Another shift of medical staff prepare to start woking at a drive-through testing center for COVID-19 in Paramus, N.J., Friday, March 20, 2020. The coronavirus testing center opened Friday in Bergen County which has been the state's hardest-hit area. Gov. Phil Murphy said only those with symptoms should get in line, and not those whom he called the "worried well," people who are feeling well but are concerned they could be infected. The facility will have the capacity to conduct 2,500 tests a week, according to the governor. (AP Photo/Seth Wenig)

COVID-19 Update July 2, 2020

I am very sad to report we have seen an uptick in COVID-19 cases.

Rabbi Dr. Aaron Glatt

Nassau County was down to 25 cases a day; that has since doubled. The Five Towns has new cases, related to travel into our area. Lakewood had five new cases connected to travel from Florida. Westchester County saw four positives related to travel. Cases continue to rise in Israel and across the country.

Last week we noted: “There are many people travelling to NY and vice versa. … This will certainly increase the risk of trouble in our own neighborhoods. Do we need to have new cases, new hospitalizations, and worse, ranchmana letzlan, before we all go back to doing what the experts say?”

I am not a navi – but I can, unfortunately, read the writing on the wall.

Right now, we “only” have some new cases – hopefully it will not get worse. But only if people heed the advice of experts. It is a terrible shame – and against halacha – for individuals or publishers not expert in medicine or Jewish law to espouse fluffy but totally erroneous spiritual sounding pronouncements about conquering COVID-19 with emunah alone. Ignorance is not bliss. Ignorance is deadly.

What did the REAL experts say THIS week?

  • WHO Director-General Tedros Ghebreyesus said: “COVID is not even close to being over.”
  • Dr. Robert Redfield, CDC Director said: “It is critical that we all take the personal responsibility to slow the transmission of COVID-19 and embrace the universal use of face coverings.”
  • Dr. Anne Schuchat, principal deputy director of the CDC said: “What we hope is that we take it seriously and slow the transmission. We are not even beginning to be over this.”
  • U.S. Surgeon General Jerome Adams implored Americans (young Americans in particular): “Wear a face covering when you go out in public. It is not an inconvenience. It is not a suppression of your freedom. It actually is a vehicle to achieve our goals.”
  • Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases at the NIH said: “New infections could reach 100,000 daily. I think it’s important to tell you and the American public that I’m very concerned because it could get very bad.”

From the CDC:

CDC recommends all people (2 years and up) wear a face covering in public and when around people outside their house, especially when social distancing measures are difficult to maintain.

COVID-19 can be spread by people who do not have symptoms and do not know they are infected. That’s why it’s important for everyone to wear cloth face coverings in public settings and practice social distancing (staying at least 6 feet away from people).

From the Infectious Diseases Society of America:

Individuals should:

  1. Wear masks that cover the nose and mouth in all public settings;
  2. Wash or sanitize hands frequently;
  3. Maintain recommended physical distancing for the protection of themselves and others;
  4. Be aware of large gatherings; plan exit routes in advance if distancing becomes impossible.

From the Israeli Ministry of Health:

Reinstituted restrictions in light of increased cases. Reduced attendees at halls and cultural performances, brissim, funerals and weddings; hall owners have been asked to hold semachot in outdoor open spaces. Reduced prayer gatherings to 50 people in certain situations.

What about wearing a face shield instead of a mask?

The CDC stated it does NOT recommend face shields for normal everyday activities or as a substitute for cloth face coverings. It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles.

Some people may choose to use a face shield with a mask if sustained close contact with other people is expected. If face shields are used without a mask, they should wrap around the sides of the wearer’s face and extend below the chin. Reusable face shields should be cleaned and disinfected after each use. Plastic face shields for newborns and infants are NOT recommended.

What hard scientific information was published this week?

