Below is an update on the Covid situation from Rav Dr. Aaron Glatt, RAA/Igud’s Director of Halacha and Medicine Commision, dated May 22, 2020 (the situation changes day to day).
COVID-19 UPDATE: May 22nd
Of course, no one needs to be told that yesterday May 21st, Governor Cuomo allowed religious gatherings of up to 10 people to take place in NYS. The OU/RCA guidelines, based on our great poskim, HaRav Schachter and HaRav Willig shlita, with approval of many other gedolim including HaRav Asher Weiss and HaRav Dovid Gohen, shlita, therefore authorize the start of the 14 day “clock” to allow us to properly assess the situation and prepare for safe minyanim in a very careful manner. I look forward to discussing various aspects of this motzei Shabbos.
What new studies of importance were published this week?
We truly are learning more about COVID-19 every day, some confirming beliefs, some shattering them.
1) The Korean CDC published interesting findings on their patients who retested positive after being COVID-19 negative. They found absolutely no evidence that these “re-positive” cases transmitted illness. Furthermore, no virus was isolated in respiratory samples from 108 “re-positive” cases, and no person was found to be newly infected from contact with re-positive cases. This is very welcome news indeed!
2) A Mount Sinai Health System study showed > 99% of individuals recovered from COVID-19 who had mild to moderate symptoms went on to develop antibodies. The study also showed that these IgG antibodies have the potential to confer immunity and protection against reinfection. While we don’t know for certain whether having antibodies confers immunity at this point, or how long immunity would last, it is very encouraging that even people with mild illness produced antibodies.
3) A new analysis from the Urban Health Collaborative at the Dornsife School of Public Health at Drexel University says nearly 250,000 people in the nation’s 30 largest cities are alive today because of strict stay-at-home orders issued by local and state governments. Stay-at-home orders likely reduced the number of coronavirus deaths by 232,878 and prevented 2.1 million people from requiring hospitalization. Wow. This analysis showed what might have happened had Americans not taken the drastic social distancing steps ordered and encouraged over the last few months. We in our communities have certainly seen the evidence of this with our own eyes as boruch Hashem we successfully flattened the curve. But we must remain unbelievably vigilant that it doesn’t come back with a vengeance.
4) Latest data from the WHO estimated the COVID-19 “R0” (actually pronounced “R naught”) – the reproduction number – as 2.0 to 2.5. This means that infected individuals transmit it to 2-2.5 others on average. By contrast, the R0 for measles is 12-18, For SARS in 2003, scientists estimated the original R0 to be around 2.75, while for seasonal influenza it’s a little over 1.
5) According to a study in the Journal of the American College of Cardiology, if the right side of the heart enlarges and doesn’t function correctly, it may indicate worse outcomes in hospitalized COVID-19 patients. Though the reason is unknown, researchers say there could be multiple factors, including possible clots, lung damage, low blood oxygen level or heart damage.
6) The CDC May 15th updated guidelines state that the incubation period for COVID-19 extends to 14 days, with a median time of 4-5 days from exposure to symptom onset. 97.5% of persons with COVID-19 develop symptoms within 11.5 days of infection.
Signs and symptoms of COVID-19 vary, but most persons with COVID-19 experience the following:
- Fever (83–99%)
- Cough (59–82%)
- Fatigue (44–70%)
- Lack of appetite (40–84%)
- Shortness of breath (31–40%)
- Phlegm production (28–33%)
- Muscle pain (11–35%)
7) Two immunology studies revealed that COVID-19 infected people harbor protective “T” cells that target the virus and potentially help them recover. This bodes well for the development of long-term protective immunity and might allow researchers to create better vaccines.
8) And finally, who did not see the very preliminary but encouraging initial vaccine results from Moderna (a clinical stage biotechnology company funded in part by the Biomedical Advanced Research and Development Authority (BARDA), a division within the U.S. Department of Health and Human Services), regarding human
After two doses, all 8 participants evaluated after either a 25 µg or 100 µg dose seroconverted with binding antibody levels at or above levels seen in convalescent sera. Plus, mRNA-1273 was generally safe and well tolerated.
In addition, mRNA-1273 provided full protection against viral replication in the lungs in a mouse challenge model. On May 12, the FDA granted mRNA-1273 Fast Track designation, and Moderna is finalizing the protocol for a pivotal Phase 3 study, expected to begin in July 2020.
What about summer camps?
Lost in the minyan announcement, Governor Cuomo also announced that summer school classes in NYS will only be performed on-line. He did not rule out, but he certainly did not provide any support for summer day camp or sleep away camps…
What about summer trips or vacations?
While we all want to hopefully go on a summer vacation, COVID-19 will not be taking a vacation, and that means we must follow all protocols of social distancing wherever we are. The most important thing to remember is that almost all documented COVID-19 cases are spread by person-to-person transmission, either from symptomatic or pre-symptomatic people. Any contact with people not living in your house has potential to spread COVID-19. However, vacation rental homes, condos or apartment that are properly cleaned in between users, and especially if they are not used for 24 hours between users probably pose a very low if any risk. Likewise, if recommended chlorine levels are maintained as usual, swimming pools should pose minimal risk of spreading COVID-19 to swimmers. However, contamination of the air or surfaces in these facilities is at least a theoretical concern, and one should space usage of pools so that different families do not use them directly back to back and certainly not together.
Anything new on Pediatric Multisystem Inflammatory Syndrome?
The NYS DOH advisory updated their case definition for Pediatric Multisystem Inflammatory Syndrome temporally associated with COVID-19 in individuals aged < 21 years.
- A minimum one-day history of subjective OR objective fever; AND
- Hospitalization; AND
- One or more of the following:
- Hypotension (low blood pressure) or shock
- Features of severe cardiac illness
- Other severe “end-organ” involvement
- One or more of the following:
- Two or more of the following:
- Certain types of rashes
- Conjunctivitis (types of pink eye)
- New gastrointestinal symptoms (diarrhea, vomiting, or abdominal pain);
· Certain laboratory abnormalities.
What is happening soon with Jewish life cycle events?
It is unfortunately too early to say anything new about our beautiful life cycle events which we miss so much. Certainly, people should absolutely continue to arrange, celebrate and commemorate these important events, but we must perform them in a fashion that always respects fully the law, doesn’t cause a chilul Hashem and doesn’t create hatred towards the Jewish people. Everyone should discuss these events well in advance with their Rav to make sure there are not last-minute unforeseen problems. In general, I do not recommend people making arrangements that potentially involve non-refundable deposits. May we im yertza Hashem have many brissim, pidyon habeins, bar/bas mitzvahs and weddings to celebrate with great joy and close camaraderie in the near future.
Rabbi Aaron E. Glatt, MD