Barbara Pfeffer Billauer
integrating law, policy, religion and science

L’Chaim: The Secret to Life in the Days of CoronaVirus

The entire world is a narrow bridge- the important thing is not to be afraid - not to let politicians manipulate our responses to the serious situation we are facing, and not to react out of fear.

This morning I received a delivery. That’s the good news; it goes downhill from here. The delivery man dropped the package on the ground, demanded that I close the door, and ordered me not to retrieve the package for several minutes so he could make his “escape.” Fear radiated from his eyes. Right now, it was only a seed. But it was still detectable.

I have read that it takes a month to inculcate new habits. By the time the Corona-virus- lock-down order is removed, it would be a safe guess that more than a month will have elapsed, and the lockdown orders will have been in place for longer than that. By that time, the habitual fear of one’s neighbors, the social aversion to one’s friends, and the permeating panic-at-large will have rooted. Since no one is sure the virus won’t waggle its spiky tentacles and re-emerge a few months hence, that fear will fester. And that fear, I fear, will become a permanent determinant and descriptor of our post-CoVID society.

It has now been almost nineteen years since I started studying bio-threats, beginning with the Anthrax apocalypse of 2001 (in which 22 people were infected and five died). Those early threats were clarion calls to prepare for bio-terrorist activity. And prepare America did. Over the last two decades billions were allocated to pandemic preparedness in the US; courses were devised, programs were instituted, Universities eager to cash-in sought funding as Academic Centers of Excellence. Some even have advanced degree programs in BioDefense. The Department of Health and Human Services and FEMA (the Federal Emergency Management Agency) put out manuals, instituted training exercises (one revolved around a sky-writer flying over a Kentucky-Derby-like rally, disseminating an anthrax-like substance while spectators stood still and stared at the propeller aeroplane flying three meters (nine feet) overhead – I kid you not), and cities engaged in practice drills. It’s not like the corona virus wasn’t on the event horizon. It was specifically listed in at least one of the reports as a pandemic candidate-of-choice. What, pray tell, were these people doing? Where, one asks, did all this money go? And how wrong could the estimates of the “experts” possibly be?

Very, it turns out. In 2016, “the World Bank … estimated the economic impact of a severe pandemic (that is, one on the scale of the influenza pandemic of 1918–1919) at nearly 5 percent of global gross domestic product (GDP), or roughly $3 trillion.” Based on the present course of activity, we will be lucky, according to Professor Norman Bailey, former Chief International Economic Advisor to Ronald Reagan’s National Security Council, if we suffer only a twenty percent reduction in global GDP.

So maybe we are doing the wrong thing, as has been suggested by the former head of the Israeli and World Medical Associations? Or maybe the pandemic planners didn’t project that this course of conduct would ensue? Perhaps we are proceeding in a reactive, short-sighted, and societally disruptive, if not destructive, fashion? I suggest that before continuing this self-immolating behavior, we stop and take stock – and retreat — if warranted.

In 1999 bioterrorism was re-introduced into the political consciousness by an ad hoc group of scientists (some of whom later sought to cash-in on resultant government funding). Since then, the general definition of “terrorism” has sharpened and its impact crystallized. Now we understand that what we call “terrorism, has a widespread impact on the entire society that disrupts the normal routine of a functional society by spreading fear and terror among its inhabitants ….” That definition certainly describes our lifestyle today.

Yet I am not afraid of the CoronaVirus – even though I am in the “at age” risk-range. I am, however, dreadfully frightened about what will become of our society – stoked by politician-generated fear-speech. Yes, we will – at least for this go-around– outwit the virus. But, in so doing, will the cure be worse than the disease?

Of late, I have heard others raise this concern – mostly relating to the economic impacts. The Israeli finance ministry (lead by economists) is wrestling with the health ministry (also lead, de facto, by an economist) over what they feel are draconian and unnecessary responses. My own concerns, however, relate to the psychological and related physical consequences of “the CoronaVirus Response,” and the undefined, unspecified, and vague time durations associated with proposed actions and its legal impact.

