There is a protest planned at 2:30 at Severance Center today. Recommendations received via social media are that all men be home, all children and everyone else be inside, that there be no toys or anything on the front lawn, the driveway, etc. Per CHPD there is no expectation that this will turn non-peaceful c”v. Hopefully, there will be no trouble, but we do not want to do anything to attract attention.
Cuyahoga County, Ohio
June 2, 2020
The Cuyahoga County Police Chiefs Association stands with and in support of the family of George Floyd in mourning his death. We are sorrowful for this loss and regret that it came at the hands of a police officer whom we trusted to obey the law. We know, too well, that our profession is one that requires difficult decisions and reactions, but we, wholly, condemn the actions of this case.
Cuyahoga County is blessed to be made up of diverse populations and police personnel. We hear our communities when they say that there is much to do to improve race relations. We, together with the community, want to facilitate those improvements by listening, even more, and together developing a tangible way forward. The actions of this one officer do not represent what our profession stands for, but we acknowledge that he represented all police officers while he was employed as an officer. We feel shame that our trust in him was broken in such a way as to lead to the death of Mr. Floyd and which is bringing into question the actions of law enforcement everywhere.
The Cuyahoga County Police Chiefs Association is committed to help heal the division
that this and past incidents have caused. It is only through a continued effort of collaboration that we will begin to make headway. Without the support of our residents, we could never be successful. Therefore, we continue to push community relations, diversity training, and improving our hiring practices. We want to assure you that the voice of the people is being heard and we want to work with our communities to create a better path forward.
Bikur Cholim arranged a drive-by birthday parade in honor of a transplant patient and his brother who donated a partial liver to the birthday boy.
A truck played a video of birthday messages and was accompanied by a police car and families from the community who joined in their cars to show support.
Social distancing will not stop Cleveland from bringing joy and comfort to our patients in their time of need!
We would like to remind you that during this time our office is closed, yet, we are available to assist you remotely. Please email us at firstname.lastname@example.org or call us at 216-862-4599 and we will do our best to respond within 24 hours.
A Note From CDJFS Director, Kevin Gowan;
To our community partners,
The Ohio Department of Job and Family Services (ODJFS) announced earlier this month that some Ohio Supplemental Nutrition Assistance Program (SNAP) recipients will be automatically receiving additional SNAP benefits for the months of March and April 2020, due to the federal Families First Coronavirus Response Act.
Assistance groups that did not receive the maximum allotment for their household size in the month of April 2020 will be issued an additional payment, scheduled for this week. This additional payment will be added to the issuance that was received in April to equal the maximum allotment amount for their household size. Additional SNAP benefits for March 2020 have already been issued to all eligible assistance groups. Please see the attached fact sheet for information about the additional SNAP benefits.
Please advise the community not to call the Eligibility Contact Center about the additional SNAP benefits. They will be automatically added to their Ohio Direction Card.
Additionally, to reduce contact with others when shopping for grocery items, retailers that provide the option of accepting SNAP benefits for online ordering have been identified. Customers will be able to order online and pay with their SNAP benefits for pick up curbside or in some cases inside the store. The customer may be able to pay outside if the retailer has a mobile point-of-sale device.
The following retailers have been identified in Cuyahoga County, both retailers require an online account to be created:
- Giant Eagle: All locations in Ohio – Minimum purchase amount is $35
- Walmart: All locations in Ohio – Minimum purchase amount is $30
Thank you for your support and assistance.
In the Spirit of Service,
Cuyahoga Job and Family Services
In addition to the above notice, we have also received notices regarding the extension of certification periods and periodic reporting (Interim Report) for SNAP and TANF (Cash).
• Certification periods for SNAP and Cash households scheduled to expire in March, April, May and June 2020 are being extended for 6 months until September, October, November, and December 2020.
