Pikuach Nefesh & Covid-19 Precautions - Questioning the Halachik Link
As I've said repeatedly, I have no desire to do this. My most fervent wish is to have our leaders reverse from the disastrous course that we are on ASAP. I hope and daven that I can soon shut down this blog. Until then, I will continue to do my part in being a voice for reason over fear.
The following is the first of a three-part series analyzing the applicability of halachic concepts like Safek Pikuach Nefesh to the current social distancing mandates during the Covid-19 Pandemic. This follows a previous article on the Jewish approach to using unreliable forecast models to make halachic or public policy decisions entitled “Tamim Tihiyeh, Forecast Models and the Coronavirus”.[1]
Pikuach Nefesh & Covid-19 Precautions - Questioning the Halachik Link
Etan Golubtchik
Covid-19, which has infected and killed hundreds of thousands worldwide is not a hoax. It is a horrible disease that has had a particularly devastating effect on the Jewish community, leading to many untimely losses. There is little debate that it would violate numerous Biblical commandments to knowingly and directly infect someone who is vulnerable to the effects of this disease. However, the halachic directives become less straightforward when the transmission is not done intentionally or directly, and becomes even more complicated when these directives themselves put other people’s lives at risk as well. The purpose of this article is to explore the scientific background and halachic principles involved in social distancing and government lockdowns as measures to mitigate potential deaths from Covid-19.
The parameters of pikuach nefeshare summarized by Maimonides in the laws of Shabbat:
One must not put off the desecration of the Sabbath in treating a serious patient, as it is written: "If a man obeys them he shall live by them" (Leviticus 18:5), but he must not die by them. From this you may infer that the laws of the Torah are not meant to wreak vengeance upon the world, but to bestow on it mercy, kindliness, and peace. (Mishne Torah, Shabbat 2:3)
The extent of the uncertainty that would allow us to disobey biblical commandments though has been highly debated over the centuries by our rabbinic leaders. [3]The Noda BeYehuda for example, famously limited the allowance for pikuach nefesh to instances when there is a sick person in front of us who needs help immediately, but not necessarily to broader death prevention matters. [4]The Chazon Ish, alternatively limited the application in cases where we do not know if and how our activities in the present will actually save lives in the future. [5]In contrast, modern leaders of Israeli halacha such as Rav Yitzhak Herzog (based on Maimonides) and Rav Shaul Yisraeli expanded the allowance of safek pikuach nefesh to include even potential life-saving situations that may arrive further in the future. Both of these commentators expressed concern as to the breadth of this application, with Rav Yisraeli concluding that even if there is a one in one thousand chance of saving a life in the future, once may desecrate the Shabbat accordingly. [6]This threshold of one in one thousand was earlier set by Rabbi Akiva Eger, and seems to be the generally accepted threshold for deciding what would be allowed.[7]
Social Distancing as a Communal Responsibility
I am not a doctor or epidemiologist, and never claim to be one. I have degrees in engineering and business, and worked as a strategic planner at a Fortune 500 company where I built and audited hundreds of forecast models. One of my responsibilities was the implementation of Decision & Risk Analysis programs which helped the company make multi-billion dollar investment decisions while incorporating real time data, forecast models, decisions trees and historical analogs, among other tools. If a reader believes that credentials are required in order to read, analyze and present scientific data and religious arguments, they should likely not read further. I personally will not respond to any ad hominem responses, but will gladly engage with any critique that specifically addresses logical fallacies or notices if I misrepresented or misunderstood source material.
[1]The earlier article can be found here: https://blogs.timesofisrael.com/tamim-tehiyeh-forecast-models-and-the-coronavirus/Many people much wiser than myself contributed to this three part series, though have asked for anonymity for reasons which are unfortunately all too obvious. One of the many sad developments of our current situation is the fear that even many respected members of our community have of providing alternative opinions or perspectives, even if well sourced and reasoned.
