Public Health, Plagues, Coronavirus, and COVID-19

דברים ד:ט''ו

וְנִשְׁמַרְ תֶּם מְא ֹד, לְנַפְשׁ ֹתֵיכֶם : כִּי )א רְ אִיתֶם, כָּל-תְּמוּנָה, בְּיוֹם דִּבֶּר ה ' אֲלֵיכֶם בְּח ֹרֵ ב, מִתּוֹ* הָאֵש

The Bottom Line - Primacy of Preserving and Saving Life

Deuteronomy 4:15

And you shall guard yourselves very well, for you did not see any image on the day that the Lord spoke to you at Horeb from the midst of the fire.

רמב''ם, משנה תורה, הלכות דעות ד:א

א הוֹאִיל וַהֲוָיַת הַגּוּף בָּרִ יא וְשָׁלֵם, מִדַּרְ כֵי ה' הוּא, שֶׁהֲרֵ י אֵי אִפְשָׁר שֶׁיָּבִין אוֹ יֵדַע, וְהוּא חוֹלֶה-- צָר ִ י* אָדָם לְהַרְ חִיק עַצְמוֹ מִדְּבָרִ ים הַמְּאַבְּדִין אֶת הַגּוּף, וּלְהַנְהִיג עַצְמוֹ בִּדְבָרִ ים הַמַּבְרִ ים הַמַּחֲלִימִים

Maimonides, Mishna Torah, Hilchot Deot 4:1, translation by Gideon Aronovich

A healthy and wholesome body is akin to the ways of G-d, because it is impossible to understand and know (the ways of G-d) when one is ill. Therefore a person needs to distance oneself from damaging influences and accustom to a healthy lifestyle.

ר' שמעון בן מנסיא אומר (שמות לא, טז) ושמרו בני ישראל את השבת אמרה תורה חלל עליו שבת אחת כדי שישמור שבתות הרבה א"ר יהודה אמר שמואל אי הואי התם הוה אמינא דידי עדיפא מדידהו (ויקרא יח, ה) וחי בהם ולא שימות בהם

Rabbi Shimon ben Menasya said: It is stated: “And the children of Israel shall keep Shabbat, to observe Shabbat” (Exodus 31:16).The Torah said: Desecrate one Shabbat on his behalf so he will observe many Shabbatot.

Rav Yehuda said that Shmuel said: If I would have been there among those Sages who debated this question, I would have said that my proof is preferable to theirs, as it states: “You shall keep My statutes and My ordinances, which a person shall do and live by them” (Leviticus 18:5), and not that he should die by them. In all circumstances, one must take care not to die as a result of fulfilling the mitzvot.

Question: What might this text mean for someone considering going to synagogue on Shabbat in spite of the threat of the spreading virus?

(א) על מי מחללין שבת. ובו ט סעיפים:
כל פיקוח נפש דוחה שבת והזריז הרי זה משובח אפילו נפלה דליקה בחצר אחרת וירא שתעבור לחצר זו ויבא לידי סכנה מכבין כדי שלא תעבור:

(1) 1. All cases of saving a life supersede Shabbat, and he who hurries in these matters is praised. Even if there is a fire in a different yard and there is concern that it will move to this yard and cause danger, we put it out to ensure that it does not spread.

Question: How might germs be compared to fire?

I. Overview - Historical Perspective


The Talmudic Era: The main contribution of talmudic medicine lies not so much in the treatment of illness but rather, as in the Bible, in the prevention of disease and the care of community health. The hygienic measures advocated were of a practical as well as of a religious, ethical nature. A principle which recurs a number of times is that "bodily cleanliness leads to spiritual cleanliness" (Av. Zar. 20b; TJ, Shab. 1:3, 3b).

Hygienic regulations applied among other things to town planning, climatic conditions, social community life, family life, and care of the body. Mention is made of a disinfectant composed of seven ingredients used for cleansing infected clothing (Zev. 95a). A town was required to have a physician and a bathhouse. Clothing had to be changed before eating. Mar Samuel declared that diseases may be carried by caravans from land to land (Ta'an. 21b). Members of a family with a sick person among them were to be avoided. The digging of wells in the neighborhood of cemeteries or refuse dumps was forbidden (Tosef., BB 1:10). It was forbidden to drink uncovered water for fear of snake venom (Av. Zar. 30a). Food had to be fresh and served in clean dishes. Kissing on the mouth was discouraged, and kissing only on the back of the hand was recommended in order to prevent contagion.

