When the new drug gets promoted by the detail men, we doctors nearly always heed that sage, time-tested advice, don't be the first to prescribe it but don't be the last. Few of us are pioneers or risk takers. Few of us are incorrigible laggards either.
Two years into Covid 19, vaccines available and effective, my synagogue remained the only place I attended other than medical facilities which maintained a no mask = go away position. The CDC position came out in March 2022 that Covid risk had decline sufficiently that 90% of the American public lived in places that did not warrant madatory face covering. In the ensuing six months, people's external airways have remained mostly uncovered in public places, indoors and out, without a worrysome spike in hospitalization, though more equivocal data on interpersonal viral transmission.
My congregation assembled a committee now of three physicians, though once four, all active or retired office based physicians, chaired by an experience biological scientist with Board of Governors experience. We have met periodically since the days following the first vaccine release at a time when Covid was a more fearful illness with high mortality. Every precaution needed to be made mandatory, even if contrary to political druthers of anti-vaxxers and anti-maskers, rare but not absent among our membership. Deadly Covid ran its cycle, followed by significant surges of delta and omicron subsets which infected some of our older members despite vaccination but caused no ICU admissions. Still every Saturday morning, all people in our sanctuary remain masked, with the exception of the man in the front by himself chanting the liturgy, and then only when by himself and chanting. For our Holy Days, far more attended and much longer than any weekly service, we had mandatory masking with an outdoors mask break two consecutive years. I went outside, breathed more comfortably for a few minutes, chatted with others which I did not do when inside, took my time getting back, and when the indoor mask got to me, took it upon myself to go back outside for a personal mask respite. The reasoning: we did it last year and it would be disruptive to do something else on short notice. Somehow, our committee has its impromptu meetings hurriedly called a few days before the congregational Board needs to take a formal position.
By the Holy Days I found myself, a minority view congregant and physician committee member, masked out, VP'd out by people of less skill unable to move from the default position, and already rationing my Saturday mornings in attendance by a reasonable personal algorithm. I don't know if anyone else also stays home unless invited to participate in some way, but our need for ten men to conduct a full service has become less secure, even failing to materialize at all once or twice.
Like any decision, it entails risk. All medical studies elaborate the undesired outcomes of research participants, whether receiving a new drug or a new surgical intervention. While a risk tolerance of nil sounds attractive, the reality is nobody who puts their retirement savings in a guaranteed no risk of loss investment will accumulate enough to retire. Yet the Rabbi, now moved on, wanted no risk, meaning masks for everyone, vaccinations for everyone, data for no one. My committee also has a worthy clinician who serves primarily as a nursing home director. Our congregation is on Medicare primarily, but we are not frail. And one more email contact, the chairman and one doc again tried to slip the status quo under the door, citing the deadline of the Board meeting.
Sometimes I have to be assertive. I assembled the actual data, both for efficacy of vaccines for which a policy can be deduced, and some editorials on masking, which have no data. Then I asked for the formality of a meeting with presentation of data, attended by the congregational President with an opportunity for a Board determination of actual policy within the coming week.
Our goal has to be to keep people from getting hurt. True of safety in the parking lot, fixing some loose carpeting that is still not entirely flush with the floor beneath it, and not infecting each other while we worship. While people could assume their own risk by coming unvaccinated, they could also claim their own risk by driving in the parking lot after drinking too much schnapps at our Kiddush following weekly services. No go on either. We have an obligation to avoid people being harmed, so immunizations needs to stay and that iffy carpeting cannot languish forever either.
Masks are more philosophy than data. In our community we have a branch of the State University dedicated to post-retirement education. Those in attendance seem more frail than those in our sanctuary. Yet, the University, which has a reputable epidemiology department, lifted the mask mandate but not the vaccine mandate this semester. That seems our best model, one that merges prudent risk, don't be first or last, and special populations needing special consideration.
We met as a group, three physicians, scientist chairman, congregational president. We each presented our positions, mine being the one with citations and philosophy, both medical and Jewish. We are not permitted to burden people unnecessarily, a condition called Tircha, but we are obligated to protect people. By now the masks are a burden. My other two colleagues acceded. So within the next few weeks, we will be like all other local congregations and like the community at large.
That's not always a good thing. Israel's argument for Samuel appointing a king was mostly that the other nations had one. Torah allowed one, but did not mandate it. We got one optimal one, still including restoration of that dynasty in our daily prayers, though probably better delaying its resumption. But for protection of people, not being an outlier is really the way to go, no matter how easy it may be to default to what we did last week.