Lastly, this article is specifically a discussion of what role community and rabbinic authority, specifically through the halachot of Safek Pikuach Nefesh, should have in the discussion of Covid-19. This is not a discussion of what the American or Israeli government should do from a policy perspective, nor whether people should disregard the laws of Dinah Demalchutah Dinah.
[2]Yomah 84b
[3]See this excellent article by Rav Chaim Navon outlining the applicability of Uncertainty in Pikuach Nefesh to Public Policy Decisions: https://www.etzion.org.il/en/uncertain-pikuach-nefesh-and-public-policy
[4]Responsa Noda Biyehuda Tinyana, Yore De'a, no. 210
[5]Chazon Ish, Ohalot 22:32
[6]R. Y. Herzog, Be-Tzomet ha-Torah ve-ha-Medina, III, pp. 13-14, Rav S. Yisraeli, Amud ha-Yemini, p. 212
[7]Rabbi Akiva Eger, 141:Teshuva 60
[8]These models are horrible representations of reality that continue to fail at predicting anything about this disease with any reliability. Other key assumptions they got wrong include:
The Infection Fatality Rate: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/7ACD87D8FD2237285EB667BB28DCC6E9/S1935789320002980a.pdf/public_health_lessons_learned_from_biases_in_coronavirus_mortality_overestimation.pdf
The start of the spread in the US: https://www.wsj.com/graphics/when-did-covid-hit-earliest-death/
Duration of infectiousness: https://www.hiqa.ie/sites/default/files/2020-09/Evidence-summary-for-duration-of-infectiousness-of-SARS-CoV-2.pdf
& many more items, overall leading them to misrepresent the uncertainty inherent in their models: https://www.biznews.com/thought-leaders/2020/08/27/science-lockdown
[9]https://www.nature.com/articles/s41591-020-1092-0These findings have been confirmed by multiple studies including: https://arxiv.org/pdf/2005.13689.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185944/, https://wellcomeopenresearch.org/articles/5-67/v3, https://www.nature.com/articles/s41591-020-1092-0, https://www.medrxiv.org/content/medrxiv/early/2020/07/24/2020.06.28.20142133.full.pdf, & https://www.pnas.org/content/117/36/22430among others.
[11]https://www.irishtimes.com/news/ireland/irish-news/covid-19-world-in-for-a-hell-of-a-ride-in-coming-months-dr-mike-ryan-says-1.4370626
[12]10% likliehood of disease (ever) * 31% contagious * 31% secondary contagious * 5.5% mortality rate
[13]Asymptomatic cases had only a 0.3% secondary attack rate compared to 3.3% to 6.2% for Symptomatic cases: https://www.acpjournals.org/doi/10.7326/M20-2671Also: https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article, https://link.springer.com/article/10.1007/s11427-020-1661-4, https://uk.reuters.com/article/uk-health-coronavirus-china-wuhan/no-new-covid-sufferers-300-asymptomatic-after-wuhan-wide-tests-idUKKBN23915T, https://pubmed.ncbi.nlm.nih.gov/32513410/, https://www.medrxiv.org/content/10.1101/2020.06.02.20120014v1, https://www.sciencedirect.com/science/article/pii/S0895398810600086?via%3Dihub& https://www.cnbc.com/2020/06/08/asymptomatic-coronavirus-patients-arent-spreading-new-infections-who-says.html
[15]R. M.M. Farbstein, Assia LIII-LIV, 1994, p. 100 (For Rav S. Z. Auerbach) & Rav S. Goren, Torat ha-Refu'a, p. 80
[16]A report written in 2006 spearheaded by noted epidemiologist D.A. Henderson was created specifically to counter the newly devised strategy by computer modelers of implementing social distancing measures to reduce the spread of a respiratory virus. This report noted that there are no historical observations of these activities reducing mortality by the spread of influenza, and that the negative consequences would be substantial. This included a 1918 study that found school closures actually increased the spread of the Spanish flu. (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.552.1109&rep=rep1&type=pdf) This report also echoed the findings of a WHO writing group that quarantining and border closures were both ineffective and impractical. (quoted in the CDC study). A 2009 guide to public health measures in Europe also concluded that there are no historical observations or scientific studies that support these measures. (https://www.ecdc.europa.eu/en/publications-data/guide-public-health-measures-reduce-impact-influenza-pandemics-europe-ecdc-menu) A separate 2011 paper by the University of Oxford’s Center for Evidence Based Medicine also found that there is insufficient evidence to support border screening and social distancing to reduce the spread of a pandemic, especially after more than 1% of a population is infected.