SNAP Emergency Allotments – What You Need To Know
Temporary funding through the Prevention, Retention, and Contingency (PRC) program will allow Cuyahoga Job and Family Services (CJFS) to provide emergency assistance to eligible families through a PRC voucher. While limited funding is available, COVID-19 PRC vouchers will provide assistance with additional food assistance, select essential supplies, and housing costs.
Please click below for additional details.
Due to the high demand of Ohioans applying for Medicaid, the Ohio Department of Medicaid has issued guidance that county Job and Family Service agencies stop processing Medicaid renewals at this time. Medicaid coverage will not be lost because the renewal process was not able to be completed. This guidance is until further notice.
- Changes in income should still be submitted. No negative action will be taken at this time.
There have been no changes to the program at this time.WIC Update:
Ohio WIC was granted a waiver from USDA on physical presence. Participants do not need to be present for their appointments. All anthropometric measurements and bloodwork are also waived at this time.Cuyahoga County WIC staff are:
- completing most of the WIC appointment by phone BEFORE the participant or parent/caregiver needs to come to load the WIC Nutrition Card (WNC).
- verbally reviewing and documenting forms, and can sign and date on behalf of the participant.
- asking that the participant or parent/caregiver come to the WIC office alone, if possible. Infants and children do not need to come in at this time.
- sending a daily text message to participants asking them to call the WIC office BEFORE coming to the WIC office.
Please note: While WIC staff are able to complete most of the visit via telephone the parent/caregiver must still come into the WIC office to have the WIC Nutrition Card (WNC) loaded. This card cannot be loaded over the phone, and the card cannot be mailed. At Cleveland Hts WIC, the parent/caregiver must enter through the MetroHealth Emergency Department (ED) entrance. Everyone entering any MH facility is screened and needs to wear their own mask (or MH will provide a mask) that must be worn when in the building. The above protocol is mandatory and put in place to protect the staff and visitors of MetroHealth Hospital. If you are not comfortable entering the building through the ED entrance, you will not be able to receive WIC benefits at this time. Please be mindful of this BEFORE discussing your benefits with the WIC representative.
At a press conference on April 16th, Governor Mike DeWine stated that Ohio will start easing restrictions on closed business starting May 1st. He cautioned, however, that what we’re used to an “open” business looking like will not remain the same. Some of the restrictions and safeguards you’re currently seeing at business that haven’t closed–such as social distancing, limits on the number of customers shopping at once, masking, gloving, and more–will be necessary for this new normal.
Even when businesses start to reopen, life will not look the same as it did before. The businesses deemed essential that have stayed open have put together stringent measures to keep their employees and customers safe.
The advisory board put together preventative measures such as regular checks of PPE stock and supply, a limit on visitors into the business, screening upon entry and clear guidelines on hygiene.
Our committee of physicians has prepared the following guidance for our community. Please read this entire document. We would have made it shorter if that was possible. This information can
make the difference.
As many of us have seen and heard about the devastating effects of COVID-19/Coronavirus, we present an initiative to help support the community manage under these very trying and stressful
This initiative is based on Healthcare Access, Contact and Observation, and Preparation of an Action Plan.
The information provided below is NOT meant to be a substitute for professional medical advice, diagnosis, or treatment from your treating physician. We recommend that you seek the advice of
your primary health care provider with any questions you may have regarding the COVID virus or any other medical condition. You should not disregard such professional medical advice or delay in seeking it because of the information provided in this document.
For any non-medical assistance please contact email@example.com or call 216-848-0379.
If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.
Do you think you may have Coronavirus (COVID-19)?
- If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.
- If you have any concerns, even on Shabbos or Yom Tov, call 911. Paramedics will come & they can take any necessary vitals
- If you are having any one of the following symptoms: fever above 100.4 (or above 99.6 for patients above 60 years of age or immunosuppressed), cough, diarrhea, fatigue or shortness of breath
- Call your Primary Care Physician
- Cleveland Clinic Express care online download from http://www.CCF.org 24/7
- Virtual visits through UH http://www.uhhospitals.org
- Once you are COVID positive
- If you are at home – set up a buddy to check up on you (or call us & we will provide one to you)
- If you are under the care of a physician and have been advised to use an oximeter to monitor your pulse and oxygenation levels contact Agudah to get oximeter via firstname.lastname@example.org or 216-848-0379
- Provide name of your physician
- Confirm that you have instructions for use
- We will make arrangements to get an oximeter to your home.
