This week’s article will deal with the obligation to safeguard ourselves from contagious diseases. What kind of obligation is this? Whose duty is it – the sick to keep their distance or the healthy to retain their health? Why should one try to protect himself if his health or lack thereof is predetermined on Rosh Hashana? Is face to face Torah study with a Corona patient permitted, since Torah itself offers protection for those who study it–as the Gemara states Torah magena u’matzla? Visiting the sick is a great mitzva – can one go visit Corona patients? The ultimate bikur cholim is performed by health care providers – they are obligated to heal their patients. Does the physician have to endanger his own life to treat a patient with a dangerous contagious disease? Of this and more, in the following article.
Careful — Contagious Diseases!
This week’s parashah recounts various curses that will befall the Jewish nation should it fail to lead a life committed to the Torah and its mitzvos: “The Lord will make pestilence [dever] cleave [yadbek] to you…” (Devarim 28:21). The Sdei Chemed (Klalim, Ma’arechet bet, end of 116) quotes the Shulchan Gavoha (Yore Deah 225:1) who deduces from the word used here – yadbek, that the disease mentioned here, dever — pestilence, is a contagious disease. He sees this passuk as a source forbidding visiting the ill during an epidemic. In this week’s article, we will take a closer look at the different opinions regarding the obligation to prevent our exposure to infectious diseases as well as the obligation to protect others should we have become infected. Addtionally – the Torah’s view of a physician’s responsibility during times of rampant disease.
Protection from Contagious Diseases
When discussing contagious diseases, Chazal warn many times to exercise great caution:
The Gemara (Kesubos 77b) quotes Rabbi Yochanan: “Beware of the flies of those afflicted with ra’atan [a form of skin disease in which the eyes tear, nostrils run, spit flows from the mouth and flies swarm about the ill]. Rav Zera never sat down where the wind blows on the ill and himself; R. Elazar never entered his tent. Rav Ammi and Rav Assi never ate any of the eggs coming from the alley in which the ill lived.
Likewise, we are told in Midrash Raba (Vayikra Raba, 16:3) that one should not come close to a metzora as it is written of the friends of Iyov (Iyov 2:12) “They lifted up their eyes from afar and did not recognize him.” Rabbi Yochanan and Rabbi Shimon ben Lakish [disagreed]. Rabbi Yochanan said, “It is forbidden to walk within four cubits to the east of a metzora,” and Rabbi Shimon said, “Even one hundred cubits.” They did not disagree — the one who said four cubits referred to a time when the wind is not blowing, and the one who said one hundred, referred to a time that the wind is blowing. Rabbi Meir would not eat in the offshoots of the alley of a metzora. Rav Amei and Rav Asei would not ascend to the alley of a metzora. When Reish Lakish saw one of them was in the city, he stoned him with stones and said to them “Go to your place and do not contaminate [the outside/creation].” As Rabbi Chiya taught (Vayikra 13:46) – “Alone he shall dwell” – on his own he shall dwell.
We also find in the Gemara (Nedarim 41b) that it is forbidden to visit those who are sick with Bordom, a sickness which is like a wellspring. The rishonim disagree as to the nature of this illness: The Ran explains that this disease means bor dam – blood spews from the lower parts of body. One should refrain from visiting those who are ill with this disease since he may need to relive himself and refrain from it when he has visitors, therefore causing him undue suffering. Other commentaries explain that this disease is diarrhea, while others explain it is a deep bloody lesion which is a result of a contagious disease.
We also find in the Gemara (Bave Kama 60b) guidelines how to behave during epidemics: “The Sages taught: If there is plague in the city, gather your feet, i.e., do not go out of the house, as it is stated in the verse: ‘And none of you shall go out of the opening of his house until the morning.’ And it says in another verse: ‘Come, my people, enter into your chambers, and shut your doors behind you; hide yourself for a little moment, until the anger subsides’ (Yeshayahu 26:20). And it says: ‘Outside the sword will bereave, and in the chambers terror’ (Devarim 32:25).”
The Gemara continues and recounts that when there was a plague Rava would close the windows of his house, as it is written: “For death has come up into our windows” (Yirmiyahu 9:20). Maharshal explains that he would close the windows so the rancid air would not enter. Similarly, the Alsheich explains (Yirmiyahu 9:20) that at those times they would hide in secret places, but when they opened the windows to let light in or to let out the hot air the death would come.
The Yerushalmi (Trumos, chapter 8:3) forbids placing coins in the mouth because many people touch them and there is concern a shechin patient may have rubbed dry spittle on it. Therefore, one should not place his hand in his armpit because hands touch many things and there is concern that he may have touched body fluids of a sick person. Those fluids, if placed in the mouth or the armpits can cause infection of shechin or other diseases. This halacha appears in the Shulchan Aruch (Yore Deah 116:5, and the Shach 3).