During epidemics, the population was advised to avoid crowding in narrow alleyways because of the danger of contagion in the air. For body care, the Talmud recommends physical exercises, massage, sunlight, employment, and above all cleanliness. Mar Samuel states: “The washing of hands and feet in the morning is more effective than any remedy in the world” (Shab. 108b). Excesses of any kind were regarded as harmful. The Talmud also concerned itself with the health of future generations and forbade marriage to epileptics or the mentally retarded (Yev. 64b; 112b).

Encyclopedia Judaica – Medicine

In The Bible: With the one exception of the incurable serpent bite (Num. 21:9), biblical remedies and treatments are all of a rational character and do not involve incantations or magic rites, nor do they include the so-called “filth pharmacy.” Biblical therapeutics consisted of washing; the use of oils, balsams, and bandages for wounds and bone fractures; bathing in therapeutic waters (II Kings 5:10), especially in the case of skin diseases; sun rays, medicated drinks, etc. The modern method of mouth-to-mouth artificial respiration was also known, as testified by the accounts of Elijah and Elisha (I Kings 17:22; II Kings 4:34-35).

H.H. Ben Sasson, A History of the Jewish People, p. 486

Animosity and persecution reached their peak during the Black Death, in the massacres of 1348-1349. This plague descended upon Europe… In many places more than half of the population perished within a brief period. Rational explanations of the catastrophe were unknown… In those days scapegoats were sought… The Jews were accused of poisoning the wells in order to destroy the whole of Christendom. In Switzerland, Jews were tortured until they produced the demanded confession. News of the guilt of the Jews was broadcast so rapidly that in some places Jews were exterminated even before the plague arrived.

In the year 5108 (1348), a terrible pestilence raged from sunrise to sunset, and not one city remained untouched. ... A pitiful outcry rose from one end of the earth to the other, unequaled until now: for a town evacuating one thousand sick people had only one hundred persons left, and a town of one hundred had a mere ten survive. And if a single Jew took ill and died, then one hundred people of the land took ill and died, the Gentiles were filled with rage and would no longer fraternize with the Jews ...

In these days, no king ruled in Aragon; had God not stood by our side, not one Jew from Aragon or Catalonia could have escaped or run away. Out of sheer spite, accusations were leveled against us: "All of this has come to pass due to the guilt of the Jews; they have brought this deadly poison into the world; they have caused it, and only because of them has this horrible plague come upon us." As they voiced this rumor, the Jews panicked, mortified their bodies through fasting, and cried out to God. This year was a desperate time for Israel, a time of grimness and of punishment. On a Sabbath eve, the Gentiles rose up against God's people in Barcelona and killed twenty people...[some of] the Jews went out to the nobles and dignitaries of the city to save the rest from the attackers...but they were powerless to save them; too many had risen against them, saying: "Let us destroy them, so that they will no longer be a nation, and the name of Israel will no longer be remembered..."

Yosef HaKohen, Emek HaBacha [The Valley of Weeping], 1557

II. Health and Hygiene

a

(ד) וְכֵן עִיר שֶׁיֶּשׁ בָּהּ דֶּבֶר אוֹ מַפֹּלֶת, אוֹתָהּ הָעִיר מִתְעַנָּה וּמַתְרַעַת, וְכָל סְבִיבוֹתֶיהָ מִתְעַנּוֹת וְלֹא מַתְרִיעוֹת. רַבִּי עֲקִיבָא אוֹמֵר, מַתְרִיעוֹת וְלֹא מִתְעַנּוֹת. אֵיזֶהוּ דֶבֶר, עִיר הַמּוֹצִיאָה חֲמֵשׁ מֵאוֹת רַגְלִי, וְיָצְאוּ מִמֶּנָּה שְׁלשָׁה מֵתִים בִּשְׁלשָׁה יָמִים זֶה אַחַר זֶה, הֲרֵי זֶה דֶבֶר. פָּחוֹת מִכָּאן, אֵין זֶה דֶבֶר:

(4) And so too a city which has a plague or [its buildings] collapse that city fasts and they sound a blast, but those [in the places] around it fast but do not sound the alarm. Rabbi Akiva says: they sound the alarm but do not fast. What constitutes a plague? If in a city that can supply five hundred foot-soldiers and three deaths occurred on three consecutive days, behold this constitutes a plague, less than this is not a plague.

