get communication out to people, you know, of every part of our community, everywhere in our community. The faith institutions are critically important for that. So, thank you for being on these calls that really helps. And of course, the Methodist church, and I know we have others as well. I mean, you touch so many aspects of our community, you know, broadly. So that is critically important.

We've worked very closely with a lot of our, what we call community benefit partners. So we have a number of federally qualified health centers and community health centers and others that we fund every year. So we're kind of on a, our community benefits people are kind of on a hotline with them working with them, trying to do things we've worked very actively with Harris Health, which is the county hospital safety net system for a long time. We still do. We've been very early. We can only get a little bit, and then later we're doing a much of their testing. So, we're able to help them with a lot of testing going into, through some of their clinics and especially at their hospitals and testing. But I think there's more that we're going to need to figure out how to do. If I'm quite honest.


Bishop Scott Jones (00:38:26):

Related to that, is there something about Type A blood being worse in terms of impact? Is that another genetic or biological factor that makes some people get a more serious case than others?


Dr. Marc Boom (00:38:45):

Yeah. You know, I have Type A, a blood and I'm A Positive. So I always tell my wife that means I'm an A Plus and she rolls her eyes at me. So that's how I remember. But, yeah, I didn't like reading those data. There is a suggestion that Type A blood, people with Type A blood do a little worse with the virus and that people with Type O blood are on the other spectrum doing a little bit better. There, there is some data and some theory that honestly, I do not, I have not delved into that to understand the science behind some of that, but there is a little science behind that that makes that at least have some plausibility. It is not to the degree that people come in and we say, "Hey, let's blood type you to figure out, are you at risk or not risk?" I mean, we might blood type you, if we're going to give you a convalescent plasma, because we have to, to match to do that. And it's not anything any of us can change. So, you know, as a joke, I'm a, I'm A Positive, I, it's not something I walk around worrying about saying, "Hey, I've got Type A blood I'm at higher risk." I, you know, I think, you know, the fact that I'm in my mid-fifties is probably a much, much higher risk factor for me. And, you know, not as much as if I was 10 or 15 or 20 years older, but that's much more of a risk factor than, you know, being Type A. And if I had diabetes or something else that's much more of a risk factor than the blood type, most likely.


Bishop Scott Jones (00:40:02):

Since you just mentioned, age is a key factor. What if the pastor of a church is the one who's over 60? From an older pastor's take, I'm 66 as Bishop. What advice do you have for those of us who are in that 65 and older group?


Dr. Marc Boom (00:40:20):

Sure. So, you know, what we see is that mortality really does trend with age. By far the highest risk group is 80 and up. Our in-house mortality, so this is not everybody who gets the diseases, this is everybody who's sick enough to get admitted to the hospital, in wave one was about 35% for people above 80. Now I put a caveat there that some, you know, we get some patients from a nursing homes and people with advanced, advanced dementia, they have advanced directives in place. So, you know, if that individual were to get the flu in a normal winter, they probably would die from the flu. You know, so, you know, a lot of those people may have gone straight to comfort measures. So just keep that a little bit in mind so that it doesn't inflate the number of deaths of course, but it just is we have a population where we don't pull out all the stops because that was their wishes.

But so, it gets particularly high there. The good news is even that's coming down now during the second wave. So, we're down to about 27% in that population. So, the whole mortality curve is shifting, which is why I think it's not just a younger population as we see things. But you start getting into six plus percent. I'd have to pull up the numbers, you know, but, range. So that's for who gets admitted, let me be real clear. So many people at can get the disease and don't get admitted. So, it's not to say 6% chance of dying if you get the disease, but once you get hospitalized about 6% of patients in that age group, roughly, are dying. So, you know, if you're 66 and you have a list that long of health problems, you probably don't need to be serving as the pastor seeing a lot of your, you know, your congregation in person, you know, at 66, if you are pretty healthy, you know, I think there are ways to do that. You just have to be extra safe. You know, some of you may have been on some of our town halls we do, Dirk Sostman, he won't mind I say this because he said it in the setting, Dirk is my chief academic officer. He's fabulous. He's 72 years old. And you know, we sat there, and people asked us all these questions and I'm talking about how I'm protecting my, you know, approximately 80-year-old parents. And he chimes in and says, "Well, I'm 72 and I'm here sitting next to Mark, you know, in this, in this town hall", we were masked when we needed to be, but you know, he can do that safely because he knows all the best practices. So I think if you're a healthy, mid 60s to 70, you know, you're, you got acknowledged there's some risks, but I think you can find ways to do that safely. I mean, if somebody was, you know, preaching and serving way past that, you have to start thinking twice about that.