The Rama rules: “One should escape the city when the plague is there and one should leave at the beginning, not at the end.”
Interestingly, the Maharshal (Yam Shel Shlomo, Bave Kama chapter 6:26), after elaborating on the obligation to protect ones’ self during a plague, writes that whoever was once stricken by the plague no longer has to fear it, because there is no concern of reinfection.
Predetermined on Rosh Hashana
In the Rashbash (195) we find descriptions of Chazal’s behavior during epidemics and warnings — to scrupulously protect one’s health and escape danger. They would escape whenever there was a plague: Rabbenu Nissim escaped twice. Nevertheless, the question of Devine pre-knowledge remains – why should one escape if contracting or not contracting the disease was predetermined on Rosh Hashana? One answer to this is that there are people who were inscribed for life because of the power of a mitzva that grants longevity while others would live on, regardless. This person can live through a plague with nothing to worry about. On the opposite side stand people who are inscribed in the book of the dead and their time in This World is up. In the middle are people who were not inscribed in either book – neither in the Book of the Living nor The Book of the Dead. These people, if they protect themselves from the plague they will live, and if they don’t – they won’t, chas veshalom.
Rabbenu Bachye explains why the Jewish nation was required to separate themselves from Korach and his followers, despite Hashem’s knowledge of who sinned and who didn’t. Hashem brought upon them the plague which is a highly contagious disease. Therefore, Hashem warns them to separate so they should not become infected. At a time when middas hadin abounds such as during a plague, it does not differentiate between the righteous and the wicked.
Thus we have two approaches to explain why one cannot depend on the Rosh Hashana judgement.
The Gemara in Maseches Kesubos (77b), after warning to keep away from those ill with ra’atan, recounts that Rabbi Yeoshua ben Levi attached himself to these [sufferers] and studied Torah with them quoting, “A lovely hind and a graceful doe” (Mishlei 5:19): If the Torah bestows grace upon those who study it, would it not also protect them?
Rabbi Yehoshua was certain that Torah would protect him from the disease. Apparently, one need not fear to study Torah in a beis midrash in which there are sick people because the Torah will provide its protection. Or will it?
The Gemara explains that Rabbi Chanina bar Papa, although he kept the entire Torah was not on the level for such behavior, and he kept his distance from the ill. The Maharal (Chidushei Aggados) explains that the Torah’s protection is offered only to whoever purified his body to the extent that he is completely separated from humanity. In every generation, it is possible to have only one or two such people. If there should be even three such people they are already rabim which are not separated from humankind. Therefore, even a holy amora like Rabbi Chanina bar Papa didn’t reach such a level.
Similarly, the Abarbanel writes (Yehsuos Meshicho, volume II, the first Iyun, chapter 2): Rabbi Yehoshua ben Levi was so attached to Hashem and His Torah and secluded in G-dliness that the natural things like ra’atan did not harm him.”
Rabbi Natan Gestatner (introduction of Lehoros Natan) explains: “Rabbi Yehshua ben Levi reached this level, purifying his body by attachment to his Creator until his body became of the level of his neshama, and the proof of this is that he linked himself with ra’atan patients and studied Torah with them, not fearing to place himself in danger and contract their disease. Although it is written “Vechai bahem – and one should live with them” truthfully, the danger of contracting the disease is confined to those who have a physical body. But Rabbi Yehoshua ben Levi purified his body until he had no physical attribute – he became totally spiritual and therefore he was permitted to connect with the ill and learn Torah. A body that is a soul cannot contract a physical disease.”
In accordance with the above, Rabbi Moshe Sternbuch shlita rules (Teshuvos Vehanhagos) that one is forbidden to learn with patients of contagious diseases while relying on the Torah’s protection because to merit that one needs to be on the holy level of Rabbi Yeshoua ben Levi.
Chazal go very far in detailing the extent one must go in order to protect one’s fellow Jew from harm, and all the more so – not to place him in danger. The Shulchan Aruch (Choshen Mishpat 427:8) writes: “Clearing away every stumbling block that causes a danger to life is a positive mitzva, as it says ‘But beware and watch yourself very well’ (Devarim 4:9). And if one did not do so, and did not clear away the obstacle, allowing it to remain, he violated a positive mitzva and sinned with ‘So that you shall not cause blood [to be spilled] in your house’ (Devarim 22:8).”
Following, are several examples:
The Gemara (Chulin 94a) outlines a prohibition against selling a sandal produced from the hide of an animal that died of natural causes. Why? One reason is because of danger. Rashi explains the danger involved: perhaps the animal died of a snakebite and the venom seeped into the leather, which can harm the sandal wearer.