(יח) אלו דברים צריך נטילה במים. הקם מהמטה והיוצא מבית הכסא. ומבית המרחץ. והנוטל צפורניו. והחולץ מנעליו. והנוגע ברגליו. והחופף ראשו וי"א אף ההולך בין המתים. ומי שנגע במת. ומי שמפליא כליו. והמשמש מטתו. והנוגע בכנה. והנוגע בגופו בידו. ומי שעשה אחת מכל אלו ולא נטל אם ת"ח הוא תלמודו משתכח. ואם אינו ת"ח יוצא מדעתו:

(18) The following things require washing the hands in water [after them]: One who rises from bed, goes out of the bathroom, or of the bath house, one who cuts his nails, takes off his shoes, touches his feet, or washes his head, some say: also one who goes among the dead, or touched the dead, one who cleanses his clothes of lice, has sexual intercourse, touches a louse, or touches his body with his hand. Anyone doing any of these and not washing his hands, if he is a scholar, his studies are forgotten, and if he is not a scholar, he goes out of his mind.

(ה) צריך ליזהר מליתן מעות בפיו שמא יש עליהן רוק יבש של מוכי שחין ולא יתן פס ידו תחת שחיו שמא נגע ידו במצורע או בסם רע ולא יתן ככר לחם תחת השחי מפני הזיעה ולא יתן תבשיל ולא משקים תחת המטה מפני שרוח רעה שורה עליהם ולא ינעוץ סכין בתוך אתרוג או בתוך צנון שמא יפול אדם על חודה וימות: הגה וכן יזהר מכל דברים המביאים לידי סכנה כי סכנתא חמירא מאיסורא ויש לחוש יותר לספק סכנה מלספק איסור (ב"י בשם הש"ס) ולכן אסרו לילך בכל מקום סכנה כמו תחת קיר נטוי או יחידי בלילה (שם) וכן אסרו לשתות מים מן הנהרות בלילה או להניח פיו על קלוח המים לשתות כי דברים אלו יש בהן חשש סכנה (רמב"ם) ומנהג פשוט שלא לשתות מים בשעת התקופה וכן כתבו הקדמונים ואין לשנות (אבודרהם ומרדכי ס"פ כל שעה רוקח סימן ער"ה ומהרי"ל ומנהגים) עוד כתבו שיש לברוח מן העיר כשדבר בעיר ויש לצאת מן העיר בתחילת הדבר ולא בסופו (תשובת מהרי"ל סי' ל"ה) וכל אלו הדברים הם משום סכנה ושומר נפשו ירחק מהם ואסור לסמוך אנס או לסכן נפשו בכל כיוצא בזה ועיין בחושן משפט סימן תכ"ז:

(5) One must refrain from putting coins in one's mouth, lest it's covered with dried saliva of those afflicted with boils. He should not put the palm of his hand in his arm pit, lest his hand touched a metzorah or a harmful poison. He should not put a loaf of bread under his armpit, because of the sweat. He should not put a cooked item or drinks under the bed, since an evil spirit rests on them. He should not stick a knife in an esrog or a radish, lest one fall on its edge and die. Hagah: Similarly, he should be careful of all things that cause danger, because danger is stricter than transgressions, and one should be more careful with an uncertain danger than with an uncertain issur. They also prohibited to go in a dangerous place, such as under a leaning wall, or alone at night. They also prohibited to drink water from rivers at night or to put one's mouth on a stream of water and drink, because these matters have a concern of danger. It is the widespread custom not to drink water during the equinox, and the early ones wrote this and it is not to be changed. They also wrote to flee from the city when a plague is in the city, and one should leave at the beginning of the plague and not at the end. And all of these things are because of the danger, and a person who guards his soul will distance himself from them and it is prohibited to rely on a miracle in all of these matters.

רמב"ם , משנה תורה, הלכות רוצח יא:ד

כל מכשול שיש בו סכנת נפשות מצות עשה להסירו ולהשמר ממנו ולהזהר בדבר יפה יפה השמר לך ושמור נפשך, ואם לא הסיר, והניח המכשולות המביאין לידי סכנה, ביטל מצות עשה

Maimonides (Spain, 1135-1204), Mishna Torah, Hilchot Rotzeach 11:4, translation by R’ Joshua Flug

Any hazard that is potentially lethal there is a positive commandment to remove it and to beware of it and to be extremely cautious in this matter as it is stated "be careful and guard yourselves very well." And if one does not remove them or places obstacles that lead to danger one has violated a positive commandment.

