COVID-19 Medical/Halachic Update

Rabbi Aaron E. Glatt, MD

With the recent updated guidelines from the CDC published July 27, 2021, many Rabbonim and lay shul leaders have asked for my opinion as to how this will impact shuls. While iy”H at a future time we will have an opportunity to explore this in more detail, for now, here are my recommendations.

For now, certain medical information from the updated CDC guidelines and the evidence based literature are essential for Rabbonim to understand.

First and most important, the COVID-19 vaccines authorized in the United States remain very effective against severe illness and death from SARS-CoV-2 (aka COVID-19) infection. Based upon the evidence based medical literature, the continued great importance of vaccination is not medically in doubt, despite “contrary” information advocated and voiced on non-scientific social media sites. Halacha demands we follow the scientific facts and best evidence, as our great poskim have reiterated time and time again. 

It is also critical to realize that the overwhelming majority of current US COVID-19 cases are occurring in unvaccinated individuals. Significantly increasing vaccination rates are urgently needed to stop the spread of COVID-19 and save lives. Unfortunately, as of yesterday, less than 58% of the eligible population of the US has been fully vaccinated.

Many shuls have completed surveys and / or anecdotally told me that their vaccinated populations are indeed much higher than this. BH, that is great if true. However, one needs to remember that unvaccinated people almost never respond to these surveys, guests coming to shuls are never included in such tallies, and patients coming to shul with symptoms remains a persistent concern. Clearly, even vaccinated persons can potentially transmit COVID-19, although much less so than unvaccinated infected individuals.

The spread of the highly transmissible Delta variants (plus other “variants of concern”) have caused CDC Director Dr. Rochelle P. Walensky to state: “This new science is worrisome and unfortunately warrants an update to our recommendations.” Hence, the CDC updated guidelines.

The major changes associated with the newly released recommendations (NOTE: they are not binding upon local Departments of Health who are free to adopt them, modify them to be more or less stringently implemented, or totally ignore them) involve five critical data points:

1) Level of COVID-19 community transmission;
2) Local health system capacity;
3) Local vaccination coverage;
4) Capacity for early detection of increases in COVID-19 cases;
5_ Specific populations at greater risk for severe outcomes from COVID-19.

Many of these factors are not easily quantifiable or even identifiable, and can rapidly change from week to week. 

Therefore, among strategies to prevent COVID-19, the CDC made the following new recommendations:

1) All unvaccinated persons should wear masks in public indoor settings. They do NOT distinguish between people who previously had COVID-19, whether antibodies are present, and / or other reasons for not being vaccinated. While there are data to suggest that previously having COVID-19 does indeed make the likelihood of acquiring a second episode of COVID-19 much less, we simply do not have adequate information on what this means regarding the Delta 9 (or other) variants.

2) Fully vaccinated persons should wear masks in public indoor settings in areas of substantial or high transmission. The definition of this according to Dr. Walensky is: 

a. “Substantial” transmission: 50 – 100 cases / 100,000 people over a 7-day period;
b. “High” transmission: 100-plus cases / 100,000 people over a 7-day period.

3) Fully vaccinated persons at greater risk might consider wearing a mask in public indoor settings, regardless of transmission level. If a person (or someone in their household) is immunocompromised and / or at increased risk for severe disease, or if someone in their household is unvaccinated (including children aged <12 years who are currently ineligible for vaccination), this is an important option.

a. This is a personal choice that is impossible to recommend globally to all communities or shuls for immediate global policy implementation because of the impossible logistics involved, and lack of medical clarity.

b. However, certain high risk settings (minyanim in a senior center or nursing home, residential communities primarily dealing with older populations) might want to explore this option globally in more depth with local medical professionals.

c. Certainly, individuals who are requesting such accommodations should be allowed and encouraged to have such “safer” spaces to daven.

Bottom Line:

Each individual community / shul should re-examine their current policies and decide what is best for them based upon the critical factors outlined. I am NOT recommending specific global changes to my prior recommendations for all shuls at this time (July 27th, 2021). This is a very rapidly changing field though, with new information from here and Eretz Yisroel coming out daily, which could impact my recommendations in the future.

May Hashem continue to protect us in this pandemic – which is by no means over.