From my brother, a Pediatrician, to his Chasidic Jewish community:
10/20 Update, Outdoor Activities, Dr. Fauci's Meeting &
the Reopening of Minyanim, New Pediatric Condition
I understand that the COVID-19 illness situation is far better now than it has been. At the same time, we have many thousands of people in our kehilla who have come through this Pandemic not infected by the virus, still not immune to the virus, and still vulnerable to infection by it. This includes hundreds of entire families as well as the many elderly or other high-risk individuals who effectively secluded themselves during the entire Pandemic.
The COVID-19 virus is very contagious and potentially very dangerous and it demands our respect now, just as it did two months ago. Any person who is still not immune to the virus will get infected by it if they come in close contact with it, just as tens of thousands of people got infected by it during this Pandemic.
At the same time, doctors, Rabbonim and leaders of the kehilla are aware that some in our kehilla have relaxed restrictions on their own and have begun intermingling socially, allowed their children to intermingle with other children or are davening in minyamin in a manner that clearly contradicts the BMG Psak.
I do hope that clear, unified guidance will be issued shortly for the kehilla. Until then, I am making a personal appeal to you — please don't forget the mageifa that was just brought upon us! Please respect this virus and the destructive power that it has demonstrated.
The virus is still within our midst and is a present, true potential
danger to our kehilla.
Please don't relax restrictions for yourself or you family yet.
Please be patient until clear guidance for the kehilla comes out
as we, with the help of Hashem, pave a pathway forward.
Outdoor Family Activities!
Many Ocean County parks are open for family walks, hikes and bicycling.
Take your family and go!
Go to an open parking lot, or a field, or an open lot, or a hill.
Walk around or run around, play catch or frisbee, hold races or
hold the children's hands!
Take your family and enjoy the outdoors!
Bring your masks and wash hands well before and after you go.
Stay distant from other families as much as you reasonably can.
If you have an open porch or back yard,
Consider a family barbecue!
Please enjoy this time together!
Dr. Fauci's Meeting & the Reopening of Minyanim
On Thursday, May 7, the Orthodox Union hosted a webinar featuring a question/answer session with Dr. Anthony Fauci. Dr. Fauci is an immunologist who is one of the world's most preeminent experts on infectious diseases. He is the director of the NIH's National Institute of Allergy and Infectious Disease and has been an advisor to six U.S. presidents, beginning with President Ronald Reagan. Since January 2020, he has been a lead member of President Trump's White House Coronovirus Task Force addressing the COVID-19 pandemic in the U.S.
I was privileged to hear Dr. Fauci speak and am presenting here a summary of the discussion. I have paraphrased the questions and Dr. Fauci's responses in an attempt to most clearly convey the content of the discussionbetween him and Rabbi Moshe Hauer of the Orthodox Union.
I hope that this discussion will be useful as a primer to read, understand, and appreciate the roadmaps that the Agudas Yisrael and Orthodox Union have both just publicly issued to help community leaders and Rabbonim reopen our kehillos.
Q #1. Minyanim are interwoven into the fabric of Orthodox Jewish life.
How will we be able to open minyanim back up? All at once or in gradual increments?
A #1. Unfortunately, social interactions in group settings like minyanim create a core risk for the spread of the COVID-19 virus. Nevertheless, the reintroduction of minyanim will be encouraged, but in a modified, gradual, incremental manner, with strict Social Distancing protocol in place for a while.
Many factors must be taken into consideration before taking this step, including how frequently minyanim will be held, how frequently individual mispallelim will be able to attend minyanim, how to ensure constant physical separation, before, during and after each minyan, and how to manage the minyanim and the entire process is an orderly way.
The initial phase of re-establishing minyanim will require that minyanim consist of no more than ten people, have at least six feet of distance between mispallelim, and have masks worn by every participant.
How and when you do this needs to be decided locally by the leaders of each community in consideration of local COVID-19 infection levels and the readiness of each community.
Q #2. As we open minyanim, how will we best re-integrate the elderly or other potentially vulnerable high-risk individuals?
A #2.
As we move toward the re-opening of societal functions, the elderly along with individuals with obesity, diabetes, hypertension, immune-deficiency or other underlying conditions must be protected from the COVID-19 virus. Individuals in the high-risk group must be the last to join in the process of opening minyanim. The healthy and young go first and lead the elderly and vulnerable first, before bringing them in. As 14-day periods pass, new cases of infection will be monitored to asses a safe time to do this. Q #3. Members of the Orthodox Jewish community have stepped forward in a major way to donate blood plasma to help treat people who are seriously sick with COVID-19 illness. It seems natural for someone to think "If my plasma is being used to help treat people who are sick with COVID-19 illness then I must be immune to the illness!" Please comment on this.
A #3. When a COVID-19 antibody test result is positive for antibodies, at this point it would be an assumption to say that the antibodies are necessarily effective and protective. In fact, I think that the disease is probably producing effective and protective antibodies, and while I do think that this will be shown to be the case, we do not know this definitely at this time.
In addition, we must wait for studies that identify the minimum serologic titer levels that demonstrate immunity. For example, if a person takes an antibody test for measles, we know definitely the minimum titer level above which a person is immune. We do not know this yet with COVID-19.