שולחן ערוך חושן משפט סימן תכז סעיף ח - י

וכן כל מכשול שיש בו סכנת נפשות, מצות עשה להסירו ולהשמר ממנו ולהזהר בדבר יפה, שנאמר: השמר לך ושמור נפשך (דברים ד, ט). ואם לא הסיר והניח המכשולות המביאים לידי סכנה ביטל מצות עשה ועבר בלא תשים דמים (דברים ד, ט ). הרבה דברים אסרו חכמים מפני שיש בהם סכנת נפשות, וקצתם נתבארו בטור יו"ד סי' קט"ז, ועוד יש דברים אחרים ואלו הם: לא יניח פיו על הסילון המקלח וישתה, ולא ישתה בלילה מהבארות ומהאגמים, שמא יבלע עלוקה והוא אינו רואה. הגה: וכבר כתבתי דברים אלו סימן קט"ז ביורה דעה וע"ש . כל העובר על דברים אלו וכיוצא בהם, ואמר: הריני מסכן בעצמי ומה לאחרים עלי בכך, או: איני מקפיד בכך, מכין אותו מכת מרדות, והנזהר מהם עליו תבא ברכת טוב

Rabbi Yosef Caro (Israel, 1488-1575), Shulchan Aruch, Choshen Mishpat, 427: 8-10, translation by Yonatan Neril

"And therefore, any matter that threatens human life, it is a positive commandment to remove it and to guard against it and to be very careful about the matter, as is written, "guard yourself and guard your soul" (Deuteronomy 4:9). And if a person does not remove it and leaves the matter which results in danger, a person nullifies a positive commandment and transgresses [the negative commandment] of "do not place blood" (Deuteronomy 4:9).

The Sages forbade many things because there is in them life-threatening danger…including not placing one's mouth on a flowing pipe and drinking, not drinking at night from wells and ponds, lest one swallow a leech and not see it… Anyone who transgresses on these things and related items, and says, 'Behold I endanger myself and others,' or 'I am not careful in this,' [the Court] gives him lashes of rebellion, and one who guards themself from these will come good blessing."

Activity: Make a list of "best health practices" for our times that might be included in both this positive and negative mitzvah.

(ה) שמא תאמר הרי מצינו שחייבו חכמים בכל מקום שישמור האדם את עצמו שמירה מעולה ולא ישים עצמו בסכנה אפילו הוא צדיק ובעל מעשים, ואמרו (כתובות ל): הכל בידי שמים חוץ מצינים פחים, ומקרא כתוב (דברים ד): ונשמרתם מאד לנפשותיכם, הרי שאין להחליט הבטחון הזה על כל פנים. והתם אמרו, ואפילו לדבר מצוה.

(5) If you will point to the fact that the Sages in all places have ordered that a man be especially attentive to his well-being and not put himself in danger even if he is righteous and a doer of good deeds, that they have said (Ketubot 30a), "All is in the hands of Heaven except chills and fever," and that the Torah states (Deuteronomy 4:15), "Be very watchful of your selves" - all of which indicates that a person is not to extend trust in God to this area, even (as our Sages state further) when a mitzvah is to be performed.

Question: Based on the above source, what does the halacha have to say to the person who decides to flaunt health regulations as an act of special piety, choosing to "Trust in God, not in Doctors."

ספר החינוך מצוה תקמו מצות מעקה

"צריך האדם לשמור עצמו מן המקרים הנהוגים בעולם, כי הא-ל ברא עולמו ובנאו על יסודות עמודי הטבע, וגזר שיהיה האש שורפת והמים מכבין הלהבה... והוא ברוך הוא חנן גופות בני אדם ויפח באפיו נשמת חיים בעלת דעת לשמור הגוף מכל פגע ונתן שניהם הנפש וגופה בתוך גלגל היסודות והמה ינהגום ויפעלו בם פעולות. ואחר שהא-ל שעבד גוף האדם לטבע, כי כן חייבה חכמתו, מצד שהוא בעל חומר, ציוהו לשמור מן המקרה, כי הטבע שהוא מסור בידו יעשה פעולתו עליו אם לא ישמר ממנו ... והרבה דברים אסרו זכרונם לברכה כדי להשמר מן הנזקים ומן המקרים הרעים, שאין ראוי לו לאדם שיש בו דעה לסכן בנפשו ועל כן ראוי שיתן לבו לכל הדברים שאפשר להגיע לו נזק בהם, והעובר עליהם חייב מכת מרדות דרבנן

Sefer HaChinuch (Spain, 13th century), Mitzva 546, of putting a fence on one's roof, translation by Yonatan Neril

" A person needs to guard themself from things that happen … in the world, because G-d created His world and built it on the laws of nature, and decreed that fire burns and water extinguishes the flame…And He, Blessed be He, endowed the bodies of people and breathed in their nostrils the breath of life, [to be] a master of knowledge to protect the body from all injury and placed both the soul and body within the heavenly spheres and they [the heavenly spheres] will direct and act on them [people]. And after G-d made people's body bound to [the laws of] nature, as His Wisdom designed, since [people] are physical, He commanded them to guide against natural occurance, because nature, which is given into people's hands, will act on people if people do not guard against it [its natural forces].