It is now clear that human bioterrorists cannot rival Mother  Nature’s bio-apocalyptic ways. It has also become clear that the sheer panic induced by Mother Nature inspired bio-terrorism does not come from the virus, itself. Rather, it comes from politicians. And that’s where the real danger lies. In days of yore, real leaders admonished us against FEAR. (Remember Franklin Roosevelt exhorting that “the only thing we have to fear, is fear itself.”) No longer.

No, it is not the virus that takes to the air waves and admonishes young children that hugging their grandparents will kill them, as did Defense Minister Bennett. The virus does not tell us to isolate ourselves for some uncertain length of time — when evidence tells that two weeks is the safe quarantine duration. The virus does not tell us that unspecified new lockdown rules are in the offing – keeping us in suspense while the government sorts out its next move. The virus does not tell US citizens to hop on the next plane back to the US (when no such plane is scheduled) or be barred from returning — indefinitely.

Neither does the virus promulgate incomprehensible, arbitrary, capricious, irrational, and uneven laws which do not foster the values of the State and have no basis in halacha (Jewish law), e.g., “that no more than two people from the same family may gather; [that] up to 20 people can attend a funeral; [but only] up to 10 people can attend a brit milah circumcision ceremony; [and] weddings can have no guests” whatsoever, or legislate rules with little or no effect on reducing transmission, for example that “prayer services cannot take place even in open spaces….” even with two meters distance between participants. Demonstrations, however, are permitted- so long as the the requisite social spacing is met.

Nor does the virus prophesy that Israel is on track for a million cases and ten thousand deaths, as did Netanyahu. But look – it appears he was right: Not a day later, the death toll began in earnest. Seventeen of our eighteen deaths materialized only after Netanyahu’s proclamation, in fact, the death spiral began immediately afterwards. (Of course, I hear the Bibi-niks saying, that was only a co-incidence. Maybe. Read to the end, dear reader, before so blithely assuming).

Netanyahu’s projected numbers of CornonaVirus illnesses and deaths derives from skewed statistics, limited data and artificial mathematical modelling. Yes, perhaps 6% of the limited population sampled tested positive for Coronavirus. And perhaps it is not impossible that 10% of the tested population may ultimately be infected – (although, how could that be, if the isolation program is working? And if it isn’t working – why are we being made to suffer the negative effects of isolation?). In fact, those being tested, at least right now, are the ones most likely to be sick or exposed– the population at risk. This is a skewed sample. To ascertain – even roughly- what might happen, one should test a random sample of the entire population – even those not at risk. And even then, as any political pollster will tell you – the results are often way off.

Apparently based on these skewed numbers, Netanyahu and Health Ministery director-general, Bar Siman Tov, came up with this irresponsible prognostication of sick and dead numbers. It bears note that oncologists no longer give prognostications of survival, precisely because of the deadly impact of the power of suggestion. No matter. Netanyahu got what he wanted: FEAR.

I suggest it was this fear that galvanized Gantz – who, without checking Netanyahu’s numbers with his own experts, – did what he felt was best for the country- based on exaggerated FEAR: false, endangering, and reckless speech. (Netanyahu, by the way, is not a stranger to FEAR Speech- first, it was “the Arabs are coming”, and then it was that Kahlon wouldn’t make it into the next Knesset – thereby inducing him to join Likud. And now it is CoronaVirus.) Is it any surprise that Netanyahu wants control of the Health Ministry in the coming government? This would be a personal, Machiavellian mafia – one that allows him special dispensation, a personal heter (permit) to avoid quarantine if exposed, when others, similarly situated, would be arrested if they failed to self-isolate).

