Al Kanfei COVID-19

A classical phrase in the Old Testament is Al Kanfei Nesharim, literally on the wings of eagles. Today the world is being transported on the wings of COVID-19. The SARS-CoV-2 virus, and its accompanying pathology, have dominated human behavior since first being reported in February, 2020. In March much of the world went into lockdown and a tentative return to normalcy is just now beginning. What will the future look like?

Many scientists are skeptical that we will soon return to anything resembling pre-COVID-19 life. These dedicated men and woman have been making unparalleled, highly cooperative efforts to develop therapies and ultimately a vaccine to both treat and ultimately to stymie this deadly enemy. The results to date are encouraging but the final chapter has not been written. What is clear is; that social distancing and lockdowns can stop the spread of SARS-CoV-2, that most people who contract the virus have relatively minor cases, and that the death rates are likely lower than the 12-15% seen in Italy, France and the UK and even lower than the 5-6% seen in other western countries. What is disconcerting are the findings that the medical world still does not understand why some individuals have such mild cases that they do not even know they are infected, while others die. That children below 15, thank the Lord, seem to be almost immune to the virus and that >80% of those going on respirators do not recover. Until these empirical findings and the etiology of the SARS-Cov-2 virus are better understood the future will remain cloudy.

The $64,000 question is, in light of the above murkiness, how to go forward. Most scientists, and many wise politicians, argue for a cautious, data-driven approach. They are clearly correct if all the data were unequivocal. However, it is not. A recently, published commentary in the Journal Lancet (“What policy makers need to know about COVID-19 protective immunity.” Lancet. 2020 Apr 27. pii: S0140-6736(20)30985-5) eloquently articulated the parameters that are necessary to make policy decisions. These included clear data on the correlation between the level and efficacy of antibodies in a person’s serum and protection from infection and disease progression. This data will take many months to gather. Furthermore, although there are more than 100 vaccines in various stages of development and several will soon enter phase 1 clinical trials (which is basically a test of safety and the ability to generate a response), it is likely that an effective vaccine will not be available before the winter of 2020. Universal protection or silver bullet therapeutics will not come soon.

In the interim, it will not be possible to continue indefinitely a lock down of large portions of the world without sustaining devastating economic consequences. One of the countries that has had remarkable success against COVID-19 is South Korea, which as of May 5, 2020 has report only 10804 confirmed cases and ~5 deaths per million people. This compares with about 25, 75 and 160 deaths per million in Israel, Germany and the US, respectively. Despite this success, the public health policies implemented in South Korea along with supply chain disruptions in China and plummeting demand in Europe and the US have caused a severe decrease in earnings estimates. The world is entering a major recession and tens of millions of people in Western countries are unemployed and dependent on their governments for basic necessities. Consequently, South Korea has now initiated a reopening of its society. The reopening is being done carefully and on the basis of scientific parameters and testing that the Moon Jae-in government has put into place. While scientists and physicians have a responsibility to advocate for each life, elected officials must consider economic factors when deciding how long to remain in lockdown. Balancing these oft-polarized positions is going to be the ultimate challenge for heads of state.

Pressure to return to the norm will be increasing as the COVID-19 cases appear to be declining and thereby “under control”. From this viewpoint it is interesting to look at the data and the way it is analyzed by the press. On April 28, 2020 an article with the following heading and lead appeared in the NY Times ‘Life Has to Go On’: How Sweden Has Faced the Virus Without a Lockdown: The country was an outlier in Europe, trusting its people to voluntarily follow the protocols. Many haven’t, but it does not seem to have hurt them.” One would conclude from reading this article that doing nothing works as well as putting a society into lockdown. Analysis of the John’s Hopkins Corona Web site on May 5, 2020 shows otherwise. To date Sweden has had 280 COVID-19 deaths per million citizens compared to about 85, 50, 40, and 160 in Denmark, Finland, Norway, and the United States, respectively. Perhaps more critically, the daily COVID-19 cases have all peaked and returned to near baseline in its 3 Scandinavian neighbors while, in Sweden daily new cases remain at relatively high levels. At present Denmark, Finland and Norway are all slowly reopening their societies and economies. Objectively speaking the lack of a lockdown in Sweden has led to many additional lives being lost and may have significant and long-term societal costs. Data driven analysis suggests that going on with life as normal before the spread of the virus is contained is a dangerous choice.

When the Lord speaks to Moses in Parshat Yitro and tells him he will use the wings of eagles (Al Kanfei Nesharim) to return the Jewish Nation to his abode, the bible states “and you will be unto me a kingdom of priests and a holy people.” Humankind is commanded to value every individual and we must choose a path that will preserve life. Nevertheless, economic devastation has consequences and can elevate both morbidity and mortality rates in the short, medium and long term. Last night I attended the funeral of a former Rehovot resident. Due to the COVID-19 rules the funeral was conducted by Zoom. Several hundred viewers looked in online while only close family members were at the service in person. The Levaya was dignified and meaningful and the niftar (the deceased) would have been pleased that the attendees were safe. In the final prayer the Kayl Malei Rachamim, the Chazan recited the phrase Al Kanfei HaShechina (on the wings of the divine presence; the form used in Eretz Yisrael). In the long term we must have faith that the Lord’s munificence will eventually end the COVID-19 plague. In the interim it is critical that our leaders, both political and scientific, work cooperatively to choose a path that will lead to a future that will be secure and that will eliminate COVID-19 as the master of our destinies.

The writer is a Distinguished Professor of Chemistry and Biochemistry at the College of Staten Island, CUNY, Former Provost of CSI and a visiting scientist at the Weizmann Institute of Science, Rehovot, Israel

 By Dr. Fred Naider