Bishop Scott Jones (00:42:49):

You've raised a significant concerns about Harris County and the Greater Houston area. What are your insights about a Beaumont area or Tyler or college station communities that are in the 40 to 120,000 population range?


Dr. Marc Boom (00:43:07):

Well, I'm going to have to apologize that I have not looked at any of their data. So I do not know the prevalence there. I know each of the counties report that. One of the places I like to go if you Google "New York Times COVID Texas", you can get statewide data by county. It's a pretty good site and it gets updated pretty much daily and you can actually then get some data in terms of how many cases per a hundred thousand people are in a county. To put that in perspective, Harris County is probably at about seven right now. So again, remember that seven cases, I'm sorry, deaths, but we're at seven per a hundred thousand deaths. So put that in perspective, 850 a year. So, you know, maybe 1% extra mortality, if all of those people might not have passed away and some of those, you know, the older person that was comfort measures only already might have died during the year. So that may even overstate a little. But of course, we weren't through this yet. But you know, compared to 260 in New York, we've done really, really well. I don't have the number for a hundred thousand committed to memory in terms of the caseload, but you can pull both of those there, you can sort it by counties. And then I would pay attention to what your county is saying in terms of the prevalence. I just don't know. We have seen overall a good trend, you know, a good trend for if you're in a smaller community. You know, that the smaller, the community, the less spread there is the less, you know, there is some spread associated with density of population.

Now, you know, there are some smaller counties in North Texas, particularly with meat packing plants that have had major outbreaks. If you went to Washington County outside of Houston, it's got, I don’t know, eight times what I just described for Houston, something like that in terms of deaths per a hundred thousand, because they've had a couple of very large nursing home breaks and breakouts in a relatively small community. So, you know, 25 deaths or 30, whatever it is, ends up, you know, on a, on a per a hundred thousand basis being a high number. So, you have to look at all the numbers with a grain of salt. But I think that that would be my guidance. I'm happy to take a look at that and chat with anybody or shoot me an email if you had some specific questions, but I just don't know those areas off the top of my head.


Bishop Scott Jones (00:45:19):

I think some of the people in the chat room are sharing some sites of particularly the New York Times sites you just referenced. So, people who are looking for more data can go there. Let me give you this question where it's in a small town church in East Texas. We gave congregants the choice to wear a mask previously. Should we begin to either ask people to wear masks as they enter or leave worship, or should we begin asking people to wear a mask for the entire worship service?


Dr. Marc Boom (00:45:48):

I would strongly urge that wherever you are have people wear a mask. If I look at what we do as physicians and nurses and clinicians, to keep our patients safe and keep each other safe, you know, we uniformly wear masks throughout the institution. I can tell you throughout this pandemic we have not seen large amounts of spread within our walls. I mean, it's because people are doing the right things. I firmly believe that are there are safe practices that can happen. Masking is enormous. The bottom line is you can trap most particles and they don't go someplace. If I, you know, I cough or sneeze or I get a little too close to you and I'm kind of raising my voice and I know there's some particles there, if you're two feet out, some of those particles are getting inhaled by you.

If I wear a mask, the proportion of that declines dramatically. We think it's tough to get a really good study, but it may be 75 to 80% decrease in risk. There's one study that came out very recently. I'm trying to remember which journal it was in. I can't remember off the top of my head, but it did kind of a multivariate analysis against a lot of the different things that have been implemented. It's conclusion was the most effective thing out there. I mean, not the full shut down, but, but for areas where people are together is masking. So, my strong recommendation, and fortunately, it's a political issue and I get that y'all are gonna deal with people, you know, with some opinions about that. But my strong medical advice is it's such a small price to pay. Yes, it's a little bit warm, but I mean, I've spent, I've spent countless hours of my life wearing a mask, you know, through medical school and through residency and taking care of patients and, you know, being in an operating room for on end, you get used to it. I mean, it's just like anything else. And, people have gotten used to it. And I see so many areas where people just do a perfect job. There's no reason that for an hour long service, that people can't come in, walk in, be with each other, keep that mask on the entire time and leave. And I think that's by far the safest way to handle.


Bishop Scott Jones (00:47:49):

What about taking people's temperatures before they come in the building? Is that something that ought to be done or is that sort of over the top?


