We are again at a crossroads. Both in the Jewish calendar entering into Yom Kippur, where life and death decisions will be made, and in the world of COVID-19, with a disconcerting continuing rise in cases in our area, where life and death decisions will be made.
Mi Bamageifa (and who will die by plague…)
In just the past 24 hours, I have been inundated with numerous pressing shailos from communities all over regarding COVID-19 exposure. Here are but a few of the quarantine questions that rabbonim and shul presidents have asked me:
“Our Rosh Hashanah chazzan said wearing a mask was too difficult. He davened from the amud without one. He developed symptoms and tested positive the following day…”
“Our Rav gave a drasha on Rosh Hashanah without a mask. He turned positive the next day…”
“A rebbi (who was also a chazzan in a shul) did not wear a mask in his school or shul. He turned positive after Rosh Hashanah…”
Of course, everyone wanted to know if everyone in the shul or school class needed to quarantine?
It appears that many people remain unconcerned about spreading COVID-19 and ruining Yom Kippur and Sukkot for everyone they come into contact with. This is evidenced by the laxity in some communities and some individuals regarding masking and distancing compliance. Based on what?
To remove any doubts about the scientific truths to date, these are the undisputed COVID-19 facts.
Worldwide as of last week:
United States as last week:
This past week, the U.S. had an average of 41,490 new COVID-19 cases daily, up 13 % from the average seen four weeks ago. That came to 13 new cases/100,000 population. At least 27 states are now reporting increased cases compared to just nine states on September 14. On average, the U.S. is seeing 770 daily deaths, and a model from the University of Washington predicted the U.S. death toll will double to 400,000 before the end of the year. The U.S. accounts for four percent of the world’s population, but has 20 % of the world’s deaths from COVID-19. Dr. Michael T. Osterholm, an excellent, reputable senior epidemiologist at the University of Minnesota, stated: “I think we’re just in the beginning of what’s going to be a marked increase in cases in the fall. And it won’t be just a testing artifact, either. This is real.”
Israel: Sadly, acheinu beis Yisrael has been averaging well over 4,000 new cases daily, a rate of 47 new cases/100,000, a rate 3.5 times the U.S. incidence and the highest rate of any other country in the world at this time. Today there were 6,782 cases. Hospitals in Israel are nearing overload, surpassing the safe number of patients that they are able to care for. Hashem yeracheim.
5 Towns: Each one of the 5 Towns falls in the highest new case incidence numbers for Nassau County. Lawrence has held the number one spot in the county for the last eight weeks, with Cedarhurst (third), Great Neck (fourth), Woodmere (fifth) and Hewlett (sixth). Inwood is eighth.
Far Rockaway: Far Rockaway has the distinction, along with five other neighborhoods (Midwood, Borough Park, Williamsburg, Kew Gardens and Bensonhurst) for accounting for 20 % of all new New York City cases.
How do you think these/our neighborhoods are described in the lay press and by the Department of Health? What type of comments do you think are being made on polite social media, never mind on the dark web and nefarious sites that always besmirch us?
Why is this happening now?
This all “re-started” with the flagrant disregard for scientifically vetted guidelines around weddings and kiddushim (large public gatherings), with many people eating unmasked and in close proximity.
What proof exists, you may ask, that such events indeed cause suffering? Maine public health officials just published a shocking report of an August 7 wedding in Millinocket. At the wedding, guests ignored social distancing guidelines and mask recommendations. The result: 135 guests got COVID-19, with seven guests dying from this wedded bliss exposure. Do you think that young couple will ever be able to look back happily at what should have been one of the most joyous events in their life, knowing that their “simcha” was the cause of so much misery? This wedding is just one in a list of several studied “superspreader” events in the country over the summer. How many more are still to occur?
Do we all have such a short collective memory of what happened Purim and Pesach? Have we forgotten the numerous funerals and shivah calls that we Zoomed? Aren’t we gomlei chassadim?
How can any person insist on their “right’ to not wear a mask when it will potentially cause a fellow person to die? When it might perpetuate a vile chilul Hashem that our community does not follow public health guidelines? How many yeshivas and shuls have to be publicly quarantined before we realize the bittul Torah and bittul tefillah betzibbur that we have caused?
All of this can still be avoided by following the simple—and not so difficult—Halachic obligation to mask and social distance. This statement is based on my conversations with numerous poskim from all aspects of the frum community.
Obviously, there will not be talks Motzei Shabbat Sukkot /Shemini Atzeret. Based upon need, we will see when future talks will be given.