A similar concept appears in tzavoas Rabbi Yehuda Hachassid: not to wear shoes of the deceased. The Iggros Moshe (Yore Deah part 3: 133) explains that he might have died from a contagious disease and his shoes might still be contaminated. Regarding the likelihood of this scenario with animals we find that the Gemara (Ta’anis 21a) reassures that contagious diseases in animals do not pass to humans except swine diseases. As the skin of the swine is soft and even edible (Chulin 122a) shoes aren’t usually produced from their hide.
Sefer Chassidim writes (chapter 673) that an infectious patient is not permitted to bathe together with another person without warning him of his disease and asking him to keep a distance from him, as it is written (Vayikra 19:18) “And you shall love your neighbor as yourself”.
Rabbi Chaim Palagi (Nishmas Kol Chai, volume 2, Choshen Mishpat chapter 69) was asked by a community regarding a physician who regularly treated infectious patients. The town’s residents were afraid to be infected by him. The community wanted to prevent the doctor from coming to shul to pray with them and asked Rabbi Chayim if it was permissible to do so. Rabbi Chaim instructed that if the doctor wished to pray he must construct barriers around his seat to separate him from his neighbors; he must enter the shul first and leave last (similar to the rules of a tzora’as patient, Negaim, chapter 13:12).
Rabbi Chayim ends that just as one is obligated to guard his smoldering cinders so they don’t cause damage to others, so too, one who knows he has the potential to cause damage to others must exercise utmost care to prevent it. If one knows or suspects that he is a carrier of a contagious disease he is obligated to keep his distance so others won’t be harmed by him.
Mikveh or Swimming Pool
Rav Yizchak Zilberstein (Chishukei Chemed, Nedarim 40b) was asked if a person with fungus in his toes, a contagious skin condition, can immerse in the mikveh. The doctor with whom the man consulted ruled that he was permitted to immerse in the mikveh because many other people also have fungus and immerse in the mikveh, so whoever is sensitive to the condition will contract it whether this specific patient is there, or not.
Rav Zilberstein ruled that the man may not use the mikveh until he is cured of his fungus because every sick person adds to the volume of fungi in the water. Additionally, there are times no other fungus sufferers have used the water before, and he will become the only source of contamination.
This can serve as a lesson for Covid-19 patients – although there are many people who are not careful to stay secluded when suffering symptoms and appear in public venues, every individual has the chiyuv to ensure he does not cause someone else to get sick. One cannot make excuses for his negligence saying that since others are not careful he makes no difference. Every person counts.
Bikur Cholim – Slight Danger of Infection
Is one allowed to visit a Corona patient, and is a doctor allowed to treat him?
The Gemara (Nedarim 39b) states that one who visits the sick removes a one-sixtieth of his illness. The Gemara adds, that this is true only if the visitor is his exact age i.e. was born in the same mazal.
The Gemara (Bave Metzia 30b) explains the passuk (Shemos 18:20): “And you shall teach them the statutes and the laws, and shall show them the path [derech] wherein they shall walk and the action that they must perform.” The braisa explains the various directives in the verse. “And you shall teach them” –the structure of their livelihood, i.e., teach the Jewish people trades so that they can earn a living; “the path” — acts of kindness; “they shall walk” –visiting the ill; “wherein” – burial…
The Gemara asks: Since visiting the ill is a specific act of kindness; why does the braisa list it separately? It answers that since visiting an ill person of the same age involves contracting a bit of his illness, a special derivation is necessary to teach that even so, one is required to go and visit him. The Shulchan Aruch rules accordingly (Yore Deah 335:2): “Even the prominent will visit the simpleton, even a number of times a day, even if he is exactly his age (contemporary).”
Rabbi Samson Raphael Hirsch (Shemos 18) explains this concept:
Derech is always the way to a goal, the endeavor to accomplish a purpose and in the sphere of one’s life’s work, indicated as a rule one’s activities in earning and making profit, on the honesty and purity of which the purity of one’s morality depends. Here the teaching on this point is taken to be: Teach them that this activity for our own livelihood and well-being, which is usually so concentrated on ourselves, must not only include benevolent care for the well-being of our fellow-men, but that this benevolent care for others is quite specially for the real purpose of our working for ourselves, that everybody is to live only for others; yea, they are to be so overflowing with this brotherly love, that they perform acts of love even at the risk of their own existence, (e.g. caring for people in illness even if there is a great danger of infecting)… but when you enlighten them, they will look at their existence and their livelihood as being solely in the way of gemilus chasadim…
Nevertheless, we still need to rule out if it is only when one is the patient’s contemporary, or if where there is a real danger of contracting the disease there remains the chiyuv of bikur cholim.