  1. A paper in the Annals of Internal Medicine looked at the COVID-15. (That’s not a typo! COVID-15 refers to the 15-pound weight gain that COVID-19 inactivity causes). Smartphone users worldwide showed daily steps dropped 27.3% (1,432 fewer steps) in the first 30 days of COVID-19. Change in step counts varied across countries, reflecting the variation in COVID-19 timing, regional enforcement, and behavior change.
  2. Anakinra (Kineret), an interleukin 1 receptor antagonist used to treat rheumatoid arthritis reduced the need for mechanical ventilation and improved mortality in severe COVID-19 patients – without serious side effects – according to The Lancet Rheumatology. “In severe forms of COVID-19-related pneumonia requiring oxygen therapy, a 10-day treatment with subcutaneous anakinra was associated with the reduction of both need of mechanical ventilation and mortality, as compared with a historical group with similar characteristics. In the context of this pandemic, with exponential curves of admittances in ICUs, the use of anakinra should be tested more extensively, preferentially through randomized trials, among patients with COVID-19 and symptoms suggesting a virus-induced cytokine storm.” Once again, promising results from immunosuppressive agents, but more data are needed.
  3. The prestigious CDC publication MMWR looked at exposures in congregate settings rather than broader community settings. What was learned? Only 46% of new COVID-19 cases reported recent contact with a known COVID-19 patient. Most contacts were a family member (45%) or a work colleague (34%). A majority of COVID-19 patients reported working during the two weeks preceding illness, and few had the ability to telework, underscoring the need for enhanced measures to ensure workplace safety.Case investigation, contact tracing, and isolation of infected persons are needed to prevent ongoing community transmission, given the frequent lack of a known contact. Enhanced measures to ensure workplace safety, including social distancing and more widespread use of cloth face coverings, are warranted as fewer than one half of patients were aware of recent close contact with someone with COVID-19. This study further highlights the need for increased screening, case investigation, contact tracing, and isolation of infected persons during periods of community transmission. Plus, ensuring social distancing and more widespread use of cloth face coverings is essential.
  4. A just published “preprint” (not yet formally peer reviewed) found that only a small number of COVID-19 patients pass it on to many others in so-called superspreading events. This phenomenon is exactly what concerns me most regarding weddings and large kiddushim, especially in the setting of travelers coming from endemic areas.Researchers analyzed surveillance data between March and early May 2020, in five (urban and rural) counties in Georgia. The overall median reproductive number was 2.88 before the state-wide shelter-in-place order was issued. The effective reproductive number was reduced to below 1 about two weeks after the order!

    Super-spreading appears to be widespread across space and time, and it may have increasing importance towards later stages of outbreaks in both urban and rural settings. Overall, about 2% of cases may have directly infected 20% of all infections. Younger adults (<60 years old) may be 2.38 times more transmissible than infected elderly (>=60), and the former may be the main driver of super-spreading. Wow!

Can you please tell me some good news about vaccine updates?

China approved a COVID-19 vaccine for use by its military, even though the vaccine has not undergone a phase III efficacy study. The vaccine, “Ad5 vectored COVID-19 vaccine” uses a recombinant adenovirus type-5 vectored spike glycoprotein of COVID-19. The phase I trial was published in The Lancet, and in the high dose group “severe fever, fatigue, dyspnea, muscle pain, and joint pain were reported in some of the recipients”. Not sure this trial would pass muster for most New Yorkers!

However, the FDA did release final guidance regarding standards for approving coronavirus vaccines in the United States, requiring that any vaccine must be at least 50% more effective than placebo. Before approval, manufacturers will also need to conduct animal studies to ensure that their candidates don’t provoke an immune response known as enhanced respiratory disease, which actually worsens infection. The agency said Covid-19 vaccines must meet all the standard laws and regulatory requirements for any other vaccines to be approved, including manufacturing and control requirements.

Vaccines against the coronavirus are being developed in record time. Phase III trials are starting NOW. The FDA left open the possibility it would issue an emergency use authorization for a vaccine, but making that decision before the completion of large, randomized clinical trials makes it harder to determine effectiveness.

How can I prevent exposure when Phase 4 comes to Nassau County?

Because of increased cases, some scheduled Phase 4 openings are being held back; potential for trouble is too high. I am reiterating some guidelines. We must strengthen our commitment, NOT relax it.

  • Outdoor events are generally safer than indoors;
  • Always wear masks / socially distance unless you are with your “bubble”;
  • Be especially careful to distance when eating at restaurants, BBQs, weddings, large gatherings;
  • Minimize riskier activity as possible; decide if a risk is really worth taking;
  • Use public areas when they are less crowded; leave if things get out of hand;
  • Wash hands after coming in from outside, and after contact with “high-touch” surfaces.

Can I still visit my loved ones in the hospital?

Anyone travelling to New York from California, Georgia, Iowa, Idaho, Louisiana, Mississippi, Nevada, Tennessee, Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Texas and Utah must quarantine for 14 days upon arrival in New York. Individuals traveling to or from those states or anyone coming from a country considered high risk (check the CDC Travel Advisory for updated info) CANNOT and should not visit the hospital. Even if asymptomatic – absolutely do NOT visit.

We all pray that relative COVID-19 calm returns to the Five Towns. May Hashem allow us to continue to safely celebrate semachot together.

I will address this and other questions at 9:45 p.m. motzei Shabbos on Zoom. Access Meeting ID 980 3243 6809; NEW Password: SUMMER2020; by phone: 929 205 6099 or via YouTube. For more information please email yiwoodmerecovidupdate@gmail.com.

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