Fire the Covid Committee

May 15, 2022 By Abraham Wyner and Alan Salzberg

Fifteen-year old Gil hasn’t walked into his Brooklyn synagogue once in 2022, although he likes to get up early, even on the weekends, and typically showed up for Saturday morning services. Gil hasn’t been attending because he is banned. Gil is vaccinated and has natural immunity from a recent case, he has not received a booster, and, under the Covid committee’s rules, everyone who enters the synagogue age 12 and older must be vaccinated and boosted.  

Until recently, the Covid committee also required N95 masks for all. Currently, children under age 5, for whom vaccines have not been approved, are the only ones that “must wear N95 masks (or similar) at all times when indoors.” At least the children are not banned outright (which has happened).  To be clear, the Covid committee’s rules over the last two years consistently go far beyond what even relatively aggressive local public health authorities like New York’s are requiring, or have ever required. This means that the Committee, whose decisions are not particularly exceptional or uncommon among many houses of worship, private schools, and summer camps, has become the ultimate arbiter of so much of our lives under Covid.

What is the purpose and benefit of a Covid committee, and are these committees serving that purpose?  The answer, in short, is that these committees no longer serve a useful purpose and are harming rather than benefiting the communities they purportedly serve. Healthy  children have little risk from Covid even without a booster, and in any case, parents who have decided against one for their children are not changing their minds. Thus,  the synagogue committees that require a booster discriminate against children in a misguided effort to protect the elderly.  As only a minority of children have booster shots, the requirement is turning away exactly the new families it should be welcoming,  basically hanging a sign out that Judaism is only for the old.

With restrictions come trade-offs. Just as engaging in certain activities exposes us to risk of Covid, banning those activities, which are generally beneficial to physical or mental health, causes harm. Furthermore, unlike a public health authority, which, at least in theory, weighs the benefits and costs of activities in different venues and across all populations, Covid committees are singularly focused on their institutions alone.

For example, in 2020, many non-profit summer camps, targeting zero Covid risk, canceled their summer programs. But canceling camp has massive costs in lost development and psychological harm almost entirely born by children.  These risks were known at the time but ignored by the Covid committees because they were charged only with mitigating the risk of covid at the camp. But canceling camp does not remove children’s physical risk. Children will still be exposed to other risks without camp, including the risk of getting Covid from their local community or family members, and it’s not at all clear whether that risk will be higher or lower – it was simply not considered at all.

One reason given to close camps was to prevent super-spreader events among the children. But we have known since before March 2020 that the risk of serious illness and death from Covid is negligible for children.  Deaths from other respiratory illnesses (pneumonia and the flu) exceeded that from Covid in this age group, even during the two years of the pandemic, and camp was never canceled due to these risks. Thus, if we only consider children’s welfare, there is little risk in going to camp, and it’s not clear whether it would actually decline if they were to spend that same time at home. Skipping camp just means the exposure to Covid is from the local community rather than from the fellow campers. On average, if anything, risk to kids might be lower since they could quarantine and extensively test before arrival.  

On the other hand, canceling camp puts older people, who are more vulnerable to Covid, at increased risk. There are relatively few adults at camp compared to local communities where there are parents and guardians, and other adults, who might get sick from children who would otherwise be at camp. A parent or guardian also has a very low risk of dying from Covid whereas an older guardian, in their 60s, has 200 times the risk of children. In other words, a holistic view of the trade-off, considering societal risk, would almost certainly have resulted in no camp cancellations, because camp would not necessarily mean more risk for children and would almost surely mean less exposure for those at much higher risk. However, the camp Covid committee isn’t tasked with considering those other risks. They are focused on the risk to the camp and that organization, and through that narrow Covid lens, the risk goes to zero when you cancel camp.

Of course, there were many camps that tried to open in 2020 but could not, for a variety of reasons not directly connected to health concerns. But many camps did open, especially the for-profit camps whose leadership does not answer to a Covid committee. We are aware of no serious health incidents at these camps, although there were some outbreaks,  and we know of no measured difference in outcomes among children or adults who attended/staffed camps and those who did not.

