Hillel’s Rules and COVID-19

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By: Joseph Zabner

אִם אֵין אֲנִי לִי, מִי לִי. וּכְשֶׁאֲנִי לְעַצְמִי, מָה אֲנִי. וְאִם לֹא עַכְשָׁיו, אֵימָתַי

If I am not for myself, who will be for me?
But if I am only for myself, who am I?
If not now, then when?
Hillel Ethics of the Fathers, 1:14

These are the true golden rules from Hillel. When I studied them in high school, they seemed to apply to almost anything. As I grew older less so. However, it is now in this time of a pandemic that I find them most useful.

If I am not for myself, who will be for me?
Yes, we need to make sure we create a safe zone around ourselves to make sure we do not get this terrible disease. The older, the sicker we are the more this rule is relevant. I will not attend a prayer at a synagogue, I will not go to a bar, I will not go to your wedding. I will wear a mask and a face shield when in public. I stopped going to my barber after 30 years of friendship because he refused to wear a mask. I did not stock up on toilet paper, but I did on canned foods and wine. Ich, Ich, Ich…

But if I am only for myself, who am I?
I have worked all my life to fulfill the Oath of Maimonides “Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling”. Yes, as a physician I tended to patients with COVID-19 in the Intensive Care Unit. I have become an activist to protect Latinos in meat packing plants. I’ve contacted frail and elderly friends and offered to bring groceries to their homes. I wear masks and face shields not so much to protect myself, but because I would feel awful if I were to infect one of my patients or my friends. I reached out to my extended family, my friends, and my old acquaintances to keep them up to date on safety and to teach them about scientifically proven treatments. I have practiced tzedakah and I am definitely not here for myself alone.
These two rules appear to be a balancing act of greed and selfishness on the one hand, and altruism and community building on the other. As Bartenura explained “and even if I have merited for myself, what is this merit and what is it worth compared to what it is that I am obligated to do?

And if not now, then when?
During a pandemic, it is the “now” time to illustrate that these two rules are not a balancing act. They are synergistically intertwined.

Let’s start with masks. The most common transmission modality for COVID19 is droplets emitted by an infected person (sometimes asymptomatic) that we inhale through our mouth and nose. The commonly used ‘surgical masks’ are somewhat effective at blocking these droplets and lower the chances of you getting infected (50%). However, if the infected person is also wearing a mask, the mask will also block some of these droplets (50%). Furthermore, if fewer people were infected (50%) because everyone wears a mask, the chances of Me getting infected is incredibly low. Sir Ronald Ross demonstrated the life cycle of the malaria parasites in mosquitos in the late 1800’s. In 1910 he published what’s known as the Ross Model, a mathematical formula that roughly explains why 50% reduction in mosquitos has such a drastic effect on the transmission of malaria. I guesstimate the 50% number for illustration purposes only, as these numbers will take time to calculate and may be variable in different areas of the world. The Ross effect will be constant.

Now vaccines. Our generation, more than any other generation before, benefited immensely by advances in vaccines. As a doctor I have never seen a case of smallpox. I remember the day in kindergarten in Colegio del Este, when we all got the yellow fever vaccines. Yellow fever in the tropics used to be like COVID19, but with a higher mortality. Maria Teresa del Toro died of yellow fever. None of my classmates ever got yellow fever. Because of a lax vaccination program yellow fever came back to Venezuela in 2019. In contrast to our parents, not a single one of our friends have sequelae from Polio. Last week we celebrated the eradication of Polio in Africa. We are in great debt to the old-Jew, Albert Sabin and the young-Jew, Jonas Salk for their research and dedication. Dozens of vaccines have made our lives better.

In order to work effectively, vaccines rely on the golden rule (nowadays they call this “Game Theory”). The decision to receive a vaccine is defined by strategic substitutability. First, vaccines do not protect 100% so if I am the only one getting the vaccine it will not work (if I am not for myself). Second, if everyone (80%) gets the vaccine, the disease will go away (herd immunity). Third, yes, new vaccines may have unforeseen rare side effects. Fourth, if everybody (80%) gets the vaccine, the disease will be eradicated, thus I won’t need to expose myself to a risk (if I am not for me, who will be for me). But if many people think this way, we would not be able to get to the 80% threshold to eradicate the disease. As Braternura stated “what is it worth compared to what it is that I am obligated to do?”. I decided to participate in a clinical research to evaluate the safety and efficacy of a COVID19 vaccine. This is a six-month study, and I got the vaccine at the end of July. Thus, do not expect a ‘miracle’ (the hard work of many outstanding scientists) vaccine for at least another 6 months. Once, some of these vaccines are found to be safe and effective, we ALL need to be vaccinated. If not for you, for your elder parents, neighbors, and sick siblings.

We grew up in a close-knit Jewish community (la comunidad) where we observed the benefits of these rules. If the brothers Benaim would have bought the land where Hebraica was built for themselves, and asked my uncle to develop it, they would have made a killing. They chose instead not to think only about themselves and Hebraica was built to bring the Jewish community together. The University of Iowa Carver Medical School has adopted a slogan “We Are All In This Together”. The COVID-19 pandemic clearly illustrates this point. What we learn from how we manage this pandemic should have relevance to other important decisions we will have to make as a society in our lifetime, including climate change, income inequality, and violence.

If not you, who? If not now, when? Hillel