Rabbi Dr. Glatt COVID Update Letter, Thursday, June 25

A lot has happened in the COVID world this past week, most of it quite disconcerting.

While our local community remains Boruch Hashem in excellent shape, there were 29 states in which the seven-day average of the percentage of positive tests was higher than the comparable two-week average, including states that began reopening their economies and easing social restrictions in late April or early May. Central NY has seen a significant uptick in positive cases, and even in the 5 Towns, Inwood has seen new cases as well. Likewise, countless countries across the world are seeing rises in new infections. Many new cases are in the 18 – 49 age bracket, but even with that, hospitalizations are trending upward in at least 14 states.

WHY?

Experts worldwide universally say the main reason behind this increase is abandonment of masks and social distancing. In general, countries and communities who follow the rules do not see new cases; those that don’t, unfortunately do.

I know no one wants to hear that; I know people are fed up and tired of wearing masks and staying away from friends and relatives. And it is very difficult to win an argument on this subject when so many people, even seemingly entire communities, seem to be doing well despite ignoring these essential directives.

So – why should I follow these recommendations when so many people don’t – and yet they are doing well?

Unfortunately, the only response that will answer this question is the answer we are all davening will not to happen. Do we need to have new cases, new hospitalizations, and worse, ranchmana letzlan, before we all go back to doing what the experts say? The leading infectious diseases and public health experts in the country all officially stated this week that they are very concerned. “There is a disturbing surge of infections in some parts of the country, as Americans ignore social distancing guidelines… The virus is not going to disappear” said Dr. Fauci, the nation’s top infectious disease expert, who testified that the virus was not yet under control in the United States. Three other leaders of the government’s coronavirus response also testified – totally disagreeing with the “sunny accounts” offered on some streets of the 5 Towns and other frum communities.

I understand how the prophet Yirmiyahu must have felt telling Klal Yisroel his words of doom and gloom while everyone scoffed at him and ignored him. Hashem yeracheim.

What will it take to understand the problem?

New York, New Jersey and Connecticut announced “a joint travel advisory” requiring visitors from states with high transmission rates (e.g. 10 positives per 100,000 tested on a seven-day rolling average) to quarantine themselves for 14 days when they visit the tristate region. There are many people travelling to and from NY for semachot, camps, vacations, and business. This will certainly increase the risk of potential trouble in our own neighborhoods. We are all connected in many ways to potential exposures.

I will take questions on this and other subjects at our 9:45 motzei Shabbos zoom meeting (Meeting ID: 980 3243 6809 Password: 5TFRBM or by phone: 929 205 6099).

Any important new scientific information published this week?

1) A paper in the journal Chest demonstrated some benefit from the interleukin-6 inhibitor actemra (tocilizumab) in patients with severe COVID-19 disease. Tocilizumab-treated patients’ oxygenation and inflammatory biomarkers improved more than non-treated patients, and there was higher than expected survival. Randomized trials must confirm these findings.

2) A randomized clinical trial in JAMA found that colchicine (a well-known gout medication that inhibits inflammation) treated patients showed less clinical deterioration than the control group. Patients in the colchicine arm also had smaller increases in dimerized plasma fragment D (a marker of severity of illness in COVID-19) compared with control patients.

While both these findings should be interpreted with caution, these two papers give additional credence to the idea that one’s own inflammatory response to the virus is part of the problem in COVID-19. Treatments such as these and other modalities like steroids that decrease the immune response might be beneficial.

3) Another small but very important paper in Nature Medicine looked at 37 asymptomatic individuals diagnosed with COVID-19 but without any relevant clinical symptoms in the preceding 14 days and during the subsequent quarantine. The median duration of viral detection in this asymptomatic group was 19 days. Surprisingly, the asymptomatic group had a significantly longer duration of viral shedding than the symptomatic group!

IgG levels (“antibodies”) in the asymptomatic group were also significantly lower than in the symptomatic group in the acute phase, and they went away faster. Fully 40% of asymptomatic individuals became seronegative (antibody no longer detectable) versus only 12.9% of the symptomatic group. The data suggest that asymptomatic individuals had a weaker immune response to COVID-19. This might have major implications for immunity and vaccine use.

How can I prevent exposure in Phase 3 (and Phase 4 iy”H on July 6) in Nassau County?

There are strategies that we must always consider as we safely open up our community.

• Outdoor events are generally safer than indoors;
• Wear masks / socially distance unless you are with your “bubble”;
• Be especially careful to distance when eating at restaurants, BBQs, weddings, etc.;
• Minimize riskier activity as possible – decide if a risk is really worth taking;
• Try and use public areas when they are less congested;
• Wash hands after coming in from outside, and after “high-touch” surface contact.

Can I safely send my children to Yeshiva and Seminary in Eretz Yisroel this year?

This is becoming a FAQ! Add the important corollary – will my kids ever go to school again?

Very difficult to address, as I do not even know what next week will bring, never mind the fall. Suffice to say however, at this time, I see no reason why one should not send students to school, here or abroad, although I suspect many programs will operate under different guidelines. Class size, trips, transportation, dormitories, cafeterias, gyms and many other school related activities will undoubtedly be different. Probably in general, we will see smaller groupings, more on-line sessions, and less exposures to outside venues.  I think the “bubble” concept to a certain extent might be appropriate for classes. Furthermore, if we get better, easier and less expensive testing, that might play a role in early identification resulting in minimizing transmission.

What about Bungalow colonies, public pools, public sports and courts?

All of these activities involve some unknown risk. Again, in general, with careful selection and appropriate distancing, I think they can be done safely if the environment is somewhat controlled. Specifically – who is there? Where are they from? How close? For how long? Common sense is the best answer to these types of questions involving unknown risks.

What about public transportation?

For those now going back to work and /or anyone needing to use the LIRR, MTA, car services or car pools, masking is essential. For trains and busses, as possible, also distance. For cars, if driving with people not in your bubble, try and sit as far apart as possible, of course both masked, and with window open as appropriate. For very short trips, there is probably minimal risk.

Can I visit my loved ones in the hospital?

One of the most difficult things we experienced with COVID-19 was the ban on visitors in the hospitals. There were simply too many risks involved and NYS banned all visitation. However, this past Friday, hospitals were allowed to choose if they wished to allow visitors under very rigorous proscription from the state. Many, including Mount Sinai South Nassau welcomed in visitors with open arms, albeit with great attention to safety.

However, if during the prior two weeks you are / have been personally symptomatic or living with someone with COVID-19 symptoms – absolutely do NOT visit. Otherwise, please go and visit safely following the limitations that the state and hospital have implemented. Make sure you call the hospital before you go to see what restrictions apply.

We all pray that the current state of relative COVID-19 calm in the 5 Towns persists.

May Hashem allow us to continue to open up safely.

Have a great Shabbos.