Bikur Cholim – Heightened Danger of Infection
The Rema (Responsa, chapter 20) writes that there is the obligation to visit those who are sick with Hepatitis. Chachomim did not differentiate between contagious diseases and those that are not since Hashem is the One who causes illness and cures it and only for the illness of ra’atan it is forbidden to visit the sick because it is contagious.
Clearly, the Rama did not mean that there are no other contagious diseases besides ra’atan. He himself ruled that one should escape from a city at the beginning of an epidemic. And indeed – he himself escaped Crakow to the town of Shidlov during one such occasion.
The Tzitz Eliezer explains (Part IX, chapter 17) that the Rama believed that there is no proof that other diseases are contagious, since the medical knowledge at his time was limited to far-fetched assumptions, many of which are known today to be untrue. This is also the opinion of the Chesed LeAvraham regarding the plague. In this situation, every disease of which chachomim, in their infinite knowledge, did not tell us that it is contagious, although there is a possibility it might be such, the mitzva nonetheless provides protection on which one can rely. He ends that we know of many who worked to cure the ill for Hashem’s sake and were not harmed by it.
Rabbi Chaim Palagi (ibid) contradicts the Rama and quotes the Ramban (Bereshis 19:17) saying that all diseases are contagious. And the Sdei Chemed (Klalim, ma’arechet B: 116) writes that the Knesses Gedola and the Kemach Soles follow the Rama in ruling that the mitzva of bikur cholim is also for patients of infectious diseases or during a plague, excluding tzora’as. But the Shulchan Gavoha (Yore Deah 335:1) writes in this regard: “And who will listen to him to place his life in danger as it is written of a plague “yadbek – you will be contracted”. It is the custom not to visit those who are ill with the plague except for those who are hired for that purpose and paid fully for this service.” The Sdei Chemed concludes: “And it is indeed difficult to rule about this issue, Hashem should have mercy on His creation and make peace in Heaven and prevent plagues and all terrible things.”
The Shevet Halevi writes (volume 7, chapter 251:5) that practically speaking, today, whereas most diseases are not seen as contagious and those that are — are a minority, and since we also know how to protect ourselves when making contact, one can perform the mitzva of bikur cholim in a manner that is medically safe. For example, entering the outer room and keeping a safe distance while asking the ill person if he has everything he needs and how he can be helped. This is also the ruling of the Klausenburger Rebbe (Divrei Yatziv, Choshen Mishpat 79:37).
Physician’s Obligation Versus Corona Patients
A physician’s obligation in treating patients of contagious diseases, including Covid is obviously different from a number of reasons mentioned by the Tzitz Eliezer (volume 9, 17, kuntress Refua b’Shabbos, chapter 5:7-9) why a doctor should care for patients with contangious diseases:
- The Torah writes “And he shall cure” (Shemos 21:19) from which the Gemara (Berachos 60a) deduced that a doctor was given the permission to heal, including healing a patient of a contagious disease. Therefore, one can rely on the Rama, Knesses Hagdola, and Chessed Le’Avraham who permit even visiting an infectious patient. And they promise “if one does so l’shem Shomayim, no evil will befall him.”
- Since the norm is for doctors to treat patients and should they refrain from doing so the result will be chaos for both the ill and healthy, treating infectious patients is not considered a sin of placing one’s life in danger.
- The physician heals people for a living, that is a reason that permits one to place his life in danger (see the Noda B’Yehuda, tanina, Yore Deah chapter 10).
- The Klausenburger Rebbe writes (Divrei Yatziv, Choshen Mishpat 79:38) that should the doctor refrain from healing the sick a pandemic will break out and everyone will be endangered, therefore one is obligated to place himself in danger to prevent danger from himself and the public.
The Shevet Halevi (volume 7, chapter 251:7) adds that doctors who can assist and cure the ill are not permitted to leave their positions. They should, though, take every precaution to protect themselves in accordance with the latest medical research.
It is interesting to add that during a cholera epidemic in the city of Posen, Rabbi Akiva Eiger instructed those who could assist the ill people to remain constantly in the lazaret (hospital) room, and he himself hired them.
In many places in the Torah we find that Chazal instruct us to protect ourselves from contracting contagious diseases. Just as one is not permitted to cause others damage, one who was infected must exercise extreme caution not to infect others. One who hasn’t reached the level of piety of Rabbi Yehoshua ben Levi is not permitted to study Torah with ill people and place himself in danger of infection. Rabbi Chaim Palagi rules that even a doctor who serves the public, is obligated to erect barriers between himself and the healthy public when coming in contact with them. Regarding the mitzva to visit the ill we find that if there is a slight danger of infection it is must be performed. But if there is significant danger of infection, the poskim are undecided and contemporary poskim rule that the mitzva must be performed only in a medically safe fashion. A doctor has, nevertheless, responsibility to treat his patients, even if he is placing himself in some danger of infection.