[17]SEIR models, such as those published by the IHME and Imperial College, have repeatedly failed to predict the spread or mortality from Covid-19, and therefore should not be considered reliable or relevant from a scientific or halachic standpoint. For a more detailed discussion, see my earlier article referenced in note 1, and for a detailed explanation of why overly simplistic SEIR models often fail, see John Ioannidis’s article here: https://forecasters.org/blog/2020/06/14/forecasting-for-covid-19-has-failed/see or this paper by Denis Rancourt: http://ocla.ca/wp-content/uploads/2014/01/OCLA-Report-2020-1-Criticism-of-Government-Response-to-COVID19.pdf. For a fascinating narrative on how modelled data and frameworks have slowly been replacing actual empirical data and observations, see this speech by Michael Crichton in 2003: https://www.heartland.org/_template-assets/documents/publications/16253.pdf
[18]WHO published guidelines in 2019 included contact tracing and quarantining of exposed individuals as something that should not be implemented under any circumstances, while school and work closures and internal travel restrictions should only be implemented in high or extraordinary severity pandemics, which Covid-19 does not qualify under per WHO definitions. (https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf?ua=1).
The US CDC 2007 guidelines would have considered Covid-19 a category 2 epidemic, and recommended voluntary social distancing measures only and a maximum of a 4 week school closure. (https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation-sm.pdf)
2017 CDC guidelines did make adjustments to their recommendations based on studies of the 2009 H1N1 flu epidemic, but even in a high severity pandemic (which Covid-19 may have been categorized as under the new guidelines), social distancing measures, even for symptomatic ill people would have been recommended as voluntary and school closures would have been limited. (https://www.cdc.gov/mmwr/volumes/66/rr/pdfs/rr6601.pdf)
[19]For a thorough summary on the evolution of how this 2005 era unproven hypothesis became recommended practice, see: http://somatosphere.net/2020/go-suppress-yourself.html//
There have been many pandemics in the U.S. this past century, some of them a lot worse than COVID. Have leading rabbinic figures in America ever called for a complete and prolonged shutdown of all yeshivas and shuls? I’ve read that in the 1918 flu certain regions shut down (or at least attempted to shut down) their churches and schools. Did yeshivas and shuls across the country do the same? Or are the current rabbinic decrees an outgrowth of our secular cultures heightened risk averse attitude?
ReplyDeleteThe Rabbinate has, I am sorry to say, not distinguished itself in this period. Let us be more frank - it failed. When teachers in previous generations risked their lives to teach Torah, today they ran and hid. When great men stood up to tyranny, the teachers of today meekly complied with it.
DeleteAnd what ever happened to our national Jewish organizations? They grumble about a certain individual who has been stealing all the headlines. Well, guess what? The only reason the void was filled by this individual was because he was the only person speaking up. He may not be articulate, but at least he was fighting back. People respect him for that. What happened to the Agudah, the OU, the RCA, Young Israel? Filing lawsuits is nice, but its not what needed to happen here. We needed our organizations to publicly protest against heavy handed government intrusion - NOT to make it a narrow anti-Semitic issue, but a universal cause to stop interfering with our lives. People support principled resistance. There is tremendous anger against the Mayor and Governor of NY, from all segments of society, particularly the rampant hypocrisy in the way they are handling it. Instead of meekly complying and telling people that we're in Galus and shouldn't antagonize the Goyim - an attitude that brings us back 100 years to the good old days of pogroms - Jewish organizations should have been forming coalitions with other groups to organize massive protests, massive civil disobedience. Not with foolish commentary, like the above alluded to person. Just a simple refusal to allow our lives to be destroyed like this.
