June 14, 2024
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June 14, 2024
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‘Unmasking’ COVID-19

Every life is sacred and should be saved when possible. Start there.

On Purim 5781 (תשאף=gematria for “take a deep breath in”) the Jewish community, along with the rest of the world, will mark a year of Nahafochu. Yet traveling to Lakewood, Monsey or Brooklyn, one might mistakenly think that the dreaded coronavirus has been eradicated. Masks are rare, except in supermarkets. It is not clear whether the animus is “Hashem ya’zor” versus “we’ve passed this test already” versus lack of trust in government.

However, the lack of public masking, en masse, is a notable flashpoint. Indeed, ultra-Orthodox Jews are in the spotlight as one of the many groups who seem to defy public health recommendations, both here and in Israel. It does indeed look like our compatriots are blatantly disregarding laws around the virus and perhaps, one might argue, bucking modern science in order to avoid the inconvenience of a mask. But are the Jews truly disregarding science? Is current practice and law purely based on science, and is it consistent? Let’s examine our view of the pandemic from a less emotional and more objective eye; this is demanded of us. The inconsistencies might make you reconsider your Purim plans or lack thereof.

Inconsistency #1: Plastic dividers. New plexiglass dividers, shower curtains and splash guards are now a common part of the scenery. To be sure, a virus could easily go around or through the hinge of the aliyah “penalty boxes” in most shuls. These dividers are notably new petri dishes that house many bacteria, viruses and other pathogens. Other than blocking a direct sneeze, they are highly symbolic at best. Not only are we not cleaning these surfaces often, but even worse, the supermarket touchpad for the debit cards are a bacterial and viral nest. Rarely are they cleaned between customers.

Inconsistency #2: Nursing home deaths. The statement, “Over 400,000 Americans dead from COVID-19 over the past year” is quite shocking. Yet, pre-COVID19, approximately 400,000 Americans nursing home residents died of other infectious diseases yearly. Picture CNN putting a tally of nursing home deaths on the screen as it is now with COVID. It would look similar in number. Additionally, 33 percent of nursing home residents die every year and 50 percent pass after three years of entering nursing home on average of all causes1. Alarm bells need to be consistent to be effective and believable. No one should die of preventable disease. We needed to wash our hands with soap for decades prior to 5780.

Inconsistency #3: Death rate. Americans are dying now at a rate of 8.977/1000 people/year. This is similar to 1978 America. Only two years ago, Americans died at a rate of 8.697/1000, which is still pretty high compared to the rest of the world (7.6/1000 people/year). Compared to China, whose death rate rose from 7.26 to 7.4/1000/year over the past year, we are doing poorly, but we were doing worse last year as well. That said, in 1950, the world was dying at a rate of 20/1000/year.2 One cannot place a cold number on the death of one person and we as doctors and society need to try to prevent every preventable death. Yet, it is truly hard to label this entire phenomenon as a pandemic as the CDC defines it: an event in which a disease spreads across several countries and affects a large number of people. Yes, over 100 million people worldwide have contracted the dreaded virus, and over 2 million out of a total 7.674 billion have sadly and unfortunately died. These numbers sound large, yet relatively speaking, this translates as a cold stat of 1.3% COVID + and and only 0.026% dying. All numbers are relative. Compare this to 2019, when 2.6 million people died of other communicable lower respiratory infections (0.034% of the world). Was that large? Sure it is larger than Bnei Brak and Meah Shearim combined, but it may not even qualify as a halachic magefa. Ask your local Orthodox rabbi. And, by the way, in case you needed another positive reason to make aliyah prior to Moshiach, one must know that in 2019 the overall death rate was 5.328/1000/year in Israel, dropping to 5.323 in 2020, COVID included. Food for thought.

Inconsistency #4: Selective alarm bells. Public health messaging alarm bells are quite arbitrary. Of course, the doctor’s individual and public health goal should always be ZERO preventable deaths, but if one is to be true to statistics and science, one must look at what the American government’s attitude truly is around public health at large. We are sounding the “public health” alarm bell at this time, but one of the greatest public health emergencies is far from contained—tobacco. Deaths from highly addictive cigarette related disease tops 500,000 per year in the U.S. in a typical year, (10 percent second hand). Nicotine ads are geared toward children and there is limited recourse. Additionally, run-of-the-mill alcohol remains, statistically speaking, more deadly and costly to society than crack and heroin; yet liquor stores remain thriving, while they often sell cigarettes and collect taxes for the American government. Do we see the paradox? Ban cigarettes to be true. Alcohol should still be open to responsible adult use, but needs heavy education and a cup of ice.