A similar argument can be made against school Covid committees, including those at colleges, which, almost in lock-step, shut down nearly all in-person instruction until the fall of 2021. Keeping students off campus didn’t keep them from congregating outside of the campus and almost surely exposed society to greater harm from Covid, while providing no clear benefit to students in terms of decreased Covid risk. The Covid committees, by shutting down in-person learning, succeeded in avoiding the accusation that they exposed students to risk at school. Notably, those few that chose not to remain closed in the Fall of 2020, like Clark University, saw no ill-effects from their decision to re-open in person in 2020.

For synagogues and houses of worship, which welcome people of all ages, the calculus is different, but the problem is still the same. Covid committees are tasked with considering the risk of Covid and minimizing it. They are not asked to consider the resulting trade-offs. The Covid committee does not consider whether and how people might have spent their time if they do not go to synagogue, and whether their alternative similarly exposed them to the risk of Covid. Nor does the Covid committee calculus consider the lost benefit of in-person meeting at houses of worship, nor the cost of isolation, especially for those same older people who are at the most risk of Covid.

Or if they do consider some of these risks, Covid committees take the individual risk-reward decision from congregants when they closed or required burdensome restrictions for attending services. These restrictions often included the requirement of masks (recently N95 masks), vaccines, and pre-registration, and the guidelines often barred guests, eating and drinking (or having any sort of kiddush at synagogues). Many synagogues banned singing, a nonscientific decision made without controlled comparisons and guided by cherry picked anecdotes and unfounded theories. In other words, for the perceived (but unproven) lowering of risk among congregants, we paid the price of forgoing the joy of many of the things that makes attending in person worthwhile, and that’s when we were allowed to attend in person at all.

Many see restrictions, especially measures like mandating mask-wearing, as a minor inconvenience.  We do not.  Teachers not seeing their students faces for two years has caused perhaps irreparable harm to the learning process.  A great deal of communication is through facial expression, and young people, especially, need the social interaction that comes with seeing each other’s faces.  And as teachers ourselves, we are sure that the experience of students has been severely degraded over the last two years.  These are not minor inconveniences, and our experience is not anomalous or merely anecdotal – recent studies reveal the  enormous educational, psychological, and even physical cost of various Covid measures.  In many places in Europe young primary school children were never required to wear masks, and despite the initial outcry, places like Sweden that eschewed mask mandates and other strict measures did not ultimately have Covid death rates that were higher than most of Europe (Sweden is currently 30th out of 48 European countries in Covid death rate).  Meanwhile, the Covid committee for  one elite Boston area college, required not only the audience but also  the actors in the spring musical to wear masks during the performance.

One overlooked problem with Covid committees is that they  often have the wrong people on it. Medical doctors and health care workers are often experts in medical treatments for individuals and are certainly invaluable resources. But do they have specific knowledge and training in non-pharmaceutical interventions? Are they trained and able to fully understand community costs and benefits, and how to trade-off between them? Not at all.

Relative to everyone else, doctors are extremely risk averse. The New York Times surveyed hundreds of epidemiologists and found that “as a group, they remain conservative in their choices about how to behave safely”. To many, this may be seen as an advantage rather than a disadvantage, but it’s not.

We believe individual risk decisions should be up to community members and, for children, their parents. However, to the extent that anyone should make risk decisions for the community, these decisions should be made not by those who are more cautious but by those whose beliefs about the right balance between the trade-offs of restrictions are in line with their communities.

Of course, there is a model in which a Covid committee makes recommendations and a broader group, like the board, then decides whether those recommendations should be adopted in light of other considerations. This model would enable that gauging of other risks and beliefs about appropriate trade-offs, while considering the Covid committee’s assessments. This was not the way Covid committees generally operate. As an example, a member of one of our local synagogue board was lambasted for the mere suggestion that the Covid committee’s recommendations be put to a vote and potentially be edited rather than immediately adopted verbatim.

Some might believe that the caution among doctors comes not from how risk averse they are but from their experience being on the “front lines” of Covid. Unfortunately, doctors working with Covid patients gain unrepresentative experience, due to availability bias. A doctor working at a hospital emergency room or Covid ward probably encountered numerous children over the last two years who are quite sick with Covid, but the majority of those not working at a hospital do not even know a single child who was hospitalized due to Covid, because the risk of hospitalization from Covid is exceedingly low among children.

