COVID-19 melted down the world at a very inopportune time in history. Just as medicine was getting a handle on previously intractable conditions, from sophisticated diabetes management to less invasive surgical procedures, a new threat that devastates our population with few good treatments overwhelms health care. Medical workers come to the rescue, as we always do, though at a personal and communal price. Somebody else keeps our food available, allows our communications to flow without interruption, and maintains most of our transportation systems, even though many of us have fewer places to go. Our elected and appointed officials went to work, most no smarter or less contentious than they were before, but emergency support came through in the form of research subsidies to enable better treatment and prevention, mass purchases to enhance lab capacity, and for many an emergency boost to available personal funds. Heroes all, except for the ones you see on TV that you wish to exclude. Two years later, and about a million fewer people, the expected cycles of nature didn’t change much. Not everything was a constant, though. Schools went on Plan B. Worship appeared on Zoom if the religious laws permitted or did not happen in those sects like my Orthodox Judaism that prohibits electronics and now assemblies on certain days. We were entertained more by screen than by theater or live exhibits. Open shelf browsing, my library joy since childhood, brought the public library in sync with many university libraries where patrons need to request the librarian to retrieve what they need — the necessities of life we had. The joys of life struggled. Fortunately, quarantines usually have conclusions. Shabbat and festivals came and went as our calendar specifies. Most agree that not having people in the sanctuary, Torah scrolls never removed from the Ark for public reading, and greeting each other with elbow bumps, if not handshakes, presented a form of civilization reversal. Now just over a century since Presidential candidate Harding proposed returning to normalcy, our congregation’s time had arrived. Our impaired places of gathering found another need for its doctors beyond the treatment of illness. Irrespective of any training we might have, our titles seem to designate us as the go-to for setting conditions for restoring our schools, churches, athletic competitions, and other public gathering places to resume their individual purposes while minimizing hazards to participants. Doctors do not even control most of medical care nowadays, and we certainly don’t dominate our non-profits, but our experiences and knowledge make us selectively very useful. Our sanctuary closed to protect health, among the most central of our religion’s tenets, so who is more credible than our congregation’s esteemed physicians to announce the all-clear? In response, our congregational president appointed an ad hoc committee of four physicians and a biological scientist to adapt our desire for communal worship and educational programming to the trajectory of the pandemic. To make sure we really represented our fellow worshippers, all four of us were past age sixty, three past age 70, and two still in practice, doing pediatrics and primary care. Doctors can get into a trap, advocated by Dr. Fishbein’s AMA for much of the 20th century, that what serves the doctors filters down to public benefit. Not quite true in his generation or ours. That brought us to our first restricted assessment. Vaccines had just come out. The practicing physicians were quite quick to propose, no vaccine=no worship in our sanctuary. However, we have a logo on our congregational letterhead with core values of embracing, engaging and enriching. Turning somebody away is not something we should be recommending, despite its medical expedience. Our members span the political spectrum, health spectrum, and psychological spectrum, including anti-vaxxers. We should accommodate them if we can. This changed the conversation to whether it will be more trouble than it’s worth or would other people who want to come voluntarily stay home, perhaps even hiding their checkbooks if we let medical threats and other undesirables in. Might the Rabbi like to teach us what Judaism says about prudent and unwarranted risk? Apparently not in the curriculum of his rabbinical seminary, but avoiding the contentious war. Next, we had to make recommendations on adapting our facilities to risk. Being retired, I did not really know what a HEPA filter was, let alone how many we needed for the cubic volume of our sanctuary. We learned at the first meeting that restricting this committee to patient providers with expertise in illness excludes a lot of essential knowledge. Do we even know who runs a business and had to adapt it to customer risk? In more than a hundred years of operation, our synagogue never made a database of members. We cannot even look at our membership census and figure out who knows how to paint a wall or use a telephoto lens, let alone who has adapted their businesses to regulations. Not being able to extract those skills that make each of us a unique and valuable contributor exposes a fundamental organizational deficit, as inviting and using talent creates the community that makes places of worship vibrant. We could ask around, we could visit stores, but we learned that we depended on certain forms of expertise that doctors do not generally have. As a surrogate for acknowledging somebody else is more expert than ourselves, we did what doctors too often do. We pooled our relative ignorance on this, buying some filters. Doctors are professionally experienced at adapting to moving targets. We look at patient recoveries as they evolve, reversals of lab work, medicines that failed to do what we expected, and modify our advice. COVID’s threat level shifted from reasonably safe for the vaccinated to a Delta phase to an Omicron variant, the latter frequent enough to cause us to close again. We looked at county infectious data, reporting a 20 percent positivity rate which explained why this cycle, we could name individuals who had acquired a serious illness. Now with some experience, we had the option of setting criteria to make the reopening data-driven and automatic. A target was set at under 10 percent for two consecutive weeks. Instead of reopening when it got to 7 percent, the expedient was another committee meeting. Despite our trained mode of thinking pounded into all of us: if this, do that, we were really too timid to let the data put us on autopilot. Governors have a tough time. They need to declare policy for all schools, parks, restaurants, and similar gathering places. The reality is really one of each institution having elements of commonality and elements of uniqueness. For this reason, ad hoc committees representing the interest of their organizations do not simply contract with a local group of ID physicians but create their committees from doctors already participating. It helps to know the attendance and traffic patterns of an individual school, scout group or country club. Our synagogue also has risks in its operations particular to its function. We have congregational singing. We have a central table where the Torah scroll is chanted while two other men serve as proctors, and another recites a blessing and watches his portion being read. To bring our Holy Scrolls to the congregation, it is traditionally paraded through the seating areas before and after reading. People extract books and perhaps masks from shelves, head coverings from a receptacle and prayer shawls from a rack. At the end, we have food and conversation. Not only do we have doctors on our committee, but all of us understand the choreography with its spacing challenges. We really could not exclude the unvaccinated from worship if we could otherwise accommodate their presence. We could require this for access to the parts where physical separation is less easily accomplished. And so we did. Normalcy does not now seem that far off. We still wear masks but have resumed handshakes and Torah processionals. A list is kept of who is up to date on boosters, but our vaccination rate approaches 100 percent. No congregant has died of COVID in its two years despite nearly all of us being on Medicare. Having congregational experienced physicians to guide this reentry has revealed many things helpful to both our professionals and to the congregational leadership, which takes responsibility for converting recommendations to policy. Our cultural agencies have done well recognizing their member physicians not only as prosperous donation sources but as people of insight who can assess challenges that have not arisen previously. As my synagogue’s experience with its physicians captured, we not only took advantage of our expertise but gave a better sense of where others not yet thought about might have made useful contributions beyond our skills. We also better understood what makes us, or any organization, unique and inviting and where lapses in engagement need remedy. As physicians we are part problem solvers, part probers, each useful beyond our usual health care settings. We make some of the best stewards for the organizations in which we engage beyond our professional responsibilities. Source
