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Extreme fear or unfettered activity both unhealthy during COVID-19

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OP-EDS

Every time we drive our vehicles into the streets in South Africa, we embrace real risk. The Automobile Association of South Africa has previously quantified that risk as 1 in 101 (1%). Almost every facet of our lives is strewn with inherent risk. This concept is apparent in larger life decisions: the risk in making a career choice, the risk in choosing who we marry, the risk of emigration. It’s also equally apparent in smaller life choices: the risk in making a worthwhile investment, the risk of trying out a new restaurant on an important occasion, or of swapping smartphone brands!

Risk taking with our most valuable resources seems counter-intuitive. Surely, the greater the value, the less risk we should tolerate? Our children ought to grow up in risk-free environments. Yet, we know that risk is inseparably paired with opportunity. It’s a catalyst for growth, and a necessary ingredient for daily life. We gladly put our children through daily risks for their own development: contact sports, unaccompanied travel, and so on.

The COVID-19 pandemic, which is now developing a somewhat endemic flavour in South Africa in its 15th month (in the absence of mass-population vaccination), is no exception to this risk model. Perhaps COVID-19’s greatest challenge to the individual is to embrace risk responsibly. Let’s explore.

A basic tenet of Judaism is the value of preserving human life over all. The Torah commands us to “live by the mitzvot”, not die by them. This concept is translated into a strict principle – pikuach nefesh – in other words, any risk that threatens life must be extinguished. Even the mere possibility of a life-threatening risk is intolerable. When COVID-19 hit our shores in February 2020, the risk of death based on the experience in Wuhan was palpable. The government took the decision to shut down the country in deference to pikuach nefesh. Saving lives supercedes all. Even with strict lockdown measures, both nationally and communally, the loss of life and devastation over the next few months in South Africa became formidable.

The appropriate societal knee-jerk reaction was to tighten measures and remain socially isolated. In fact, preserving an approach of “hiding away until the pandemic is over” seemed achievable for most South Africans. However, as the indicators surfaced that this pandemic may indeed last a couple of years and as several months of social and economic dysfunction followed, it became more and more apparent that the “no risk” approach was damaging us economically, developmentally, spiritually, and socially. Ironically, after the first and second waves, we re-engaged in outside life with new case numbers significantly higher than they had been, even in the initial no-risk-tolerated pangs of the pandemic.

This was, perhaps, the juncture at which I noticed, as a GP, our community’s approach to COVID-19 becoming polarised. Individuals who had been personally affected by COVID-19 seemed to maintain strict measures of infection prevention. Those who hadn’t either chose to continue the same strict approach, or to deflect and nurture the importance of risk taking. The vast majority of patients felt that risk investment in their personal lives outweighed the risk of serious complications should they contract COVID-19, and pushed for resumption of “normal” life, in spite of not being vaccinated.

Balancing risk is the most important task incumbent upon every community member, especially at this perplexing time between a second and probably third wave. I strongly believe that, other than in exceptional high-risk individuals, aversion to all risk is detrimental to well-being. COVID-19, with its variants, vaccination challenges, and higher-than-ever worldwide infection rates, is here to stay for the short-term future at least. I have treated significant numbers of patients with mental-health challenges and neglected chronic diseases because of irrational risk aversion. Children need to develop friendships and learn the important formative skills of outside-world independence. Keeping them cooped up at home or preventing them from playing sport (for example) will damage their development. Grandparents need to spend time with their families, especially if COVID-19 prevails over the last years of their lives. Businesses need to take on expansion and new ventures. Treading water is a poor approach to build prosperity and preventing income loss.

I believe that advising patients to “stay home and save lives” is now inappropriate and detrimental (other than in extraneous circumstances). Furthermore, this approach creates a far bigger contingency in our society that swings to the other extreme and exercises no caution. The danger in this latter approach is far worse.

I also believe that throwing off masks, attending indoor packed events, and not limiting social-event sizes (for example) is just as inappropriate and unacceptable, especially in light of the possible increase in new cases.

