Archives for September 2020

COVID and Rosh Hashana and Yom Kippur by Mendel Singer PDF (Full version with appendix)

We’re all tired of COVID. Tired of hearing about it. Tired of having our lives revolve around it. Tired of wearing masks, not seeing elderly relatives who are isolating. We just want things to be normal again, even more so with Rosh Hoshana/Yom Kippur coming up. Can we just have a normal yomim n’oraim? Doesn’t Klal Yisroel need it now?

We are all suffering from Corona Fatigue. Hashem, take this away! Let us daven and learn in peace, let our children have normal school.

Nonetheless, like it or not, Rosh Hoshana/Yom Kippur raises substantial and unique challenges we don’t face on a typical Shabbos and this needs to be carefully considered by shuls in their ongoing heroic efforts to maximize normalcy and safety for their kehilla, and by individual making their person choices about where to daven. In this public letter I will discuss the special health challenges of Rosh Hoshana/Yom Kippur, and end with a moshul. After that is an appendix that addresses the following questions for those willing to read longer:

1. What is the state of COVID in our community and in the county?
2. It is so confusing! Things keep changing and there’s so much conflicting information!
3. Hospitalization and deaths are down – why? Has the virus mutated into a less lethal form?
4. Where do we stand in terms of treatment for COVID?
5. Immunity after having COVID
6. Fair expectations about a vaccine
7. Herd Immunity

Why trust me? I write from my perspective as a professor of public and population health for 25 years (and a Vice Chair for 6 years) at the distinguished medical school of Case Western Reserve University with over 70 publications in peer-reviewed journals, despite my primary focus on education. These publications include research in infectious diseases: HIV, Tuberculosis, Rotavirus, Hepatitis A and C, and antibiotic resistance in respiratory infections. I have worked with the county health department, and been honored by it with a resolution after a mumps outbreak in our community about 10 years ago. I have done one study of my own related to COVID, recently published in the top Rheumatology journal, Annals of the Rheumatic Diseases. Since I have taken hydroxychloroquine in the past for my auto-immune disorder and am supposed to go back on it long-term, it was personally disappointing to determine that this drug provided not the slightest benefit in preventing COVID. As I tell my students, never apologize for results – the truth is the truth. Just be sure you have the right methods. I know good study design and proper statistical analysis. My opinions are totally driven by what the data says and what it doesn’t actually answer.

Let me preface the discussion by stating that as a professional I can supply information to help people and Rabbonim understand the health situation and risks. I am not going to make specific
recommendations for the following reasons:

1. There are differences in shuls in terms of: how many elderly or otherwise high-risk congregants, available space, air circulation, windows, or the outdoor space or economic wherewithal to
   create optimal solutions such as davening outdoors. Obviously, in terms of other communities, there are differences in numbers of cases.
2. Solutions have to work for the kehilla. Rabbonim are constantly doing a balancing act. Prioritizing safety is important, and so is shalom – always a key ingredient at a time of judgement of Klal Yisroel. There will always be people who think measures don’t go far enough and others who think those same measures are too extreme.
3. The decisions end up involving criteria that are way above my pay grade, e.g. halacha and hoshkofa.

Have rachmonis on your shul Rav! The pandemic has put enormous burden and stress on our Rabbonim. And we certainly can’t just dismiss it by saying “that’s why they get the big bucks”!
Remember to be extremely sympathetic to, and be mispallel for our Rabbonim – an amazing group that distinguishes our community.

Shalom!!! The pandemic creates a situation that is rife for machlokes, and at the time of year when shalom is most important! People are stressed and have conflicting opinions about COVID. Some of us, myself included, have had tense situations over COVID.

What are the special COVID health challenges of Rosh Hoshana/Yom Kippur?

Transmission of the virus is very dependent on the volume of exposure. Think of other viruses and when one child gets it, a sibling that sleeps in the same room is more likely to get it than other family members. And even though every family member will have some exposure, some won’t get it. Exposure is dependent on length of time, distance, air circulation, wearing face coverings to reduce how far droplets go, the force of the droplets (regular speaking voice vs. projecting one’s voice to speak loud or sing, speaking vs. coughing vs. sneezing). Volume of exposure not only matters in terms of getting infected, but it can also affect severity of infection. When a small volume of exposure does cause an infection, it is more likely to result in an asymptomatic or mild infection.

