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The cultists are in principle mindless tools, only interested in summoning Cthulhu. Since he is the medium, they can't harm him. Everything else is none of their business. They all are just waiting for Pierce to step into the ritual circle and to start the ritual, that's all.
In the Counter-Ritual ending, none of the events probably happened at all. Pierce just went insane and got sent to an asylum. Everything that happened was just his mind playing tricks on him.
No idea about the Sarah ending, since I only got the 2 main ones so far.
Fuller just took him in his asylum as a test subject, like he did with everyone else. (Fuller can get back to life thanks to his research on Leviathan "oil", as he explains it at the end of the game.)