It requires every family and individual to decide on an approach that will allow them to function in the long term without incurring unnecessary risk. Masks, hand sanitising, and social distancing still save lives. It’s up to each unit to decide on balanced measures like small social circles to mitigate risk, strict mask wearing in public places, outdoor socialising, individual family member isolation after inadvertent high-risk behaviour, and so on.

Although the answers aren’t always clear or even consistent, I firmly believe that every individual in our society has a personal responsibility to create for himself/herself a list of COVID-19 rules in an attempt to stay safe, prevent danger to others, but as importantly still to allow himself/herself the opportunity for growth. We imminently await a mass rollout of vaccination, but the reality is that never before has the world attempted such a widespread vaccination programme. It will take a long time. On an individual level, even after receiving a vaccine, risk still exists.

If you are someone who has either kept every one of your guards up since Level 5 lockdown or you have gone to the other extreme and are even doubtful about whether “COVID-19 poses much danger in South Africa anymore”, please think again. Find a balance. Embrace risk responsibly, and review your approach often.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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OP-EDS

No evidence that COVID-19 vaccines cause infertility

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Fighting misinformation and a pandemic is taxing. However, it doesn’t help for Reform UK leader Richard Tice to make misleading claims about COVID-19 vaccines and fertility.

In a widely shared and now-deleted tweet posted on 19 July, Tice claimed that “forcing” young women to have the COVID-19 vaccine is “almost certain” to lead to “increased stillbirths, miscarriages, disabled children, and infertility”. There’s no evidence to support his claim.

There’s no evidence that new vaccines against COVID-19 cause infertility, yet that’s a worry that’s been cited by some healthcare workers as a reason why they’re reluctant to be first in line to get the shots.

Unfortunately, there was already a bunch of people out there saying there’s no such thing as COVID-19. “It’s no worse than the flu,” said some. Many of these people gained substantial followings for themselves on social media. When the vaccines came along, they used these platforms to stir up conspiracy theories.

Claims that the vaccine can affect a woman’s fertility due to the generation of the spike protein have been circulating since the start of the rollout of the vaccine.

In early December 2020, a German doctor and epidemiologist named Wolfgang Wodarg, who has been sceptical about the need for vaccines during other pandemics, teamed up with a former Pfizer employee to ask the European Medicines Agency (the European Union counterpart to the United States Food and Drug Administration) to delay the study and approval of the Pfizer/BioNTech vaccine.

One of their concerns was a protein called syncytin-1, which shares similar genetic instructions to part of the spike of the new coronavirus. That same protein is an important component of the placenta in mammals.

If the vaccine causes the body to make antibodies against syncytin-1, they argued, it might also cause the body to attack and reject the protein in the human placenta, making women infertile.

Their petition was picked up by anti-vaccination blogs and websites, and posted on social media. Facebook eventually removed posts about the petition from its site for spreading misinformation.

The idea that vaccines could be deployed for population control was also woven into the plot of a recent, fictional mini-series on Amazon Prime Video called Utopia. In that show, a drug maker obsessed with population control creates the illusion of a flu pandemic to convince people to take its vaccine, which doesn’t prevent infection but acts against human reproduction.

A spokesperson for Amazon Studios says the series is pure fiction.

The coronavirus’s spike protein and syncytin-1 share small stretches of the same genetic code, but not enough to make them a match. This is like two people having phone numbers that both contain the number 7. You couldn’t dial one number to reach the other person even though their phone numbers share a digit.

Looking at the two largest systems currently monitoring adverse reactions to COVID-19 vaccines, the Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom, and the Vaccine Adverse Event Reporting System in the United States rely on voluntary reporting from medics and members of the public, and are intended to provide early warning of any previously unknown risks.

There is no evidence that COVID-19 vaccines affect fertility. The Pfizer/BioNTech and Moderna vaccines have been widely used during pregnancy in other countries and no safety concerns have been identified. Evidence reviewed by the MHRA has raised no specific concerns about safety in pregnancy.