The risks posed by Rosh Hoshana/Yom Kippur are so much greater than a typical Shabbos that it requires greater vigilance for the following reasons:

1. The very long hours together means great exposure to those davening nearby. More people walking around at times. Many people using the same bathroom. More time for people to cough or sneeze.
2. Lots of singing and louder davening means voices being projected and more droplets being released and with greater force, carrying further.
3. Crowding. Whatever limitations shuls put in place for Shabbos may not be sufficient for our holiest days. More women want to come to shul, and that often means more children who are also capable of both getting infected and spreading COVID. While there is some weak evidence that kids under age 10 may be less likely to get infected or transmit, it is still far from clear to what degree that is true since we don’t generally test kids.
4. Let’s face it, everyone desperately wants to be in shul on our holiest days! Any Rav can recount the many times people have not taken important medications or fasted on Yom Kippur when their health demanded differently. It’s awfully easy to say “it’s hardly even a cough”. A little sneezing –“probably allergies”. A fever? It’s yom tov and you can’t take your temperature. How easy it is to say it’s probably just a little warm in the house. Maybe the slightest low-grade fever, “that’s nothing”. How can I daven at home on Yom Kippur? I need the zechus of being judged with my kehilla. This may be the greatest threat, that people who are actually mildly symptomatic and very infectious may come to shul, be there for many hours, singing and davening loudly and using the bathroom creating substantial exposure to others. A possible solution that would require a halachic question to your Rav: can a shul pay a goy to do a no touch forehead temperature scan on people before they enter the shul on Shabbos or Yom Tov? Maybe done on the 1st evening and each day of Rosh Hoshana, and the evening and day of Yom Kippur? Again, way above my pay grade.

I will end the main letter with a moshul (followed by an appendix). When COVID first broke out, we all searched for the cure – the treatment that was already out there that would end this pandemic. Early on there were times we got our hopes up. Some treatments worked so well in the lab! But not so well in people (this happens all the time). Then we got our hopes up that a vaccine would come quickly and end the disease. But even with heroic efforts all over the world and over a hundred different vaccines in progress and everything being fast-tracked to the extent possible while maintaining safety, it still takes longer than we hoped. We continue to wait.

Meanwhile, face masks and social distancing have been effective in reducing transmission. And we’ve been chipping away at the disease. While everyone’s attention was on a cure or a vaccine, we’ve been making progress in managing the illness and reducing mortality. Steroids have been shown to cut mortality in patients on ventilators by as much as 20-30%. Some other drugs have shown modest reductions in mortality. We’ve learned when to use ventilators and when less invasive sources of oxygen can be used (including some very creative reworking of existing equipment). The disease is still around, but all these measures together have reduced the number who are hospitalized and the number dying.

In this moshul, COVID is the yetzer hora. We often hope we can find a cure for the yetzer hora, some major transformation through radical change in our avodas Hashem. Sometimes that works. More often, it doesn’t. The vaccine represents Moshiach, the ultimate cure that completely ends the yetzer hora, which we must daven for and work towards making a reality. The face masks and social distancing – this is keeping away from situations where we are more likely to yield to the yetzer hora, as we are taught that it is better to stay away from temptation than to challenge the yetzer hora on his turf. All the treatments and improvements in clinical practice in managing the disease – this represents the little by little approach to teshuva recommended by the baalei mussar and chassidus. Yes, sometimes we can make jumps and sustain them. In between, we try to keep chipping away, improving little by little. When we stop and look back, we be quite surprised to see that we’ve come a long way! The tried and true approach to teshuva.

May our tefilos this Rosh Hoshana and Yom Kippur be successful! May we merit the ultimate spiritual vaccine, Moshiach Tzidkeinu, speedily in our days!

Kesiva v’chasima tova!

Mendel E. Singer, PhD MPH