Dr. Marc Boom (00:47:57):

You know, it, it can be done. It's probably a little over the top. I mean, so we do it at the hospital, but of course we're protecting vulnerable people who are, I mean, you know, so, you know, people are vulnerable. We're saying you need to come to the hospital so we can care for you don't avoid us. So, we know we have lots of people who have vulnerabilities within our walls, so we're extra cautious, but I can tell you we've temperature, screened thousands, upon thousands and thousands of people. Probably tens of thousands at this point. We don't get a lot of positives to be honest. It sets a tone as much as anything. It's a time where we are able to ask some questions and quizzes and kind of, you know, check on people and make sure they're wearing a mask and all those things we're trying to automate some of it because we used some staff that were in the labor pool cause their areas were shut down. And now of course, you know, as the hospital came back up there, they need to be working at their home units in their home places. In a church setting again, if I were, I mean, I guess what I'd say is if I were leading that congregation, I'd say to everybody, "Hey, we got to have a social compact that if there's any doubt, you stay home and you know, that's the strong, compact." And I probably wouldn't put in a, you know, a quiz, questionnaire, temperature screen. You can, don't get me wrong, but I don't think you're going to find that to yield that many people that you turn away or anything like that.


Bishop Scott Jones (00:49:16):

What are the rationale for getting tested for convert or for antibodies under what circumstances should somebody go to get a test?


Dr. Marc Boom (00:49:27):

Sure. So two kinds of tests, right there is the PCR. So that's the swab in the back of your nasal pharynx. Increasingly we hope there'll be some more nasal swabs, cause it's just a little more comfortable. I mean, it's, it's uncomfortable. It's not that bad. Okay, it's not like everybody's favorite thing, but we've all, most of us who've had anything healthcare it's, you know, it's very low in the scheme of discomforts, but they will put a little swab kind of through your nose all the way to the back of your throat a little bit that looks for the genetic material of the virus. So it tells us is genetic material of the virus presence. I say it that way because it doesn't distinguish between an alive virus and a dead virus. So when you see some of the noise about, well, I tested positive three weeks later and I was negative before. Well, we don't really fully understand is that live virus or is that just some fragments that are left? And the thing is very, very when it's there, it finds it. So that's for two, I would say two times that people should be tested generally. In your population, I'll give you a third, sometimes others, you know, one is clearly, if you have symptoms. Doctor orders it. Let's get you tested. Let's find out if you have it. It's probably about 75 to 80% sensitive, meaning take a hundred people with it. It will pick up, let's say 75 or 80, but it will give you a false negative on 20. The reason for that is it's a difficult sample. It's uncomfortable. It's hard to really get it. You know, the virus may sometimes, I mean it binds receptors in the lungs, so it's possible it's not as much back there and we're down below. So we've all dealt with situations. I mean, I had a patient in my own practice came in, we admitted him. He had an X Ray CT that looked like it. We knew he had it, but we could never figure out that he was positive. And four weeks later after I'd sent him home, I did the antibodies and sure enough, he had it. So anyway, that's, that's number one for the PCRs. If you're symptomatic, number two is if you are exposed. And so if you have a known exposure, usually we use close by it, exposure for some meaningful point period of time. So not a glancing exposure, but five, 10, 15 minutes. It's a discussion with your clinician. It's when do you test? Usually you wait, usually say, stay home. Let's not have you cause more problems potentially, but it's too soon to test you if you call me the next morning.

And let me give you a couple of days because you'll be more likely to be positive. So sometimes in, in, in asymptomatic exposed people we will use that test as well. That's what most, for most of the world, that's where they're going to be tested. The third is in some surveillance setting. So we do surveillance on staff to try and avoid having an asymptomatic staff member. Of course, masks are a big, huge protection to that, but nonetheless, we want to avoid that. So we do some additional surveillance, but in your setting that that's not something you would do. You know, there are some meat packing plants and things where this has been a real problem. Certainly, nursing homes, prisons, other places like that, people are using surveillance techniques, but I, that's not a technique y'all need to use. Then the other end of the spectrum is the antibody testing. Antibody testing generally does not tell you, yes, you have the disease now. It tells you, you had the disease before. Now I say generally, because about a few days in, you may start to be positive, but it's really not the diagnostic test that we use. There are two broad kinds. There are what are called a lateral flow assay, which is, think of a pregnancy test, right? You get the plastic strip and they're, you know, in that plastic strip, there is a, you know, a paper that's basically, you know, got a reagent that will react if the right, you know, in that case, hormone is present when you're doing a pregnancy test and that's the way those work. They, especially after the FDA got so much criticism around how they handled the first round of testing, which PCR, which is a challenge they let a ton of these things in, and then scientific community started looking at them and said, hold on. These things don't work. Most of them are lousy. So I really don't recommend you use those. There's a couple exceptions. We have a couple, we might use occasional settings, but we've really validated them. But by and large, I wouldn't use them. The reason is the sensitivities not too bad. So in other words, giving you a, a true positive isn't too bad. So if you had a hundred people with it, they're gonna do a pretty good job getting, you know, telling you whether you have it, but they have a very poor what's called specificity, but just think of that as the false positive rate. So they, you know, in best case scenario, they might have 95 to 99% specificity, which means if I, which means, you know, think of it as a false positive rate, which sounds pretty good until you look at a disease that has 3% of the population has it.

