“He said to them: Go and see which is the good way to which a man should cleave…Rabbi Eliezer says: One who considers the consequences [of his actions]…” (Avos 2:9)
We are about to
embark on a grand experiment in our community. This experiment will not be a
planned or controlled experiment, but a natural one born from the human
tendency toward inertia. We are the guinea pigs, but we are also the ones
running the experiment.
This experiment
will attempt to answer the question: What happens when you take several
thousand unvaccinated children, mix them together in school, send them home,
and then have the entire community come together in synagogue a short time
later. Since every scientific experiment contains known and unknown variables,
and since we will be subjects in this experiment, it seems prudent to
understand the variables. We should start with what is known currently about
the pandemic, especially with respect to the Delta variant:
1.
Transmission levels in the city and
state are high.[1]
2.
The Delta variant makes up nearly
100% of cases.[2]
3.
The Delta variant is more than
twice as contagious as previous strains.[3],[4],[5]
4.
The Delta variant causes more
severe disease than previous strains.[6],[7]
5.
The vaccine works well against
Delta but is imperfect, and there have been many documented breakthrough
infections.[8]
6.
Vaccinated people can still spread
the infection even though they don’t get sick.[9]
This combination
creates a perfect-storm scenario. Thousands of children in our community are
going back to school, and since they are unvaccinated and Delta is more
transmissible, it is all but guaranteed that there will be transmission among
students in the school. There have already been reports of school-based
outbreaks in schools that require teachers and students to mask while indoors,[10]
so we can certainly expect outbreaks in our schools where there is no masking. Students
will then bring the virus home, and it will spread around the community, a
process that would likely take one to two weeks before anybody realizes (at
which time it is too late). Then everyone will pack close in together in shul
for several hours with singing and handshaking, the highest risk scenario.
Those in the
community who are unvaccinated will be at high risk of infection but may be in
the early phases of disease before they have symptoms (or they may never
develop symptoms) and could get seriously ill or spread the virus further. Those
who are vaccinated could still acquire the virus and transmit it (although for
a shorter time).[11]
People who have weakened immune systems due to age or other chronic illnesses
and may not have mounted an adequate immune response to the vaccine would be
vulnerable to severe infection without realizing it.
All of this would be
a strong argument for masking in schools. It is why all the Baltimore area
public school districts are mandating masks. When I have brought the idea up to
various educators, I am looked upon as if I am a madman, an idiot, or some
sinister combination of both before being told that there’s no way people will
wear masks. Perhaps I have more faith in the fortitude of our children, but I
know when to admit defeat (sometimes). Nevertheless, I would like to propose
the following short-term plan.
I would recommend
that all shuls require masking through Sukkos. I know that wearing a mask in
shul will be a tremendous burden for many, especially after we’ve grown
accustomed to facial freedom for the past several months. I also know that
masks are imperfect, but there is good evidence that they limit the spread of
disease.[12]
If the transmission is slowed, it will allow time to see if there are
significant increases in case levels or if people get seriously ill. We can
then respond accordingly while at the same time potentially preventing
significant illness, debility, lost parnassa
from missed work, long-haul symptoms, or worse. If it turns out that there
are no major outbreaks in the schools and case rates continue to fall, the
masks can go back in the cupboard, hopefully for good.
Honestly, I think
the chances of an outbreak that leads to serious disease in our community are
small – we have high vaccination rates and children have lower rates of severe
infection – but the chances that I am wrong are significant, and the stakes are
high enough to warrant taking this seriously.
You might say to
me in response:
“We are not seeing a major
rise in cases, hospitalizations or deaths, so why should we worry?” That may be the
case now, but the present is not a guarantee of the future. Based on what I
presented above, it is a reasonable assumption that we could see a spike in the
coming weeks.
“Just about everyone is
vaccinated, so we are protected.” The actual vaccination rates, while
certainly high, are unknown, and the unvaccinated are not always forthcoming
about their status for fear of stigma. There still may be enough vulnerable
individuals in the community to cause a disastrous outcome.