Its not too late. Rabbis and Orgs just have to wake up and realize the game has changed. This war wont be won by writing letters to the editor.
There is a lot that goes on behind the scenes. Check out a new website called emes.news They have information that you probably won't find anywhere else. Although my name on here is Emes I am not affiliated at all with this website. I just also believe in the emes :) .
DeleteEtan, thank you for putting this post together. It is interesting, thought-provoking, and is magdil Torah u’maadera (I think that’s the right conjugation). Gershon, thanks for posting.
ReplyDeleteI think it’s important to recognize which elements of Halacha are used in this post and which aren’t. I have no particular idea about who has invoked safek pikuach nefesh in a strictly legal sense and who has in a values-based sense to defend lockdowns, quarantine, and mask-wearing. However, this post seems mostly relevant to the former category.
Meaning, whether or not something reaches a certain threshold is relevant for the specific mechanism that kicks in to permit chilul Shabbat, for example. However, it does not mean that all of sudden someone is at a qualitatively higher risk. For example, if the threshold is 1/1000, the difference in risk between 1/1000 and 1/1001, which is halachically significant, is no greater than the gap between 1/1001 and 1/1002, which has no halachic relevance. In other words, invoking the technical definition is only relevant to its particular halachic usage.
However, from a values-based approach, safek pikuach nefesh teaches us that we are willing to compromise our practices for even a possibility of death. Therefore when it clashes with other values such as Jewish education, ideal tefillah, mental health, and public Torah learning, it carries weight like any other value would. This is despite not meeting the halachic threshold to allow chilul Shabbos.
So, unless we are talking about violating specific issurim in the Torah (and not simply doing mitzvot asei in a less-than-ideal manner), meeting the technical definition of safek pikuach nefesh should not be particularly relevant. And if you are able to identify any specific issurim that current COVID restrictions might violate, you should give them the same halachic treatment as well.
Yair, thank you for your comment. I don't agree with your assessment that this term has been used mainly as a value based category. Rabbanim are still putting out letters and haskamot and facebook posts using terms like 'Pikuach Nefesh', 'rodef' and even 'murderer'. Safek Pikuach Nefesh was invoked constantly, especially around the holidays, but also concerning funerals and weddings and the like, to justify the limiting of these mitzvot. These terms have legal weight, especially when coming from rabbinic authorities. If we were only discussing values, psukim like 'VeCahi BaHem' would be relevant, but not these halachic terms or restrictions.
DeleteRabbi Akiva Eger's and Rav Yisraeli's position of one in one thousand is a somewhat arbitrary statistical threshold, but obviously a point is needed to differentiate actual danger that has halachic significance as opposed to the regular risks of daily life. Without a limit, Safek Pikuach Nefesh can be used to justify limiting pretty much anything: walking outside during a rainstorm, driving, swimming, eating fatty foods, etc. Whatever the specific number is as a cutoff, halachicly we are always forced to pick one (see, for example, Batel BeShishim). I have tried to demonstrate here that the risk profile of an untested asymptomatic person causing the death of another is well below any threshhold ever even considered by former rabbinic leaders, implying that our response is without precedent anywhere in halacha.
I also do not understand your distinction here between mitzvot asei and mitzvot lo taasei. MItzvot Asei are not some optional yoke we can choose to ignore whenever our values seem to clash with them. We don't say that we are not required to teach gemara to our children because it contains anti-feminist values that we disagree with, nor that we can disregard or disrespect our parents because they hold different political values than us. One could say that that is one of the key differences between orthodox Judaism and its breakoffs. Orthodox Jews believe that doing G-d's mitzvot should always come first even if we disagree with them due to our own 'values'.
I agree with most points in your response, but they do not address what I actually said.