So if you take 10,000 people and we know 300 have it because that's 3% and you have a specificity of 95%, you're going to do 10,000 tests. You know, that, you know, 500 and you know, therefore 9,700 people don't have the disease. You're going to get 5% of those people. We'll just call it 5,500 for easy math. You didn't get 500 false positives. You know you have 300 true positives and you'll get 95% of them. So we'll just call it 300. You'll have one and a half to two times as many false positives that you do true positive. So it becomes almost impossible to understand and use. So the other type of test, all of the sophisticated labs, whether you're talking to hospital based lab, Lab Core, Quest, we all have much more sophisticated assays. They typically quote, you know, the FDA saying a hundred percent specificity, at least 99.8% specificity.

So when you have a positive, you're probably 95% sure it's a positive. The real setting for using that is understanding somebody who has had the disease. So, you know, when do we need to know that? Right? So my patient that I described who came in, he was sick. He went home, we said, boy, he still had it, but we never got the test. It was pretty useful to know a month later that he had had the disease, both for me to learn and our team to learn about the presentations. For him to know that, Hey, I did have that and my hospitalization was for that. And we know he's at least at a, at some reduced risk in the future. For most people though, it's more of a curiosity, or a relief, right? So boy, I felt lousy back in March, but I didn't get tested. You know, I wasn't sick enough to go to the hospital back then. There weren't many tests. I wonder if I had it. And it's perfectly fine. Your physicians can order that there's tons of testing capacity, very easy to do cause it's a small blood draw. But for most people, honestly, the antibody test is not that useful. The biggest use is for doing prevalence studies and for doing, you know, epidemiologic studies. So for the scientists to do it, maybe some work settings at some point, like for a hospital where we have all this high risk, where at some point we might want to identify people who've had it that we didn't know had had it some point, cause you know, at some point you put them on the COVID unit, if you know, they've had COVID and those kinds of activities, but for most settings, not something you're gonna, you're gonna use that much.


Bishop Scott Jones (00:56:33):

What about resuming children's and youth ministries and especially preschools?


Dr. Marc Boom (00:56:38):

The really good news is children don't get sick, you know, by and large. Texas Children's, you know, has a few patients in house at any given time, maybe 10 at max. And of course, you know, I think you have to talk to them, but my understanding is many of those are kids who have underlying health conditions. So they're at a higher risk. That's the good news. There's a rare condition. And it still looks to be pretty rare, but it is existence, which is a kind of an inflammatory syndrome that's similar to something called Kawasaki Syndrome that, you know, kids can get very sick from and die, but it is really rare. So, the good news is that's not a group you have to worry about, you know, having the life of a child at risk by putting them back together.

They of course can spread that to their family members. I've never met a four-year-old who knows how to socially distance, you know, so you get into issues, you know, with the younger children. Older kids, for sure you are safe. You know, if you want to have some things, smaller numbers, still socially distance, they should wear their masks. They need to be taught and educated, you know, about what they're doing. They don't need to be sharing all the same play equipment and things, but to go in for a Sunday school lesson or things, there's probably some ways you could do that safely in my mind. Similar to how you'd handle, you know, an adult, you know, with twist of course, but an adult. The little kids, it's a tough one, right? Because we've had we've many employees who have their children in daycare. How else would they work? And you know, many families who want to do that, I think there are ways to do that. I would be putting, you know, younger staff there and I would be acknowledging the fact, you know, you have to have a kid with a runny nose, or that's not the most simple, dramatic thing, but still if a child's got any symptoms at all, they need to not be there. And families need to keep them out. And if you do need some daycare, you know, you need to figure out some ways to really minimize, you know, the normal three, four-year-old behaviors that are going to happen. So, you know, smaller groups find some games you can play, educate them, you know, without scaring them, you know, find some fun games that involve not being touching each other and using the same stuff. I mean, there are probably some creative things that, that, you know, child life specialists and teachers and Sunday school teachers there's the daycares that are open now could advise you all on for sure.