“If someone chooses to not
get vaccinated and put themselves at risk, that’s their problem.” While I do think that not getting vaccinated is
foolish, I don’t think foolishness is a reason to stop caring about others. Additionally,
vaccinated people who mounted a weak response are at higher risk if there is
increased transmission.
“I’m low risk, so I’m not
worried.” I
am also low risk, but the thought that I may be responsible for getting someone
else seriously ill is frightening enough. (To do so on the Day of Judgment is
even worse.)
“People are just done with
COVID.” I am too, believe me. The question,
however, is not whether we are done with it but whether it is done with us. It
clearly is not. I rounded today in a long-term ventilator facility and saw a
lady in her 40s who is now ventilator-dependent, bed-bound, and alone in a
nursing home. She has been there for several months and will likely remain
there for the rest of her life. Her only hope of going home is to get a lung
transplant, but she is currently too weak to even be considered. Every time I
am out and about in the community, I am haunted by the fear that the people I
see in 7 Mile Market, shul, and in the streets on Shabbos will be next in line.
If all we have to do to prevent one person in the community from meeting the
same sad fate is to wear a mask in shul for a few weeks, wouldn’t it be worth
it?
We will soon be
standing in front of our Creator, asking for another year of life. How much
better to do so while demonstrating how much we value that life, not just our
own but that of others as well?
May we all be
written and sealed for a healthy new year.
[1]
Coronavirus.maryland.gov, accessed 8/31/21
[2]
https://covid.cdc.gov/covid-data-tracker/#variant-proportions, accessed 8/31/21
[3] Musser,
J, Christensen PA. et al. Delta variants of SARS-CoV-2 cause significantly
increased vaccine breakthrough COVID-19 cases in Houston, Texas. DOI: https://doi.org/10.1101/2021.07.19.21260808
[4]
Musser JM, Christensen PA, Olsen RJ. et al. Delta Variants of SARS-CoV-2 Cause
Significantly Increased Vaccine Breakthrough COVID-19 Cases in Houston, Texas.
medRxiv. 2021 Jul 22
[5]
Nasreen S, Chung H, He S, et al. Effectiveness of COVID-19 vaccines against
variants of concern in Ontario, Canada. medRxiv. 2021 Jul 16
[6] Twohig KA, Nyberg T,
et al. Hospital admission and emergency care attendance risk for SARS-CoV-2
delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort
study. Lancet, Published online 8/27/21.
[7] Ong SW, Chiew C.
Clinical and Virological Features of SARS-CoV-2 Variants of Concern: A
Retrospective Cohort Study Comparing B.1.1.7 (Alpha), B.1.315 (Beta), and
B.1.617.2 (Delta). Lancet Preprints. Published online 6/7/21.
[8]
Mlcochova P, Kemp S, Dhar S, et al. SARS-CoV-2 B.1.617.2 Delta Variant
Emergence and Vaccine Breakthrough. Research Square Platform LLC. 2021 Jun 22
[9] Riemersma KA,
Grogan BE, Kirta-Yarbo A, et al. Vaccinated and Unvaccinated Individuals Have
Similar Viral Loads in Communities with a High Prevalence of the SARS-CoV-2
Delta Variant. medRxiv. 2021 Jul 31
[10] Lam-Hine T, McCurdy
SA, Santora L, et al. Outbreak Associated with SARS-CoV-2 B.1.617.2 (Delta)
Variant in an Elementary School — Marin County, California, May–June 2021. MMWR
Morb Mortal Wkly Rep. ePub: 27 August 2021.
[11]
Riemersma KA, Grogan BE, Kirta-Yarbo A, et al. Vaccinated and Unvaccinated
Individuals Have Similar Viral Loads in Communities with a High Prevalence of
the SARS-CoV-2 Delta Variant. medRxiv. 2021 Jul 31
[12]
Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread
of SARS-CoV-2. JAMA. 2021;325(10):998–999.