Inconsistency #5: School closings: German researchers have proposed that closing certain parts of society (e.g., schools) while leaving others open (e.g., liquor stores) has created a mushroom cloud effect and has spread the coronavirus even faster. By the way, kids have three times the greater risk of dying from flu, God forbid, than from COVID-19. Also children are 16 times less likely to die from COVID-19 than adults. Recent studies from Georgia have shown that schools are not superspreaders. Teachers should and could take caution, as they are older, but even this caution needs to be put into perspective.

Inconsistency #6: Deadliness of COVID-19 itself. The truth is that the deadly nature of COVID-19 is not necessarily the virus itself, but the underlying inflammatory state of the host. Deaths were 12 times higher among patients with reported underlying conditions compared with those without reported underlying conditions (19.5% versus 1.6%)3. Very often, “previously healthy” patients with COVID-19 became hospitalized as the virus unmasked an underlying dormant illness. We Americans were already at risk, overweight and carrying an inflammatory sac of fat around our pancreas (myself included), literally poison to all organs. COVID-19 triggers the attention of the already overdriven immune system and makes a big surprise party around the lungs and many blood vessels. Couple that with the inflammatory plaques around the coronaries and aortas building up since age three. Thus, COVID-19, in its thrombotic and clotting nature, has allowed these fatty plaques to clog further into heart attacks and strokes. Yes, the disease itself hits the lungs and even leads to blood clots in the lungs, but the real culprit is the immune response combined with underlying inflammation. COVID-19 is the unmasker of baseline inflammation. It is the unmasker of a poor diet. It is the unmasker of lack of exercise. Indeed, deaths from non–COVID-19 causes (e.g., Alzheimer disease, diabetes, heart disease) increased sharply in five states with the most “COVID-19 deaths.”4 The real alarm bell is the underlying conditions that put us at risk.

Inconsistency #7: Masks. The World Health Organization tells us that it is hard to expect the gold standard of a randomized controlled trial comparing mask wearers to non-mask wearers. This is for ethical reasons. It would be similar to comparing the building homes with a flowing sewage system versus those without sewage systems, and seeing which household contracted more disease. Public health measures often can only be observed for results. Causality is difficult to ascribe despite the obvious. This is similar to masking. We only have some studies that are not robust. Only one observational study has directly analyzed the impact of mask use in the community on COVID-19 transmission. The study looked at the reduction of secondary transmission of SARS-CoV-2 in Beijing households by face mask use.5 It found that face masks were 79 percent effective in preventing transmission, if they were used by all household members prior to symptoms occurring. That said, the source of 80 percent of all COVID infections remains unknown. The remaining known 20 percent is likely at home and restaurants, or any other place you can think of that one hangs out in crowds with potential prolonged exposure.

It is clear that masks must help to at least stop infected drops from exiting a person’s dalet amos; whether they prevent infection likely depends on the mask itself (N95 versus shmatte). Yet, know that any place that people feel the most comfortable, they take masks off for long periods (e.g., restaurants and home, most commonly), where virus can linger and spread. Sure, your fellow family diners don’t mean to spread COVID-19 to you, but if infected, it is very likely from your nearby loved one, not the passing haredi at Whole Foods. And perhaps the optics aren’t good when black and white Jews are maskless, but true mask advocates need to be consistent, wearing them round the clock, even at home. Lack of societal rule consistency leads to both conscious and subconscious questioning of the sincerity of public health recommendations and rightly screams hypocrisy.

Every life is sacred and needs to be saved, but COVID-19, overwhelmingly and scientifically speaking, is not the death sentence that is projected on the news. It is real. It is not a hoax. Be careful. Protect the elderly and immunocompromised. But at the end of the day, the Infinite Creator is the Dayan HaEmet, even with all our efforts.

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143238/

2 https://www.macrotrends.net/countries/USA/united-states/death-rate

3 Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. Weekly / June 19, 2020 / 69(24);759–765)

4 Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess deaths from COVID-19 and other causes, March-April 2020. JAMA. 2020; 324 (5): 510-513.

5 Y. Wang et al., Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: A cohort study in Beijing, China. BMJ Global Health 5, e002794 (2020)

Rabbi Dr. Yosef P. Glassman, M.D. lives in Bergenfield and is the director of hospital medicine at a community hospital in Lakewood, where he leads the COVID-19 unit. He is also CEO of HADARTA.org, which encourages elder aliyah specifically to Safed.

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