Furthermore, even after we determine that antibodies are effective and protective, and after we determine the minimum serologic titer levels that demonstrate immunity, we will still need to determine how long the antibodies will remain effective and protective. Long-standing immunity, in which a person can not contract the illness again, can not be assumed.
It is a risk to assume a person is protected by antibodies at this time. Until we determine these matters, do not relax restrictions. We must continue Social Distancing protocols.
Q #4. What does a positive antibody test tell us about contagiousness, about whether or not a person is still shedding the virus into the environment?
A #4. Nothing. Through a certain point in the beginning, a person with a positive antibody test could still be shedding the virus. The test that is used to determine if a person is shedding the virus is a nasopharyngeal PCR test. If the test is done two days in a row, separated by 24 hours, and both tests are negative, this demonstrates that the person is not shedding the virus.Q #5. Our High Holidays (Yomim Noraim) are coming in the fall. This is a time when the entire community comes together in prayer. What should we expect? How should we think and plan?
A #5.
Here is my thought process: If we continue in a measured, organized fashion to re-open minyanim with strict Social Distancing protocols in place, and we closely monitor the levels of new cases of the illness, we will see that new cases of the illness will continue to drop well into June, July and August. However, we expect that fall will bring increased levels of the virus and potential for increasing cases of the illness.The potential for a dangerous "second wave" of the pandemic will exist in the fall. But whether or not we will have a second wave, or how severe it will be, will depend on how prepared we are.
We will need to have systems well in place to identify new cases of infection immediately, to trace all contacts of the infected person rapidly, to quarantine all potentially exposed contacts of the infected person right away. We will need to test quickly, isolate quickly, and have a strong surveillance system well in place. This all must be in place to avoid a dangerous second wave of the illness.
However, even so, we now live in a new reality. This will be a new normality for a long time.
The risk of the COVID-19 virus will be with us and will follow its cycle of high risk in the fall and winter and low risk in the spring and summer. A vaccine will be developed and then it will need to be administered across the entire population in order to achieve herd immunity, that is to say, in order that we reach the point when the vast majority of the population is immunized. At that point, the virus will no longer be in our midst. This process will take at least two cycles – which is two years.
Pediatric Multi-System Inflammatory Syndrome
In earlier COVID-19 Info emails, a disclaimer was included at the top of every email — COVID-19 information is changing continuously. All information contained herein is subject to change at any time. On April 22, I shared with readers the observation of how COVID-19 illness had been sparing children of significant symptoms — as though the mageifa was passing over our children. Indeed, it was true.
But, as you may well have heard, over the last few weeks a new, potentially serious pediatric condition has emerged that caught doctors by surprise. The new formal name of the condition is “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19.” News reports have mistakenly called it "Kawasaki Disease."
Important Points Regarding the New Pediatric Condition
• It is rare.
• It is most probably an after-effect of the COVID-19 illness.
• It is not contagious and does not spread from person to person.
• Although it is a potentially serious condition, most children who
have had it have done well.
First, it is important to know that this condition is still rare. While many children with this condition have been hospitalized, and some required intensive care, the good news is that, to date, most children have done well.
This mysterious condition has presented with different patterns of illness. The common feature of this condition is a long-lasting high fever in a child
who feels and looks ill.
In addition to the fever, some children have had severe abdominal pain, vomiting and diarrhea. Others have had certain features of Kawasaki disease, which is a rare condition that can cause symptoms such as beet-red, cracked lips, red swollen hands, an intense body rash, and bilateral conjunctivitis without any discharge. Some children have had heart or kidney issues, blood clotting problems, or respiratory symptoms. Others have presented with toxic shock, while some even have had evidence of Cytokine Storm Syndrome. (See the 5/3/20 email for discussion of the Cytokine Storm in COVID-19 illness, an exaggerated immune response that has caused organ damage in adults with COVID-19.)
It is highly suspected that this condition is a late-stage inflammatory response to COVID-19 illness. Many, but not all, children with this condition tested positive for COVID-19. Even in those children who did not test positive, COVID-19 illness is still suspected because the tests themselves have had varied accuracy. One suspected possibility is that the antibodies the affected children are making to the COVID-19 virus are creating an immune reaction in the child's body. Noone knows for sure yet.
However, the good news so far is that, to date, most children with the condition have done well.
As parents, it is important to know that this condition is rare. It is NOT a contagious illness that can be spread from one person to another. It is most likely a late-stage reaction to COVID-19 illness.
It is very important to know that a child with this condition will have had a high fever for many days, and will feel and look sick. However, it should be reassuring to know that pediatricians often see children who have fevers that last for many days who get better fully. As long as the child appears fine, especially on Tylenol and Motrin, that is the most important thing.
Important Things to Know if Your Child Has a Fever
• Fever is a very common symptom during childhood and is
one of the healthy ways a child's body fights infection.
• Even an extended fever for many days in a child usually
goes away on its own.
• The most important thing to do when your child has a fever
is to look at the whole child:
#1: Does the child look overall fine to you or does the child
appear ill to you?
#2: Does Tylenol or Motrin make the child perk up and make
him or her look fine to you?
• If the answer to #1 or #2 above is "yes" (which is the most
common situation) you can feel reassured that your child is fine.
• If the answer to #2 is "no," then call your child's doctor.
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