Risk Benefit: Protecting Democracy

There is no question that the CoronaVirus pandemic is serious. Certainly, social distancing is imperative. So is eliminating public events and crowding. Staying at home also seems to be effective and important. But the question is for how long –and whether indeterminate duration of individual isolation in non-exposed persons is proportionate and effective – or disproportionately harmful? And while many lay Israelis believe the government can do what it wishes in an “emergency”, nothing could be farther than the truth – neither in Israel nor in the US. Even under emergency situations, care must be taken that basic laws or Constitutional guarantees, the underpinnings of Democracy, are not trampled on – and that requires that only the least stringent measures shown to be effective are implemented.

The tension between protecting public health and preserving individual liberty is not new. But, as Benjamin Franklin supposedly said, he who prefers safety at the expense of liberty, deserves neither. And since the vast majority of citizens of Democratic countries will certainly survive this pandemic, vigilance must be expended to assure that on “the morning after,” there will still be a democracy to come home to. Our countries were built on ideals. We have never sacrificed them before; it would be a sad testament to jettison them now.

To assure the preservation of Democracy, American law, as summed up by two leading scholars on pandemic preparedness law, Lawrence Gostin and James Hodges, requires that regulations pertain to:

individuals [who] must pose a significant risk of spreading a dangerous, infectious disease; (2) interventions must be likely to ameliorate risks; (3) least-restrictive means necessary to achieve public health objectives ….; (4) use of coercion should be proportionate to the risk; and (5) assessments must be based on the best available scientific evidence.

The Israeli legal situation is effectively almost identical. The Public Health Ordinance (of 1940) gives broad power to the government to protect public health, however, all measures must be enacted subjected to the 1992 Limitation Clause of the Human Dignity and Liberty, a basic law, which provides, that “any infringement on autonomy may not be greater than required and must be “carried out in according to a law befitting the values of the State of Israel.”

Gostin and Hodges agree that self-monitoring and home quarantines are effective and legitimate public health tools – when applied to those who are exposed.  But virtually all countries have instituted modified lock-down orders applied to everyone –not merely the exposed. These directives are expected to survive far beyond the scientifically evidenced quarantine period of 14 days. Whether this extended and indefinite lockdown will withstand legal challenge remains to be seen.

Open-ended Lockdowns Imposed by Fiat and Fear:

The part that disturbs me most, however, is the duration of the lockdown. After two weeks of isolation (or say three for good measure) , everyone who has been exposed and is susceptible, should have manifested the disease. What purpose is served by continued isolation and lockdown beyond that time period? Indeed, why is our government even contemplating even more draconian measures, without giving the ones in place a chance to demonstrate their effectiveness?

Two countries, Sweden and, at least for now , the Netherlands, have not imposed these universal isolation directives. (Although they have instituted requirements for social distancing, their objective is achieving herd immunity which will protect the population in the event of a resurgence of the virus). When all this is over, investigation of the Israeli (and the world) response, its proportionality, its efficacy, the degree of invasiveness and its protection for future events — will be compared with Sweden and Holland. Such an investigation will be illuminating.

Until then, we face additional questions, such as when and who decides when restrictions will be removed. Do we risk removing social distancing orders if we have a reduction of cases of 50%? 70%? 100%? Do we wait till we have no cases at all for two to four weeks, which, in this case, would be the classic definition of the end of an epidemic? If even one case is transmitted after requirements are abandoned, we are back to where we started.  Does the Prime Minister, perhaps politically motivated, make the decision ? The non-Medically trained Minister of Health? A vote of a partisan Knesset?

Or, perhaps the Swedes and Dutch have it right? Let’s get people exposed so they are protected for the next go around. (And let’s get the ventilators and protective equipment on hand so we can tend to the most vulnerable). We won’t know the answers to these questions until after the pandemic subsides. By then it may be too late to undo the damage of open-ended restrictions. And we need some answers now.

FEAR Kills: And absolute fear kills absolutely

As I write this, some 18 people have died from CoronaVid 19 in Israel. When the epidemic is over, the number will undoubtedly be higher. Nevertheless, I venture to say it will not be as high as the additional lives lost from stress-related harm caused by fear and isolation. At that point, the higher-than-usual mortality rates and lower-than-usual birth rates will end up staring back at us.