- Advance Planning
- Prepare PCP phone numbers & download virtual visit app
- Keep on hand Pedialyte or other electrolyte solution in case of illness & need to rehydrate.
If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.
In many cases, you may have any one of the following symptoms: fever above 100.4 (or above 99.6 for patients above 60 years of age or immunosuppressed), cough, diarrhea, fatigue or shortness of breath and will need to know your options for getting care. You cannot currently go to a site to get tested for COVID-19 without an order from a physician. If you have a Primary Care Physician, please call them first as they have the best knowledge of your medical history and can provide the best possible care. If you do not have a PCP or would like a virtual visit you can get one through the Cleveland Clinic Express care online. This visit gives you the opportunity to speak with a medical professional on your smart phone or computer without having to leave your home (during the virtual visits, medical professionals will be able to order COVID testing if they feel it is medically necessary and can guide you on next steps). You can access an online virtual visit through http://www.CCF.org. Click on “start a virtual visit” to start the process. There is an app to download onto your computer or smart phone and from there you can start your visit.
Advance preparation is ideal so you have what you need when you are not feeling well. Find your PCP’s phone number and leave it by your phone or enter it as a contact in your phone while you are still feeling well. Download the CCF Express care app in advance in case you need it – it is easy to put on a phone or computer and it is open 24/7 for care. You will need to enter your name address, email address & insurance information. At this time patients will not be charged for the virtual visits over and above what is covered by insurance. Once in the site, there is a list of physicians whom you could choose & it details the number of patients waiting for a visit before you. It only takes a few minutes to set up and is very easy to use.
Virtual visits are also available through University Hospitals – follow the links for same day care on http://www.uhhospitals.org
It is recommended that if you have to go to the ER, you stay in the same hospital system as your primary care provider for more cohesive care.
Contact and Observation
It will be important for our community to connect with those in quarantine so they do not feel isolated. In particular, our friends experiencing symptoms from the virus, may require additional attention. Toward this end, a team of healthcare professionals in the community have advanced an initiative to help prevent potentially dangerous consequences of isolation. This is especially helpful for individuals who are living alone.
The committee recommends the creation of a buddy system for our friends who test positive for COVID 19 and find themselves in mandatory quarantines. Each person who is positive for COVID 19 should ask a friend (outside of the household) to establish twice daily contact via telephone or (preferably) video chat. The buddy will act as a “second set of eyes” in addition to any family members who are in the home. It is challenging to evaluate a patient’s medical condition, but some basic indicators certainly include common sense determination of whether a person is eating, drinking, and breathing properly (is the patient breathing faster than usual). Additionally, community volunteers who are willing to perform this role with confidentiality and discretion have been identified for anyone who has trouble identifying their own “buddy”. Please let us know if you need a buddy (email@example.com or call 216-848-0379).
Once you are COVID positive and under the care of a physician, you may be advised to monitor your pulse & oxygenation levels. This is a device that is easy to use. A probe that is placed on a fingertip, and painlessly, without penetrating the skin, measures heart rate (pulse) and oxygen in the bloodstream. The exact details for how to use the device, management and expectations for oxygen will be determined by your physician because readings are to be interpreted differently for each individual person, their particular health needs and medical condition. It would be ideal if every household has a functioning thermometer for each quarantined person in the home – for those in self-quarantine after exposure as well as those in mandatory quarantine and known to be COVID positive.
Agudah has acquired a limited number of pulse oximeters. If needed and recommended by your health care provider, please email firstname.lastname@example.org or call 216-848-0379 with your request, the name of your physician and confirm that you have instructions for use & we will make arrangements to get an oximeter to your home.