A couple of important brief news items worthy of dissemination:
From The New York Times (based upon unpublished research from the Riken Center for Computational Science, a research institute in Kobe, Japan, a city noteworthy for saving many Holocaust refugees and housing yeshivas during World War II):
Plastic face shields do not prevent the spread of microscopic airborne particles created by such activities as talking, singing or sneezing. Such shields do almost nothing to stop the spread of microscopic airborne droplets that are a major vector for spreading the disease. While I have reported that face shields may be somewhat protective for teachers and others wearing them while working with unmasked children, they are almost completely ineffective at protecting others from the wearer’s own droplets, This is according to Makoto Tsubokura, a professor at Kobe University and the lead researcher on this project.
A laboratory marker measuring the ability to perform aerobic exercise was lower in military recruits who recovered from symptomatic COVID-19 versus recruits who had not had COVID-19. Decreased pulmonary aerobic capacity was observed in even such young individuals recovered from COVID-19. Long-term effects on lung function have been noted after even mild to moderate influenza infection and appear to be present after COVID-19 as well. Additional research to understand the incidence and long-term consequences is needed.
From JAMA Internal Medicine:
Recombinant human granulocyte colony–stimulating factor given to patients with a very low lymphocyte blood count appeared to prevent progression to severe disease and death in COVID-19 patients. A very preliminary report, but another potential line of therapy.
From the MMWR:
While early in the pandemic, COVID-19 incidence was highest among older adults, this picture has drastically changed and may explain in part the decreased rate of hospitalizations that we are experiencing and allowing for less severe disease presentations. During June-August, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for < 20 percent of all confirmed cases.
Important to remember, however, is that younger adults do contribute to community transmission of COVID-19. Across the southern United States in June, increases in percentage of positive COVID-19 testing results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days. What this means is that the next two weeks are very important in determining what the current increased caseload will mean to the “at greater risk” populations. The authors, therefore, strongly stated that strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is critical to reduce infections and subsequent transmission to persons at higher risk for severe illness.
From the MMWR:
Fortunately, influenza activity is currently low in the United States and globally, although cases have already been reported in our region. An important and lifesaving additional benefit from masking was described in this important paper.
Following widespread adoption of community mitigation measures to reduce COVID-19 transmission, the percentage of U.S. respiratory specimens submitted for influenza testing that tested positive decreased from <20% to 2.3 percent and has remained at historically low levels. Data from southern hemisphere countries also indicate little influenza activity. The global decline in influenza virus circulation appears to be real and concurrent with the COVID-19 pandemic and its associated community mitigation measures. However, it remains critically important to get vaccinated against the flu. Influenza vaccination for all persons aged ≥6 months remains the best method for influenza prevention and is especially important this season when COVID-19 and influenza virus will co-circulate.
From the MMWR:
Symptoms associated with COVID-19 infection are, baruch Hashem, milder in children compared with adults. However, we should not mistakenly think that all children will have unimportant mild clinical illness. There have tragically been 121 COVID-19 associated deaths among children aged > 21 years reported to the CDC by July 31; 12 (10%) were infants and 85 (70%) were aged 10-20 years. 33 percent of the deaths occurred outside of a hospital.
Persons aged > 21 years can unfortunately get very sick from COVID-19. This paper, as well as the Eurosurveillance paper above, illustrate why this disease cannot be taken lightly by anyone.
From the BMJ (not to be confused with the BMG)
Post-acute COVID-19 (known colloquially as “Long COVID”) is a poorly understood multisystem disease, sometimes occurring even after a relatively mild acute illness, but more frequently in patients exposed to a higher inoculum of virus and having more severe disease. Clinical management requires a whole patient perspective, is quite labor intensive, and has only limited benefit at best. At least 10 percent of people experienced prolonged illness after COVID-19, with a recent U.S. study finding that 35 percentof people had not returned to their previous level of health 14-21 days after their positive test. While many of these patients recovered spontaneously (albeit slowly), with holistic support, rest, symptomatic treatment, and gradual increase in activity, the true long-term prognosis of long COVID-19 remains to be determined.
Finally, the CDC just published guidelines for holiday celebrations, although not the High Holidays or Sukkot ( www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html ). Their practical advice for secular and non-Jewish holidays is very congruent with what we have discussed many times in this venue. One part masking, one part social distancing and one part hand hygiene, sprinkled with a tremendous amount of decent seichel, will make for one very delicious safe and enjoyable holiday.
In the merit of our masking and thereby doing the bidding of Hashem, may we all merit a Gmar Tov and good Shabbat.
By Rabbi Aaron E. Glatt, MD