The only reason a Covid committee should exist at all is if there is some special knowledge regarding risks or restrictions that might be important that the Covid committee is in a unique position to convey. In some settings, like the university, that may be possible. However, there is no indication that most  Covid committees have any special knowledge.

Furthermore, local public health authorities employ a cadre of professionals specifically trained for the task of guiding the public regarding appropriate responses to public health crises like this one. And, as discussed above, the public health authorities can at least in theory weigh the trade-offs between certain activities. These authorities have made recommendations and governments have imposed rules.  It stretches the imagination of these statisticians to imagine that a private school’s or synagogue’s Covid committee has the know-how to second-guess those authorities. Rather, the attitude that the Covid committee knows best, more than not only the community they serve but more than the professional experts they are over-riding, is sheer hubris that puts these Committees, and those that happily follow them, in the same category as conspiracy theorists on the right. We now consider whether the Covid committees’ decisions that go beyond what localities have required have a basis in science or the data.  We begin with vaccine mandates.

That we had a strong vaccine for Covid within a year of the outbreak was nothing short of miraculous.  As an example, Pfizer’s emergency use authorization filing indicates that the group who took the vaccine experienced only one-twentieth the symptomatic infections as the similarly situated blind control group.  These strong results continued as the public began to receive vaccines in the Winter and Spring of 2021.

With the Delta variant, the effectiveness against infection dropped off some, and a booster restored some of this effectiveness.  However, with Omicron, the vaccine has lost nearly all effectiveness against infection.  Current Israeli data indicates that people who have received a booster have little or no decrease in infection rates. In nearly every age category, the booster appears to be less effective at preventing infection. Fortunately, both vaccination and the booster continue to be helpful in preventing serious disease. Although the true value of the booster will remain unknown until proper clinical trials are  completed (don’t expect them soon: in a shocking turn of events, the FDA seems happy to recommend boosters using observational data only), and have just allowed a fourth shot for older people, despite recent evidence it is nearly useless against infection.

The change in effectiveness that began with Delta and continued with Omicron, means that a requirement of a vaccine or booster at this point only helps the individual (by preventing serious disease).  Barring those who are unvaccinated or unboosted does not reduce the risk of getting Covid for anyone. 

Despite this, a booster mandate, which goes beyond any state or local authority (some of which require vaccines but none of which require boosters), is a common requirement imposed by Covid committees.  These additional mandates are driven by anxiety and misinformation. They have no value and harm the young disproportionately.  Realizing the limited effectiveness and tiny risks for infection for young people, local authorities, even ones like New York with employer mandates, have not mandated Covid vaccines for school children, much less boosters.

Covid committees that require a vaccine or booster also typically refuse to accept either a Covid test or a recent infection as an exemption to the requirement.  This despite the fact that Covid tests are very accurate, and serve the purpose of ensuring, much more than a booster shot, that a person is not infectious and therefore poses no risk. 

Prior infection has also been shown to provide excellent protection against future infection, which often exceeds the protection from vaccines, according to the CDC.  With Omicron, this likely waned if the infection was from a pre-Omicron variant.  However, a recent study published in Nature indicates that those who got Omicron in December and January (the BA.1 variant) have excellent protection against the current variant (BA.2). 

The paternalistic over-reach of a booster requirement, which does not follow the science, and which completely ignores other measures to prevent infection, has led to families with teenagers, many of whom realize the risk to their children is exceedingly low, being barred from private schools and places of worship, as the anecdote at the beginning of this article describes. 

Covid committees have gone further than just banning people from attending a voluntary service.  In one of our communities, a Covid committee required all pre-school teachers to be boosted (again a requirement that went beyond the localities requirement, which included vaccination but not boosting.  A favorite teacher, who was fully vaccinated and had recently had Covid, but did not want to get a booster, was forced out by the Committee.

In short, the science says that the commonly required booster shot does little or nothing to protect others from getting Covid, no matter what their age, but the Covid committees choose to ignore the science. 