And the Sages of blessed memory forbade many things in order to guard against damaging things and from negative occurrences, since it is not fitting for a person to hold a belief in damaging themself. Therefore it is fitting for a person to put their attention to all the things that can potentially cause damage to the person, and a person who transgresses on them is liable to rabbinic lashes of rebellion."

Questions:

1. From which Torah sources do the Sages understand our obligation to protect our health?

2. What can these sources teach us about our responsibility to protect our bodies and health?

3. To what extent are these values reflected in the modern understanding(s) of protecting our health?

III. Doctors

(ה) עֻבָּרָה שֶׁהֵרִיחָה, מַאֲכִילִין אוֹתָהּ עַד שֶׁתָּשִׁיב נַפְשָׁהּ. חוֹלֶה מַאֲכִילִין אוֹתוֹ עַל פִּי בְקִיאִין. וְאִם אֵין שָׁם בְּקִיאִין, מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ, עַד שֶׁיֹּאמַר דָּי:

(5) If a pregnant woman smelled [food on Yom Kippur], they feed her until she feels restored. A sick person is fed at the word of experts. And if no experts are there, they feed him upon his own request until he says: enough.

Question: What does this source teach about the authority of doctors? What implications does it have for observing CDC guidelines? Who has more authority in these matters, doctor or rabbi?

אָמַר אַבָּיֵי: לָא לֵימָא אִינָשׁ הָכִי, דְּתָנֵי דְּבֵי רַבִּי יִשְׁמָעֵאל ״וְרַפֹּא יְרַפֵּא״ — מִכָּאן שֶׁנִּיתְּנָה רְשׁוּת לָרוֹפֵא לְרַפּאוֹת.

Abaye responded and said: One should not say this, as it was taught in the school of Rabbi Yishmael that from the verse, “And shall cause him to be thoroughly healed” (Exodus 21:19), from here we derive that permission is granted to a doctor to heal. The practice of medicine is in accordance with the will of God.

Question: What does this source teach about the connection between science and faith?

IV. Spiritual Meaning of Communal Sickness

(כח) ...שאין ספק שכאשר תקרינה בעולם מצוקות ותלאות, הוא יותר נקל לאדם לשוב לבוראו למי שאינו שב בעתו בעונה הזאת בזמן הזה. על החיל אשר נגע השם בלבם לפשפש במעשיהם ולשוב בתשובה הן בעבירות שבין אדם למקום הן בעבירות שבין אדם לחברו:

(כט) ומה שמייראנו יותר בעבירות שנכשלים בהם בני אדם תמיד הם שני דברים. האחד ענין שבועות וחרמות. והשני עון שנאת חנם...שהיא עבירה שמתמיד בה האדם תמיד ואין שום תועלת והנאה לאדם בה ואין הטבע נוטה אליה. מפני זה אמרו רז"ל (יומא ט) ששקולה שנאת חנם כנגד ג' עבירות עבודת אלילים גלוי עריות שפיכות דמים. לפי שהטבע נוטה יותר לאותן ג' עבירות ממה שנוטה לשנאת חנם. ואם באתי לפרש היאך יארך יותר מדאי. ולפי שהנכשל באותן עבירות אינו נכשל בהם אלא פעם אחת בזמן מרובה. ועון שנאת חנם נכשל האדם תמיד.

(28) ...For there is no doubt that when the world is visited with distress and adversity it is easier for a man to return to His Creator. How much more so should we return, in our time and in our epoch when the Lord has smitten such a multitude, to examine our deeds and repent both of those sins between man and his Creator and those between man and his fellow man.

(29) And there are three considerations which cause me special concern in respect to two sins that men are constantly guilty of — the first, vows and oaths; and the second, causeless hatred...[which] is a transgression that one constantly persists in and that affords no benefit or enjoyment to a man which would cause his nature to incline towards it. It is for this reason that our sages placed causeless hatred over and against three transgressions: idol worship, illicit relations, and murder — for man's nature inclines more to these three than it does to causeless hatred (to explain the how and why of this would take too long) and because it is only once in a long while that one succumbs to them, whereas one constantly succumbs to causeless hatred.

CDC Recommendations

  • Avoid close contact with people who are sick.

  • Avoid touching your eyes, nose, and mouth.

  • Stay home when you are sick.

  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

  • Follow CDC’s recommendations for using a facemask.

    • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.

    • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.