DeleteI did not claim that most people are using pikuach nefesh in a values-based way. I said I do not know who is and who isn't. My main point is that I believe your post is relevant to those that are using the concept legally and not in a values-based manner. Therefore, I agree that the technical definition of pikuach nefesh and statistics are relevant to those who are wielding it as a sword to cut down those who do differently. Calling a group of people rodfim requires actual proof they are causing deaths and clearly that is not the case. The same goes for claiming "it is assur to go Place X or Event Y" as that is a halachik pesak. So in terms of those people, I think the information in your post is relevant and immensely important.
Regarding the distinction between mitzvot aseh and lo ta'aseh, I was particularly careful to write "not simply doing mitzvot asei in a less-than-ideal manner." Most of the mitzvot that are being limited are mitzvot that have no maximum limit. In fact the ones you mentioned are quoted directly from the Mishna in Masechat Pe'ah which introduces them with the phrase "These are the matters that have no fixed limit." How much to engage in these mitzvot is a values-based decision that IMO isn't relevant to the halachic category of Pikuach Nefesh. If we make decisions to limit, for example, Talmud Torah to due our familial responsibilities, mental health, or some other mitigating non-halachic factors, I don't see why we can't do the same for public health, even if it isn't technically a safek pikuach nefesh situation.
Finally, I made no such claim about rejecting Jewish practices for the sake of secular values. I am advocating for a position that risk of mortality, even when it falls below the threshold of technical Pikuach Nefesh, should be taken into account. In such a case it wouldn't take on halachic status, but would still be relevant in values-based public policy decisions. In such a situation, it would take on the status of a Jewish value, not a secular one. (Although I completely open to the possibility that the other values will completely overwhelm the risk of mortality based on it's low percentage.)
In summary, I 100% agree that if our current situation does not reach the threshold of technical Pikuach Nefesh, it is inappropriate to invoke it to confer statuses on individuals, and to declare certain practices to be assur. However, I do believe it must be taken into account with policy decisions. If you want to call it "v'chai bahem," I am fine with that.
(As I wrote that last line, it occurred to me that might agree about all this. My original intent wasn't even to disagree; it was to clarify.)
Yair, thank you for your clarification, and I apologize for misunderstanding your arguments. I fully agree with your point that these are matters of public policy and not halacha, and I will go into much further detail on this point in Part 3.. The intent of this series is specifically counter the arguments circulating concerning what halachic responsibilities people have during this time.
DeleteBuilding on your point about values in balancing mitzvot asei, I am of the opinion that this can only truly be done on an individual level. Only an individual can be aware of all of the factors in his decision to visit a lonely grandparent, for example. What risk are they putting that grandparent in and how does that balance against their requirement to always provide them with the respect they deserve as a human being and a patriarch. Another example would be the child who does not study well on zoom and is struggling socially and mentally and how that weighs against the need for social separation to reduce covid. It is disturbing to me that Poskim feel that it is appropriate to apply blanket halachic rules without knowing the specific facts of each case.
Thank you again for your engagement and detailed response.
Thanks for the reply. I'm still curious about your use of "individual" vs. "communal" decision-making. Specifically in this quote: "If not applicable on an individual level, communal action becomes much harder to justify."
DeleteBased on context, it seems by "individual level" you mean as a stand-alone halachic requirement, without the complexities of application to an entire swath of the population. In other words, a Rav can pasken for an individual student or congregant because he knows all the issues at play for that one person. This doesn't work for a blanket p'sak on the community.
However, this Rav might advise an individual to be more strict than normal regarding pikuach nefesh (e.g. avoiding shul or a family simcha for less than a 1/1000 chance). If so, (that "safek" pikuach nefesh below the halachic threshold is still relevant for p'sak) why can't it be used for communal p'sak as well?
I can see one of three responses to this:
1. No rabbis should be paskening COVID questions for an entire community because of how it affects so many different people differently.