The booster does offer some protection against serious illness over vaccination, though the rates of serious infection are so small for those under 40 that whether vaccinated or boosted, fewer than 1 in 100,000 had serious Covid.  In fact, serious Covid remains rare in young people, even when they are unvaccinated altogether.  The CDC has not disclosed full hospitalization rates by age for Covid, but CDC data shows that it is very small.  Israel currently shows 2,500 infections and only 2 serious infections among the  approximately 1.3 million unvaccinated children aged 5-19 (with no data provided for children under 5). 

Because of these very small rates, even if the vaccine works to prevent serious illness, clinical trials, unless they have millions of participants,  will fail to show a difference in the rate of serious illness among the control group of the unvaccinated  compared to the  rate of serious illness in the vaccinated . For example, on April 11, the Israel data show 0.3 serious infections per 100,000 vaccinated children versus 0 serious infections per unvaccinated children aged 12-19, and, conversely, 0 serious infections for vaccinated children aged 5-11 versus 0.2 serious infections for unvaccinated children age 5-11.  The total number of serious infections for ages 5-19 is 2 out of 1.1 million vaccinated children and 2 out of 1.3 million unvaccinated children.   This is the reason why, to date, no Covid vaccine has been approved for children under age 5.

Perhaps the argument could thus be made for mandating a booster for older people for their own protection, but such a paternalistic attitude does not comport with the lack of restrictions in other areas. We do not see community organizations mandating other individual health decisions, such as calorie intake or alcohol consumption.

While New York still requires workers to be vaccinated (not boosted), they have dropped vaccination mandates for those dining indoors and engaging in other activities. If they follow the evidence, even completely ignoring the cost of barring people from attendance, Covid committees should drop the vaccine requirements.

Covid committees required numerous Non-Pharmaceutical Interventions (NPIs), including various levels of social distancing, requiring that windows be opened in the dead of winter and the use of loud HEPA filters. The most controversial by far, though, has been the ongoing requirement that people wear masks. As discussed earlier, we found masks to be extremely burdensome and personally both psychologically difficult, as well as an impediment on communication and learning.  But do they even work?

Public health authorities initially did not recommend masks for the general public, and the WHO still does not generally recommend masks for those under 12. However, by and large, most public health authorities did, at least at one point, recommend masks be worn indoors. These requirements were based on a guess that masks, would work for the general public, on the sheer hope that the successful use of high-quality single-use masks by health-care professionals would translate to successful public use of masks of all sorts. Thus, many localities first recommended them and then mandated them.  Covid committees went beyond these requirements in mandating them well beyond the time when local governments lifted such requirements, and, recently, often insisting on extremely uncomfortable N95 masks (even for children, despite the CDC stating that N95s  “are typically designed to be used by adults in workplaces, and therefore may not have been tested for broad use in children”)

It seems few have never stopped to ask, do masks even work, or when the question was asked and answered, few listened.

A mask provides a visual physical barrier and thus logically stops virus from emanating from a sick persons mouth and nose. Physical tests of masks have shown they block some percentage of viral particles (typically around 50% or even more, for cloth and surgical masks, and 95% or more for N95 masks). However, after a number of studies of use of masks by the general public, mandating masks has not been shown to do much of anything to prevent Covid.

This seeming contradiction may be for any number of reasons: even if a large percentage of viral particles are blocked, enough virus may be present for infection in a longer interaction; despite requirements in some venues, people still spend much of their time interacting with people without masks; people do not wear masks in a way that creates a maximal barrier, and even if any given exposure reduces the chances of infection considerably, over a long exposure, because of the mathematics of probability theory, the rate of infection equalizes.

For whatever reasons, from a public health perspective masks have not been shown to be effective and thus mandating them makes no sense.  Nearly all local authorities have removed mask mandates, with the only remaining place where masks are required by state or Federal law being on public transit.  Indeed, the only people for whom masking may have a substantive protective benefit are workers who have large number of short interactions in enclosed spaces.  For everyone else, infection rates are driven almost entirely by  community prevalence and viral contagiousness.

The strongest study in favor of masks for the public is from Bangladesh and was published in Science. It found that cloth and surgical masks had very little effect. Overall, 7.63% had “COVID-19–like symptoms” in communities where masks were encouraged versus 8.60% in communities where they were not. Many people took the headline of this study, which stated that there was a statistically significant effect for surgical but not for cloth masks, as evidence that we just need stronger masks, but the study proves no such thing.