Change in Condition
If there is a noticeable change in the observed condition or pulse oximeter readings of a quarantined person, a buddy can help (encourage) the person seek medical care.
Preparation of an Action Plan
Everyone should develop a plan of action upon learning of his or her COVID 19 diagnosis. It is important to recognize that only a very small percentage of people infected by COVID 19 will require emergency medical care, but if such care is required, it can be engaged more effectively when there is a pre-specified plan of action.
Anyone experiencing a true medical emergency should call 911 for immediate attention. If you have any concerns, even on Shabbos or Yom Tov, call 911. Paramedics will come & they can take any necessary vitals.
Individuals should be aware that no will be able to accompany the patient to the hospital (unless the patient is a minor). DO NOT let that prevent the patient from going to the hospital and getting the care they need.
We would also like to encourage and emphasize maintaining hydration if you are ill. Everyone should consult their rav for any shaila, but we are sharing that per the psak of Rav Boruch Hirschfeld as well as information verified by Cleveland Kosher the following options are available and are OK for use on Pesach for Cholim, although they do contain kitniyos. First choice would be Pedialyte as well as WHO oral rehydration solution. Other options would include Gatorade or Powerade. There is also an at home rehydration solution. Recipe: 8 teaspoons of sugar, 1 teaspoon of salt, 1 liter of water (approximately 5 cups). Stir the mixture until the salt and sugar dissolve.
It is our prayer and hope that everyone will stay healthy and have a Chag Kosher V’Sameach.
Based on success in other countries, the CDC is now recommending that people wear cloth face coverings when out in public and social distancing can’t be maintained, e.g. grocery stores and
pharmacies. I would add Jewish stores as well. The reason is that as cases mount in an area (as they are in many Jewish communities), there are many people who are infected but don’t know it. Some may have no symptoms at all, but might still be able to spread the virus by coughing, sneezing, or even talking from a close distance. By wearing a cloth mask you may be protecting others, and if others are wearing them too, they will protect you. Kol Yisroel areivim zeh b’zeh! And wearing gloves may protect both you and others.
DO NOT WEAR SURGICAL MASKS OR N95 RESPIRATORS – leave them for the professionals who desperately need them.
THEY ARE EASY TO MAKE! They can be made with or without sewing! For example, a t-shirt and scissors is all you need! Or a bandana and a coffee filter! Instructions here: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html (Consult your Rav about the permissibility of making these during Chol HaMoed)
by Mendel Singer, PhD, MPH (Master of Public Health)
The consensus is remarkably broad: Rabbinical experts, leading physicians, the CDC and Hatzolos. They all agree. People should not be traveling for Pesach. People from the hard hit NY/NJ/CT area especially should not be traveling and shouldn’t be leaving home except for the true necessities. In Lakewood, Rabbinic and medical leaders are telling people not to get together for Pesach – even within Lakewood! This is very hard to do. New chossonim and kallos will be making Pesach by themselves. Families will be apart. It will be hard logistically and emotionally. It may mean using kulos you normally wouldn’t rely on. But is it really necessary? But my (fill in the blank) can’t make Pesach. Can’t? There are some cases where this is literally true. But we need to
ask ourselves – what if being together for Pesach causes, chas v’shalom, a tragedy? Hashem would know. Your family would know. Certain friends and neighbors would know. But most importantly, you would know. How would you live with yourself? After all the experts said not to do it.
We are hearing of terrible tragedies, not just sick elderly, but some healthy frum people in their 30’s and 40’s who have died. About 1/3 of cases are age 20-44, and about 1 in 5 of the hospitalization. This is all too real. Who is at risk? All adults are at risk. Some are at greater risk of death than others. How many will get infected? We are expecting several hundred thousand cases in Ohio alone. How many will die? Way too many.
