I’m sharing these thoughts in honor of my father, Dr. Israel E. Press, on the centennial of his birth and during the week of his bar mitzvah parshiyot of תזריע־מצרע
Tazria-Metzora is nestled in the midst of וַיִּקְרָא spanning Leviticus 12:1 to 15:33. The preceding week’s portion addressed so-called dietary laws, which acquires greater significance when we look at the ancient wisdom proscribing indiscriminate culinary freedom that may wreak havoc when humans eat bats, rodents, and God-knows-what else might originate in wet markets, or what are actually wild markets. This is not meant to disparage individual cultural practices as much as it is to point out that the practice of keeping kosher may be rooted in the fundamentals of interaction between human and non-human microbiomes or biological ecosystems. That is, of course, speculative on my part.
There are numerous debates as to exactly what tzara’at (צרעת) is, for example vitiligo as opposed to leprosy, but the centerpiece of this week’s double parshiyot seems to be some sort of spiritual malady with a physical manifestation in the form of a dermatologic condition. In accordance with the translation and commentary by biblical scholar and commentator Robert Alter, about which I’ve blogged before, consider the following.
13:1 – “And the Lord spoke to Moses and to Aaron, saying: “Should a person have on the skin of his body an inflammation, or a rash, or a shiny spot and it become the affliction of skins blanch on the skin of his body, he shall be brought to Aaron the priest or to one of this sons the priests … When the priest sees it, he shall declare him unclean … the priest shall confine the person with the affliction seven days.”
Alter comments that the ancients perceived and described diseases and their symptoms differently than does modern Western medicine, and some conditions they understood to be a single malady may actually have been a variety of diseases, not all of them intrinsically related.
The examining priest (כֹּהֵן) determines the diagnosis, acting in this sense in the role of a physician – the concept of which was different in the time of the Torah than it is now. Certainly the challenge of differential diagnosis was greater then, as compared to the tools that the contemporary physician has at his or her disposal.
The regulations for handling this condition seemingly reflect some ambiguity but that may be rooted in our lack of understanding of tzara’at, which waivers between pathology and spiritual impurity. Therefore the quarantining of the affected individual for a period of seven days before being re-checked might reflect a fear of contagion in the medical sense or might be indicative of concern about ritual contamination. The biblical scholar Rabbi Jacob Milgrom proposed that the wasting of the flesh involved in tzara’at is associated with death, and that the laws stated in this week’s Torah portion are an expression of the impulse in וַיִּקְרָא/Leviticus to separate all deathlike phenomena from the living.
What if at the end of the mandatory period of quarantine the tzara’at appears to be resolved? The parsha addresses that in 13:17: ” … he shall come to the priest, and the priest shall see him, and look: if the affliction has turned white the priest shall declare the person with the affiliation clean. He is clean.” Alter poses the obvious question. Why the apparent redundancy in doubling up on the word “clean”? He answers that this is probably indicative of the procedural aspect of the law: first we have instructions about what the attending priest must do, and then a replication of the official diagnostic declaration the priest is to make: “He is clean”. The quarantine can officially be lifted.
Ah, but what if the signs of tzara’at are still present? 13:43 continues: “He is unclean. The priest shall surely declare him unclean. His affliction is on his head. And the person afflicted with skin blanch, in whom the affliction is, his clothes shall be torn and his head disheveled, and his mouth he shall cover, and he shall call out. “Unclean! Unclean!. All the days that the affliction is on him he shall remain unclean. He is unclean. He shall dwell apart.”
Alter comments that the tearing of the clothes is usually associated with mourning, and hence an allusion to the potential deadliness of tzara’at. The afflicted person is instructed to pull some sort of scarf or head covering around his mouth, according to Abraham ibn Ezra, so that he will bring no harm to others through his breath.
The rest of Tazria-Metzora addresses the state of cleanliness not only of the individual, but of one’s garments and one’s physical surroundings. The parallels to our time are striking with regard to quarantining, proper cleaning, mouth coverings, and caution in declaring that the communicable disease and infectious crisis has abated. One difference in our time of the novel coronavirus is that this infectious and communicable disease has no overt dermatologic sign like tzara’at. Or does it?
From the current issue of Dermatology Times comes a discussion about skin rashes appearing as early signs of COVID-19:
Interestingly, patients with these skin symptoms do not seem to display any other typical symptoms associated with the virus, including shortness of breath, cough and fever, and also tend to test negative early on.
“This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress,” says Ebbing Lautenbach, M.D., chief of infectious disease at the University of Pennsylvania’s School of Medicine. “Sometimes this might be your first clue that they have COVID-19 when they don’t have any other symptoms.”
Lesions on the toes have been observed to disappear following 7-10 days in some patients, while others go on to exhibit more classic symptoms of the virus.
Dr. Ebbing tells USA Today these “COVID Toes” could be a part of an inflammatory response or blood clotting.
“The short answer is nobody knows,” he says.
Just this week, the American Academy of Dermatology announced a registry and is now conducting a survey aimed toward all health care professionals taking care of (a) COVID-19 patients who develop dermatologic manifestations, or (b) dermatology patients with an existing condition who then develop COVID-19. Their hope is that the information provided will aid the understanding of dermatologic manifestations of the COVID-19 virus.
In some respects, same as it ever was …