2. This is out of the realm of "p'sak" and is under the category of "policy" because so many of the issues at play are not Torah-centric.
3. This is out of the realm of "p'sak" and is under the category of policy because the health issues do not hit the pikuach nefesh threshold and therefore no specifically halachic mechanisms exist to invoke, only values.
Is one of these three your opinion, or did I miss another possibility?
Thank you for this clarification. I was planning on going into detail on your option #1 in Part 3 that should come out later this week. Your option #2 seems somewhat problematic to me because I don't want to take any of this out of the realm of 'Torah centric" We are definitely People of the Book and we should always be trying to balance all of our biblical obligations as best as we can, of which VeChai BaHem is definitely a part, but so are many of these other mitzvot.
DeleteMy specific comment here though closely relates to your option #3. Without a halachic mechanism on an individual level, I believe it is harder to invoke one on the communal level. That's not to say that there isn't precedent, and I bring Rav Shlomo Zalman and Rav Goren as examples. The halachot of Maarat Ayin also seem to demonstrate that this does happen sometimes in halacha. Generally though, I assume you would need a secondary mechanism or a really strong proof to justify this expansion. In part 2 is where I express my concern that this strong proof doesn't exist either.
Working off of #3, I understand how your analysis should prove how the effect of Safek Pikuach Nefesh should be limited in terms of determining COVID-related psak. However, you openly agree that the value of "v'chai bahem" is still relevant from a psak perspective.
DeleteBeing that your post has been published after policies/psakim have been put in place, would you say your analysis "debunks" some of these psakim? Do you think rabbonim (such as those in the RCBC) have made errors and used Safek Pikuach Nefesh inappropriately? If not, then your analysis, as interesting as it is, becomes chiefly academic.
If you do believe the rulings to be in error, I'm curious as to the force behind that argument. Is it based on language that has been used or based on the actual decisions? If it's the former, there are two possibilities:
1. The rabbonim do not have a proper handle on the halachot of Pikuach Nefesh
2. The rhetoric being used by the rabbonim doesn't actually match their thought process (which I would agree is a problem nonetheless).
If #2 is true, your analysis is moot in terms of debunking the current policies, although you would have shed light on a problem in terms of fear-mongering.
However, by posting this, Gershon seems to claim that #1 is true, as he definitely believes this post to be more than just academic. Are you in agreement that the psakim/policies put forth by many rabbonim are in error (either based on an incorrect usage of Pikuach Nefesh or some other mistake)?
Just to point out, if you do think the current rulings are incorrect, I have no problem with that. I'm just trying to clarify what is at stake by Gershon posting your analysis - it seems to be a claim that the local rabbonim are wrong from a halachic knowledge perspective (as opposed to being misinformed about the science).
I would agree with your option 1 though with the adjustment that I don't beleive that rabbonim have a proper handle on the metziut and available data, and are therefore misapplying the halachot of Safek Pikuach Nefesh. I believe that in our current highly politicized and emotional environment, the science and available data is being misrepresented or exaggerated and leading to poor decisions from not only a policy perspective, but also from a halachic perspective. Based on conversations I have had with many people far and wide, I am not alone in this opinion. Unfortunately, many are afraid of repercussions for voicing these opinions, or are too intimidated by the scientific and halachic literature themselves to try and make a reasoned well researched argument. I have done my best here and in the later parts of the series to try and lay out the scientific arguments as clearly as I can in a way that they can be applied by rabbanim in a halachic framework.
DeleteOn a separate note related to option 2, I am also bothered when rabbanim use words like 'murderer' and 'rodef' to describe people who are doing normal acts or mitzvot. Those terms are completely inappropriate and imply a measure of intention or control that does not exist here. It is the epitome of human hubris to think that we can control the spread of a virus, and that any person should be directly or indirectly culpable for another's death by disease. If we were to apply this standard generally, every single doctor and nurse in the world would be guilty of murder, as nosocomial infections are one of the leading causes of death worldwide.
Thank you for your engagement and feedback