But we can be very careful in the house! We can clean constantly! When a person with COVID-19 coughs, droplets travel up to 6 feet – and onto surfaces. On metal, it survives for about 2 days. And people touch things! And then they touch their face – about every 3-5 minutes, though they aren’t aware of it. If an infected individual is in the house, before they even know they have the infection, they will be leaving the virus around the house. If someone is isolated in the house, they will have touched things first before reaching their area of isolation. Someone else will interact with that person. It is very hard to contain. There are many large families where all members got the infection.
What if the visitors and the local family just all self-quarantine for 14 days? But it may be much, much longer than 14 days. During those 14 days, if someone gets infected, you now have 14 days from then. That could repeat again for each person in the house getting infected. 14 days could easily turn into a month. And what happens if you have trouble with your refrigerator/oven/plumbing around/during Pesach? How do you get it fixed?
What we don’t know can kill. How many people are infected but show no symptoms? We can’t know until we have capacity to do population testing. Can these people without symptoms transmit the infection – yes, but we don’t know how common that is. How many children are infected without symptoms and able to transmit? We don’t know. Does recovering from the virus mean you’re immune? Most likely, but we don’t know for how long. It certainly isn’t expected to be lifelong immunity. Will immunity last until the end of this outbreak, including potential second wave in the fall? We don’t know. We know some people have tested positive within a month after recovering and having tested negative, though the cases we know about haven’t had symptoms. Can they transmit? We don’t know. But we are literally learning more every day.
But maybe we will all end up getting it eventually anyway? The extreme measures we are adopting is intended not only to minimize the number of cases, but to “flatten the curve” – minimize the number of cases at any one time so we don’t overwhelm our hospitals and intensive care units. This is a real concern. In NY, Gov. Cuomo is talking about a huge shortage of ventilators in the next 2 weeks. Many other states are not far behind. Our local hospitals are very concerned. But that isn’t the only reason to try and delay cases. It won’t be that long before we know much more about the effectiveness of several promising treatments that are being tested now. Delaying cases may mean pushing cases to a time when it can be treated successfully. The stay home measures are critical to saving lives – perhaps someone you love, or even you. A vaccine is a long way off. Several have just started testing, but to know that they work and to mass produce it – probably 8 to 12 months. Meanwhile, social distancing, stay home and various other measures are our primary means of saving lives. That and washing our hands very well and often. 20 seconds, with soap.
In Lakewood they sell “Pesach meals in a box” – all 10 Yom Tov meals for a family of 5 for $349. Where there is need, people step in. Videos are posted teaching how to make Pesach at home. We can do this.
But there’s another way to look at this – a more positive way. We have a very great opportunity. By not getting together with others, by not traveling for Pesach, we can be oisek in the mitzvah of pikuach nefesh! I have confirmed this with HaRav Boruch Hirschfeld, Shlita. How many of us have dreamed of having the chance to save a life, to fulfill the mitzvah of pikuach nefesh? This is your chance. The people who do this mitzvah daily are begging you. And many have changed their plans. Yasher koach to them all!
As a professor who does public and population health, I am speaking out. My colleagues and many former students of mine are working day and night at the Cuyahoga County Board of Health or at/with the hospitals, or other community health organizations. As someone who suffers from an immune system disorder, I can’t be on the front lines with them. I am at home. Like most of us should be.
Stay Home, Save Lives. Pikuach nefesh is literally within your grasp.
Mendel Singer, PhD MPH
Associate Professor and Vice Chair for Education
Department of Population and Quantitative Health Sciences
Case Western Reserve University School of Medicine
An open letter to the Cleveland community,
What I have been seeing daily on the front lines in the Emergency Department astounds me. What I see on the streets of our community horrifies me.
I have started to see more and more out of state license plates gracing our home city. Maybe I am misjudging, but my suspicion is that there are people coming from the New York and New Jersey area for Yom Tov.
Why? Because we can’t make a Yom Tov ourselves? Because our family is pushing us? Because we think we are above the rules? The rules of law and nature?