The Royal College of Obstetricians and Gynaecologists states on its website: “COVID-19 vaccines don’t contain ingredients that are known to be harmful to pregnant women or to a developing baby.” It goes on to say that studies of the vaccines in animals to look at effects on pregnancy have shown no evidence that the vaccine causes harm to the pregnancy or to fertility.

It’s clear that getting the COVID-19 vaccine won’t affect your fertility. Women actively trying to conceive may be vaccinated with current COVID-19 vaccines. There’s no reason to delay pregnancy after completing the vaccine series.

Importantly, COVID-19 can be severe in pregnant women. The Centre for Disease Control includes pregnant women as a high-risk group for severe COVID-19 illness, therefore we need to see pregnancy as a comorbidity for COVID-19.

Therefore, getting vaccinated against coronavirus is an important consideration for pregnant women. Recent data report an increased risk of intensive-care admission, the need for mechanical ventilation and ventilator support, and both intra-uterine foetal death and death in pregnant women with symptomatic COVID-19.

We can gain perspective by looking at the available statistics. By January 2021, consider that more than 22 million people in the United States had been infected by SARS-CoV-2. In fact, experts believe that number is much higher because 22 million is just the number tested and found positive.

Most think the real number is at least three times that. Therefore, consider that 70 million Americans have been infected, or about 20% of the population. If the infertility theory was true, we would expect that the body making antibodies against natural infection would show up in the fertility statistics. It hasn’t.

The incidence of infertility in any population is one in seven couples. There is no evidence that this pandemic has changed fertility patterns, so if the raw viral illness doesn’t appear to affect fertility, why should vaccination do so?

Although there’s no reason to believe that the vaccine poses a risk to women who are pregnant or are trying to conceive, there is evidence about the danger of COVID-19 infection for pregnant women, which is a reason we should embrace rather than avoid vaccination.

Pregnant women get sicker when they get COVID-19 compared with other people their age, and pregnant women with COVID-19 are more likely to experience pre-term delivery. The effect of COVID-19 disease on pregnancy is real, and it’s important to prevent it.

A recently published peer-reviewed journal article discusses the potential negative impact of the COVID-19 disease on testicular function, sperm production, and male fertility.

Some studies have shown that the SARS-COV-2 virus has been found in the sperm of men with COVID-19 infection, and it may have an impact on the male hormones necessary for normal sperm production. Also, there are numerous reports of men with testicular or scrotal pain after getting COVID-19.

Men who are worried about their fertility should probably get the COVID-19 vaccine as there are some concerns about the potential effect of COVID-19 disease – but not the vaccine – on male fertility.

In all the data thus far, we don’t see any increased risk of developing infertility, either in the near or distant future, with getting these vaccines.

We need to get everyone vaccinated as soon as possible, otherwise we’re going to completely muddle through an ongoing pandemic.

This article doesn’t replace the option of discussing COVID-19 and vaccination with your primary healthcare provider.

  • Dr Lawrence Gobetz is a reproductive medicine specialist and the medical director of Vitalab, a centre for assisted conception.

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OP-EDS

Vaccination is the mitzvah of the moment

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On Sunday, amidst all the challenges and trauma of this pandemic, I had a most inspiring experience. I decided to visit the pop-up vaccination site at Rabbi Aharon Zulberg’s shul, The Base, just to see what was happening. I witnessed a truly heart-warming spectacle: scores of passionate volunteers from our community helping people of all backgrounds register on the Electronic Vaccination Data System and get vaccinated.

The pop-up site was part of a wider initiative called GiVV (Gauteng Vax Volunteers). Set up and run by Dr Menachem Hockman, Josh Falkson, and Raphi Segal, in partnership with the Gauteng health department, it involves high school and university students volunteering at vaccination sites and government hospitals across the province to speed up the data-capturing process and improve efficiency at these sites.