Indeed, not long after the initial lockdown was instituted, David Ehrlich, the “much beloved owner of Jerusalem’s Tmol Shilshom,” suddenly died of a heart attack at 61. Another co-incidence? Maybe. Except, according to the work of Michael Marmot, coronary fatalities are related to stress and fear – and national stressors kill individuals. Marmot illustrates such triggering events with the effect of the Gulf War on Israeli death statistics. In 2002, three months after the World Trade Center Episode and two months following the Anthrax scare, neonatal mortality rates in the US spiked for the first and only time in the twenty years before or since. A very recent study demonstrated that stress affects sperm, such that a “baby’s brain develops differently if the father experienced a chronic period of stress before conception.” The effects of the stress on sperm lasts as much as a month after the stressor is removed.

Extensive isolation is also extremely hazardous to mental health. A recent article in Lancet, the premier British Medical Journal, counselled against prolonging quarantine unnecessarily, citing development of post-traumatic stress disorder and even suicide as a long-lasting consequences. Social cohesion, according to Marmot’s work, is protective against disease and impacts on national longevity. As the isolation orders are protracted, social cohesion, as we know it, fragments, and with it our previously robust longevity statistics disintegrate.

And remember the Israeli basic law requiring all public health enactments to be consistent with national values? Women, as recent Facebook posts attests, are freaked out about going to Mikveh. Public Health experts counsel against it. Rabbis urge immersion – generating further dissonance and conflict. Whether mikveh-going is or is not safe, the stress now incident to ritual-immersion is not conducive to baby-making.

And what about the domestic abuse cases that are spiraling out of control? Or the isolation of aging Boomers who haven’t yet cottoned on to being Zoomers- who will die — alone. And as free trials to exercise programs dry up – what about a population slowly dissolving into a sedentary lifestyle – emerging from this episode 15 or 20 pounds sideways to obesity?

OK – perhaps we know about increased heart attacks due to stress or suicides resulting from fear – but what do we know about corona virus? And there remains that pesky statistic that Italy has disproportionately high death rates.  (The blaming it on the oldsers excuse, based on lopsided Italian age-demographics, doesn’t cut it. Japan has an older population than does Italy; Germany’s is almost as old, and both those countries have relatively low death rates). Could panic be an explanation? Does the constant barrage of fear-mongering (of which the US and Israeli press is complicit) have any impact on susceptibility? Are panic-pushing proclamations by politicians in some way contributory to case-increases? Don’t think there isn’t any evidence to go on – there is.

According to Richard Wilkinson, in at least one carefully controlled study, highly stressed participants were 75% more likely to catch five different strains of coronavirus! Not CoVid19 or SARS, of course, we can’t experiment with them, but a cold – and the cold-virus is as closely related to our CoVod 19 as we can experimentally get.

So, every time a politician or bureaucrat or media entry prophesy absurdly dire case numbers and predicts off-the-chart death rates (and noting that Dr. Fauci just stated that he’s never seen worst-case scenario model numbers ever materialize), consider that the politician predicting doom, or the journalist forecasting gloom, or the bureaucrat envisaging apocalypse just might have added another statistic to the case count or killed another person. Of course, in the process, they also added more partners to their political party, more readers to their newspaper, and more funding to their budget.

And as for two weeks of enforced quarantine – let’s see if the allegedly (?) now-exposed Netanyahu is hoisted by his own petard.

 

 

About the Author
Grew up on Long Island, attended Cornell University (BS Hons.)and Hofstra ULaw School, MA in Occupational Health from NYU, Ph.D,. in Law and Science from Uof Haifa. Practiced trial law in New York City, Taught at NYU, University of Md Law School, Stony Brook School of Medicine. Currently Research Professor of Scientific Statecraft, Institute of World Politics, Washington, DC, Professor, International Program in Bioethics, University of Porto, Portugal. Editor Prof. Amnon Carmi's Casebook on Bioethics for Judges, Member of Advisory Board, UNESCO Committee on Bioethics. Currently residing in Netanya, Israel.
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