Sunday, Aug 1, 2021

On the Covid Vaccinations

By Dr. Daniel Berman

Boruch Hashem, Covid-19 is almost completely gone from the frum communities for now. In the whole country, cases are plummeting. There still are sporadic cases, even in the frum communities, although they are rare.

The most common questions now being asked in our communities relate to the issue of vaccination, especially for children and young adults. There is reluctance in our communities to vaccinate this group, based on hashkafic and/or halachic grounds, as well as for medical concerns. Although I am not qualified to respond to questions regarding the former, I believe that there are a number of medical points that need clarification. My hope is that with the correct medical information, rabbonim and rabbeim answering shailos whether or not to vaccinate can give the proper guidance.

There is a broad consensus that the vaccines have played a huge role in the present decline of Covid-19. The State of Israel was the first country in the world to vaccinate the majority of its population and Covid-19 has just about disappeared from Israel. As the number of vaccinated grow in the United States, cases of Covid-19 are falling rapidly.

Understandably, some might claim that the declining numbers are unrelated to the vaccines. They can argue that in 2020, the ferocious onslaught of Covid-19 that occurred during the PurimPesach period was followed by several months of almost no cases. During that time, the feeling of “we’re done” prevailed. There were no vaccinations available at the time. However, after Tisha B’Av, and particularly during Elul, going through Sukkos, there were large outbreaks in our communities. Fortunately, these outbreaks did not take the same toll on lives as the first one, but there were significant losses and disruptions of normal life for families, shuls, and yeshivos. It seemed that the outbreaks started at simchos and quickly spread through the communities.

Excluding vaccines from the equation, there is sufficient reason to be concerned about the possibility of Covid-19 returning, albeit to a smaller extent, to our communities. Although there is a prevailing feeling that “everyone had it,” there still is a susceptible segment of the population who have evaded infection to this point. I cannot predict what kind of personal and communal disruption such potential outbreaks could cause, but suffice it to say that these strains pose tremendous challenges for our community, especially in regards to yeshivos and schools, and consequently to family life and parnassah, and I believe that there is enough basis for concern.

Before discussing the vaccines in more detail, it should be pointed out that natural immunity in those previously infected, although not perfect, has been quite effective. There were a number of cases of second infections that were occurring, especially in February and March of this year, but none of the cases appeared to be too serious. I have personally consulted on many hundreds of patients with Covid-19 at Montefiore Einstein Medical Center. Only one of those many hundreds had had Covid-19 once before, and she was quickly discharged after a relatively mild illness. For now, the immunity is still lasting even from Purim of 2020 in preventing serious illness and second cases, for the most part. This has, boruch Hashem, been a crucial source of immunity for many in our communities since last Purim and Pesach.

Similarly, it is quite clear that the vaccines have been extremely effective in preventing serious illness. I have not seen a single fully vaccinated individual come into the hospital with a serious new infection. One can argue that the vaccines entered the Bronx (Einstein Hospital) population when cases were already falling on their own and that the absence of serious illness relates to a natural fall in cases. However, the drop in serious cases has correlated so closely to vaccination rates in every vaccine study in a consistent manner and in the countries where vaccines were most available (Israel, United Kingdom, and the United States) that it is difficult to deny a causal relationship. In Europe, where the availability of vaccinations lagged, Covid-19 infections continued to spread, until the vaccines became available. Infection rates started to decline from that point.

Like natural immunity, vaccination does not prevent all infections. Indeed, of the first 100 million vaccinated individuals in the United States, 10,000 became infected with Covid-19. However, almost all of them have reported to be mild cases. Furthermore, this number was a 90% reduction from the number of cases among those who were not vaccinated.

The key to preventing a resurgence of Covid-19 is to have no place for the virus to attack and then spread when sporadic cases enter our communities. Naturally immune and vaccinated individuals block the virus from infiltrating. The term that is used to describe this is “herd immunity,” which does not have an absolute figure. Numbers are thrown around as to what percentage of the population needs to be immune for “herd immunity” to exist. Whatever the numbers are, they are much higher for the frum Jewish communities, which have so much more interaction among individuals within communities and with outside communities.

The reluctance to vaccinate emanates somewhat from the fear of putting into the body something that is so new, which is reasonable, but primarily from a proliferation of false and distorted information. In our world of social media, one human being on the planet can invent an idea that spreads around the world more quickly than the virus itself. For example, the leading fear is that of infertility issues. There is absolutely no basis for this. There is not even a plausible biologic theory to account for such a possibility. Many readers will question this. How could it be that something that they have heard so many times from different people does not have some basis? The truth is that there is no basis.

Can there be unrecognized long-term side effects? It is extremely unlikely. In the history of vaccines, complications have always been discovered within a few months, as is the case with the Covid-19 vaccines. Long-term side effects have never been associated with vaccines. There is confusion with medications – not vaccines – which can cause complications that are only discovered years later. There is no reason to think that this one vaccine is any different.

People are also concerned about a new technology in vaccines using messenger RNA. The technology actually began more than 10 years ago with SARS-1. It is a fascinating new technology that might introduce new vaccines and improve older ones. Instead of vaccinating with a live or killed vaccine, we are using the genetic fingerprint, in the form of messenger RNA, of one protein of the virus to produce the protein in the body and induce an immune response. The messenger RNA is immediately destroyed by the body once the protein is made.

With regard to real adverse effects, blood clots, including in the brain, have been related to the Johnson & Johnson vaccine. They occurred only in women aged 18-48 and were rare. Furthermore, at this point, the condition is recognized and almost always treated effectively.

Myocarditis has been reported, especially in young men. Again, the incidence is rare, and almost all of the cases have been mild. There has not been a single death in the United States related to this. Almost all of the individuals with myocarditis have recovered uneventfully.

Over one billion individuals have been vaccinated on our planet. The incidence of serious side effects has been incredibly small. With the rapid spread of information in our world, rare events are highly publicized and create tremendous anxiety.

All medical decisions should be made based upon a careful and accurate risk versus benefit analysis. The resistance to vaccination is from the parents of children and young adults primarily. It is understandable for one to come to a conclusion that any risk is not worth it to prevent an illness that is so mild and not life-threatening to children and young adults. The CDC reported that from January through March 31, 2021, although many adolescents were infected, not a single one died.

In evaluating benefit, I believe it is extremely important for as many people as possible to be immune so that the virus does not have a place to “land.” We do not want to have the inconveniences and hardships caused by outbreaks to families, schools, and yeshivos. We want learning and simchos to continue without any interruptions. We want all of the bubbies and zaidies to be present at simchos without worrying about getting sick. We also cannot ignore loss or distortion of taste and smell, a common symptom of Covid-19, which has affected a significant number of young people, lasting even until now, which likely can be avoided with vaccination.

It might be that it’s “over.” However, the virus is not gone, and with increased travel, it can easily come back and spread through non-immune individuals. In making a careful and accurate assessment of risk versus benefit for individuals and for Klal Yisroel, we should understand what the actual risks are and not what they are perceived to be. With an accurate understanding of the medical risks and benefits, I strongly believe that the conclusion should be that we should get everyone who is not yet immune, including children and young adults, vaccinated. Although I defer to rabbonim and rabbeim for the ultimate decisions on these matters, I encourage those with lingering doubts to have the correct facts before making a passive decision that could have ripple effects upon our communities. For those with natural immunity, whether or not to get vaccinated is for another discussion. We should not allow the virus to have a chance to disrupt our lives again.

Dr. Berman is an infectious disease specialist.

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