The kindness and selfless concern for others; the ingenuity to come up with innovative solutions to tough challenges; and the determination to see them through – this initiative represents the best of our community, exemplifying everything we stand for. And all in service of that most sacred of Torah principles – pikuach nefesh – the mitzvah to protect and preserve life.

In one day, the team at The Base vaccinated 3 000 people, which is truly remarkable. That’s 3 000 people now protected from the worst effects of COVID-19, with all the positive knock-on effects that it entails for our society.

It also serves as a reminder of the urgency to get vaccinated. Vaccination is the mitzvah of this moment. It falls squarely within the parameters of pikuach nefesh, and we need to seize it with both hands. Every day we delay can potentially cost life.

We have a mitzvah to preserve our own life and take care of our health, and to save the lives of others. By getting vaccinated, we fulfil this vital mitzvah. We take steps to prevent ourselves from becoming seriously ill, and we protect those around us from a potentially deadly disease which, in its current Delta variant, is particularly contagious.

And, it goes well beyond the people we come into direct contact with. As a country, as a society, the sooner we reach societal immunity, the sooner we rid ourselves of the suffering and death of COVID-19. Every immunisation is a step towards freeing ourselves of this pandemic. Vaccination is the only way out. Like polio and numerous other diseases humanity has overcome, the only way we will get past coronavirus is to vaccinate the disease into oblivion.

By getting vaccinated, we also fulfil our role as Hashem’s partners in creation. The Talmud teaches that G-d gave doctors permission – and in fact, a mandate – to heal. The commentators explain that G-d wants our partnership in healing the world. Doctors, nurses, virologists, immunologists, all of those involved in the holy work of healthcare are, in fact, Hashem’s partners in creation.

Having faith in G-d doesn’t mean that we can sit back and do nothing and expect Him to take care of us. Of course, we recognise that no doctor can heal and no vaccine can protect from disease without Hashem’s blessing. But our sages teach us explicitly that G-d wants us to work as His partners in creating a better world by using the laws of nature that He, Himself created. And we daven to Hashem and acknowledge that even our best efforts cannot succeed without His will and partnership. There is no contradiction. Both are essential.

And so, at this pivotal time, we need to act with speed and urgency. We need to fulfil our obligations to Hashem, our community, our fellow countrymen, and to ourselves. We need to embrace this mitzvah and get vaccinated if we are eligible. This isn’t a mitzvah that can be delayed even for a moment. Pikuach nefesh, the opportunity to preserve life, isn’t something we stand around debating.

The virus won’t burn itself out, no amount of wishful thinking will make it magically disappear. SARS-CoV-2 will constantly reinvent itself, mutating into new variants, wreaking fresh havoc on our lives, our livelihoods, and our health. The only way to stop it is the vaccine. The data is conclusive. Countries around the world with advanced vaccination programmes have shown us that even when infections start to rise again, hospital admissions are lower by orders of magnitude relative to previous waves. In effect, through vaccination, we transform coronavirus into a manageable form of flu.

I’d like to take this opportunity to call on everyone who is eligible in our community to vaccinate themselves and to assist and encourage those who haven’t. The options are plentiful, the process is easy. Our own Hatzolah and The Chev have just launched a programme: you make a booking; you arrive; you are in and out of the door in minutes, with very little paperwork and at no cost.

The vaccine is our ticket back to the life we knew. We must take it.

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OP-EDS

Mental health – the pandemic behind the pandemic

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In addition to the health pandemic we are, unsurprisingly, in the midst of a global mental-health pandemic. Instead of hiding behind whispers and closed doors, mental health has, unfortunately and out of necessity, become a pervasive hot topic. The stigma has, in part, been eroded, as we have a sense that the uncertainty and huge challenge of our times effects all of us, albeit in different ways.

Mental health isn’t just the absence of mental illness, it also refers to functionality, resilience, and ability to cope and self-regulate at least most of the time. Of course, there are bad days, but generally, if functioning at work, at home, or in regard to other relationships isn’t impaired, we experience “normal” reactions to an unprecedented, abnormal global situation.