Bishop Scott Jones (00:58:59):

I've had a couple of questions submitted asking if being outdoor for worship lowers risk factors at all that would allow for singing or other things, or do we still need masks even in an outdoor environment?


Dr. Marc Boom (00:59:12):

So, I think most certainly outdoors is safer than indoors. We're not seeing many reports of why it's spread events outside. You know, a couple of caveats, you know, we know there was a 60,000 person march, you know, with not nearly a majority of those individuals wearing masks who were there. I saw some other protests where everybody was masked in the medical center. Those, those, you know, gave me a lot more comfort, you know, clearly there was some spread there. I mean, we know there was, so I'm not saying outside is fully safe, but the good news is the prevailing wind currents. And other things tend to lift things up. You don't have a roof; you don't have a circulation system. So, outdoors is very safe. You still should obey and follow a social distance. If you're going to have people close together, I would still mask them if you're going to put a large group of people together. I still, I would still try to go for six feet. You know, at six feet, I'm conservative, I'd still prefer people wearing wear a mask, but if you got everybody six feet outside, you know, you're coming and going masking, but if you wanted to have some masks off during that, that's probably okay. I'm conservative. Let me be honest. I would prefer that everybody wore a mask and I'd still prefer that was not an ultra large gathering. But I don't think those are gonna be your highest risk settings for, for communicating the disease.


Bishop Scott Jones (01:00:36):

Mark. I want to thank you for this conversation. There were questions that came in that we don't have time to get to, and we have recorded this conversation. It will be posted at, on our conference website. And for many of the United Methodist on the call, we will send you a notice about exactly what the link would be. But Mark, you are an incredible leader for our community. We are grateful to have you as a partner with the United Methodist Church and grateful for all the work that Methodist Hospital is doing. So thank you.


Dr. Marc Boom (01:01:10):

Can I, may I jump in one thing. First off, I want to thank Bishop again for all of your leadership and for all of your op eds and everything else. We even authored one together. You did the work, I just put my name on it, but you've really provided tremendous leadership and I appreciate that because it's helped get the message out. And that's a good segue to my call to action for the group here. I mean, particularly those of you in the Greater Houston area. This is a tough time. It's an important time for us. We want to avoid a shutdown. I'm not confident that we can definitely avoid that. I'm an optimist. So I think if we rally together, we can, but it requires everyone in the community doing this. So yeah, your voices are so amazingly important. Your reach just directly of who you will preach to in a couple of days and obviously other times as well, but Sundays, just a couple of days away, you know, is thousands and thousands and thousands and thousands of people virtually. I think it mostly, but in person as well. You can really help spread the word. You know, I've seen the Bishop talk about God's love and really loving each other and really wearing a mask, protecting each other's, us loving each other and doing what Christ really expects of us and modeled for all of us. So please help us with that because I do think we are at a very important time in our history and we really want to avoid, you know, having things get out of control over the next two, three, four weeks and, you know, potentially having the virus even determined for us, not our political leaders, whether we have to take a, you know, major financial and, and economic and social sacrifices again. And there's a lot of harm in all of those realms and in the health realm with shutdowns, you know, and it hurts everybody. It hurts the socioeconomically vulnerable even more. It hurts frontline, hourly workers far more than it hurts salary workers. It cuts, you know, against, against race, against socioeconomic status. It exacerbates so many things. It exacerbates health issues when people avoid hospitals and it of course exacerbates kind of the overall economic health of our region. So we can be in all this all in this together, but we really, I mean, y'all help so much cut through the, the, the clutter and the noise that's coming from both ends of the political spectrum in saying, you know, there are right evidence-based things to do that the clinical leaders are asking us to do and together we can do this. So I appreciate your helping us with that message cause y'all are critically important. So thank you.


Bishop Scott Jones (01:03:42):

Well, Mark, we are certainly happy to come alongside you and take the scientific and medical judgements that have so freely shared with us and add to at our community leadership. Friends, let me just say to any United Methodists who are viewing this, A. Your Bishop, at least, is strongly encouraging you to get people to do the right things, to practice the social distancing, and the personal hygiene questions. I'm also giving you a strong recommendation that let's not move forward to further reopening for the next several weeks. I think it's time to refocus on being the best that we can possibly be. This really is about loving our neighbor. It really is about being community leaders. Let's do everything we can to slow this virus down and get back to a flattened curve. Mark, thank you for the time. Thank you for joining this call. God bless you.


Dr. Marc Boom (01:04:44):

Thank you. Bye bye everybody.


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