In fact, the estimate effect of the two types of masks was similar. Both surgical and cloth masks were close to the threshold for statistical significance, with one being just above the threshold and one being just below. Most statisticians don’t recommend judging evidence using a hard threshold. Indeed, statistical significance is not the same as clinical significance or practical importance. Any reasonable statistician looking at these results --  which have sample sizes in the comparison groups of more than 10,000, yet barely reach statistical significance, and show very small effects --  would conclude that the only strong evidence here is that the effect is not large. Whether it’s exactly zero or slightly above is more difficult to say.

Earlier studies of mask efficacy were in line with the Bangladesh study. While these studies tended to be small, they were sufficiently powerful to demonstrate significant differences in Covid infection with respect to other behaviors. For example, one analysis, reported in the CDC’s Morbidity and Mortality Weekly, studied  people who did get covid and compared them to similarly situated (matched by age and gender) people who did not. The frequency of mask use was not a significant difference between the groups. While it was a medium study (250 people total), it was big enough to show that other activities were statistically correlated with Covid e.g., going to restaurants, going to bars where people were not social distancing or observing precautions, and having close contact with people who had Covid.

The few studies that showed larger effects for mask use on the population level were not randomized and failed to correct for other major factors, like behavior and vaccination status (some of those regarding mask wearing in school were reviewed in a widely circulated article in the Atlantic. Despite the science, Covid committees continued requirements for wearing masks, whether they be surgical masks, which have been studied and have very little value, or N95 masks, which have not been studied at all for use by the general public for whom the masks are usually not fitted or worn properly.

For the Covid committee it is an unshakable article of faith that masks are not just moderately protective  but an extremely effective method for preventing the spread of the virus. As is the belief that only uncaring, self-centered and ignorant are unmoved by the precept  “my mask protects you, your mask protects me.”  When one of us contracted Covid, while living alone, there were only two possible sources: a 45-minute spin class with 5 unmasked attendees or three 90-minute classroom lectures each with about 100 masked attendees. Everything we know about the contagiousness of the virus suggests that the dominating factors are community prevalence and the number of long exposures in enclosed spaces. Thus the classroom is the overwhelmingly most likely source: it is much more probably that an infectious case would be present among 300 loosely masked students (who are largely taking no precautions) than among 5 middle aged bikers. Masks would have to offer massive protection from infection to reverse the odds (the math: the exposure ratio is 5 by 45 versus 300 by 90, meaning the risk was 120 times higher in class before we take the masks into account). Nevertheless, most people, including most medical professionals, strongly believe that the unmasked exposure to a small number of people is a more likely source of infection than a masked exposure to hundreds in an enclosed indoor space. The university was so sure of this,  that its contract tracers didn’t ask about exposures in masked setting, including classrooms. The University reports that there have been no-known cases of classroom transmission – sure, because you can’t find what you don’t look for.

So what motivates the Covid committees to maintain such strict measures? One argument made by Jewish organization is the precept of “pikuach nefesh”,  which requires that saving a life supersedes nearly all the commandments. Yet it is a misapplication to demand the protection of life at all costs. About one in 70 adults  will have their lives ended in a car crash, often not the fault of the victim, yet we almost all drive.  One of us lost a great grandparent who was killed by a car while walking to shul on shabbat.  Yet, neither driving nor walking to shul are rabbinically prohibited. Similarly, there are many who believe that the protective measures should remain in place until the vaccine is approved for all. This is especially senseless because vaccines for children have so little utility that authorization may never happen (and if it is approved the decision will not be based on effectiveness.) The impulse to restrict is a  version of the “precautionary principle” that argues that it is logical to incur costs if the downside of not doing so is sufficiently large, even if the probability of the downside is small (or highly uncertain).  Neither “pikuach nefesh” or the “precautionary principle”  is a license to entirely ignore costs, downsides (known and unknown) and downstream consequences.

It is our hope, in this epoch of  rising infections but few serious cases, that our communities will recognize that the choice of activities to engage in must be left to the individual and that organizations will conclude that their Covid committees should be thanked for their service and disbanded.