Having said this, the pandemic has served as an incubator, with high levels of depression and anxiety launched by loss and uncertainty.

Initially, I resented the term “new normal” and would talk only about “now normal”, which encompassed the belief that we wouldn’t be forced to settle for this, and that our world mostly as we knew it was awaiting us on the horizon.

What has transpired, however, is that the horizon is being extended and in addition to the anxiety, sadness, and fear that spills out everywhere, there’s also an identifiable unnamed feeling precipitated by the extent and duration of unfamiliar and scary ways of being.

The losses and feelings are expected and obvious. Fear of contracting the virus, fear of isolation, uncertainty about the future, and loss of control. The losses are unprecedented. Unquestionably, most of all is the loss of life without the capacity or necessary rituals associated with severe illness, death, and mourning. Beloved family members are on their own at a time when they need us most.

Often, there is the lack of closure and the inability to pay our respects according to our culturally comforting way. Then there is the overwhelming sadness and anger because “it’s just not fair!”

There are also job losses, which generate a lack of purpose and money, fuelling fear of survival. All of this is in an environment of loss of predictability, certainty, routine, physical contact, and some degree of emotional connectedness.

Boundaries have become blurred. We don’t work “from home”, we work “with home”, parents becoming teachers, children online, limited socialisation, adults having no transitional time, teenagers skipping milestones and rituals concerned with the development of their identity. All of this has required courageous conversation, task negotiation, and often an unsuccessful attempt at establishing any kind of personal boundaries or appropriate self-compassion.

Often, our clients are embarrassed to step forward as what they’re feeling may be unnamed. “It’s just a lack of motivation and energy” they say, a lethargy, a tiredness, and an inability to flourish, a sense of resignation.

In this way, so many of us feel dissociated and de-personalised, not connected enough with “my life as I knew it” and with the outside world. “Who am I?” is a regular question.

These feelings are usually associated with diagnosable mental illness but at these times, appear societally contagious. All you need to do is state your case with openness, vulnerability, and authenticity, and you will open a floodgate, if not an echo chamber, of people who tell you they know exactly what you are talking about because they’re feeling the same thing.

So what do we do?

First, to tame it you have to name it. It’s counterproductive to try to dismiss or deny your personal reality. If you don’t own the story, the story will own you, and will manifest through disassociation withdrawal, or prolonged sadness that can become depression, irritation, low frustration tolerance, and the inability to self-regulate. There may also be physical symptoms like headaches, lower back pain, and appetite and sleep disturbances.

Now, more than ever, we need to experience the immeasurable power of empathic support. This means to develop trust in the people who “have your back”, who will listen to understand, who will really “get it”, and won’t pre-empt you with their own story, at least not initially.

Your tribe, and it can be a tribe of one, will check in, show genuine interest, and understand that love and care are verbs – doing things, not just talking about things. And, usually the “doing thing” is being there and listening. You feel recognised, validated, understood, and not crazy!

Taking care of yourself isn’t selfish, it’s essential. You cannot be available for anyone else unless you feel worthy of your own compassion and self-care. This starts with the basics. Good nutrition, enough sleep, and understanding the importance of exercise – which should never be underestimated in relation to mental health. Take care of your children’s parent, of your parents’ child, and of your boss’s employee.

Conflict often manifests when you have time and space in your head, and unresolved issues and relationships emerge and become toxic. It’s difficult to remember that it’s always more important to be happy than to win.

The pandemic has made us realise that life can change in a heartbeat, and what we thought was under our control might not be. It also has resulted in a priority shift. Mostly, a new priority of relationships and gratitude for connection that we now realise is more important than anything. So take a risk, and make the first move, even without a guarantee. People can’t hear what you don’t say.

And please, cut yourself some slack. Recognise the resilience that you have displayed, the obstacles that you have overcome, and the value that is uniquely you.

We move on by remembering the past, using our experiences and memories, and reimagining and creating a better future – the horizon is getting closer!

We will navigate the journey together.

  • Dorianne Weil (Dr D) is a clinical psychologist.

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