The coronavius is not particular in whom it infects. You may have it and not know it. The cold you had last week may, or may not, have been it. Devastating effects are seen not just in the elderly and otherwise sick, but in regular people, just like “me”. And for all the numbers of people that have died of the disease that it causes, COVID-19, there is an equal number that have a high chance of being ventilator dependent. Their numbers don’t get factored into the death toll published daily by the Ohio Department of Health, but their numbers are rising exponentially.
Do you think you are more important than your neighbor, your parents, your children? Do you think you are smarter than the rabbanim who have essentially forbidden coming or having family over for Yom Tov? Are you smarter than the medical doctors, epidemiologists and military personnel who do this professionally? Come on people. Think of someone else if not yourself. Stay home. Ma’aras ayin is real and so are the numbers.
Stay home, so I can go to work and take care of those who can’t care for themselves.
I just received a phone call from the manager of a store in the Cedar Green district. He is seeing people from New York and New Jersey coming into his store. He knows they are from there because he has spoken with them on their past visits, and when they order things and leave a New York or New Jersey phone number, or when he helps carry things out to their car and they have New York and New Jersey tags, he knows that these folks are here from out of town. He asked me what I could do about it.
Last week I issued an announcement strongly encouraging people to not host company from out of town at this time especially from these states, and asking for voluntary compliance. I’m disappointed that people are not looking out for everyone’s interest. This is a public health emergency, and we must all take it seriously. Anybody who is now here from New York or New Jersey should immediately self quarantine for 14 days, together with whomever is hosting them. And part of self quarantining is not going into our stores.
I know this is a difficult time emotionally because this is a time of year that we normally spend with our family, and the holidays have great significance. That is all the more reason why we must be vigilant about staying safe. So that we can celebrate the next holiday and the holiday after that and all the ones after those.
Thank you for all the steps you have been taking to keep healthy and minimize the spread of the COVID 19 virus. Staying at home as much as possible, per the Governor’s order, and keeping six feet distance between non-family members, will make a difference to your health, as well to the health of others in our community.
Today I am requesting another precaution to help contain the spread of the COVID 19 virus in Cleveland Heights. Starting immediately, I am asking each resident if you have any visitors coming in from states that have been hard hit by the virus, such as NY, NJ and FL, or if you’ve traveled or recently hosted guests within the last fourteen days, I am asking you to voluntarily self-quarantine for 14 days.
New York, New Jersey and Florida have been some of the states hit hardest by this dangerous virus. Other states that I am also concerned about are CA, IL, LA, MA, MI, PA and WA. I’d like to ask for the same voluntary 14 day quarantine for you, any family members that may have been present, and for those individuals traveling here from those states.
Staying at home, socially distancing, regular hand-washing are just a few important steps we must take to eliminate this virus. Using good judgement, and also self-quarantining when you may have come into contact with higher-risk people are also critical components in keeping healthy.
Remember, you can go out and enjoy our beautiful parks and walking/biking paths, but you must keep six feet distance from non-family members. Take a walk, walk your dog, work in your gardens and enjoy the nicer days we’ve been experiencing. Please stay off the playground equipment as it is not sanitized, and our basketball and tennis courts are closed for the time being.
Beachwood and University Heights have issued similar requests. If we all work together we can minimize our own risk of exposure and the overall health and safety of our families and our community.
I thank you in advance for your cooperation. I wish you good health.
Mayor Jason Stein
Sign up at https://forms.gle/432f2W3U6aGrbBoL8
5-7pm Monday at Lee Road Library.
From Cleveland Patch:
The Heights Libraries will be holding a drive-thru produce pantry on Monday. Guests will not need to leave their car for any reason during the pick-up process.
Full article link: https://patch.com/ohio/clevelandheights/drive-thru-produce-pantry-be-held-monday-heights-libraries
Also, those who are not feeling well (even the slightest), or at high risk for illness (chronic illness, above 60, pregnant, immunocompromised, etc.), are urged to remain home, for their own safety and for the safety of others.
Additionally, anyone who was exposed to someone who tested positive for COVID-19, MUST self-quarantine for 14 days. This is relevant to potential cases in our community (Heaven forbid), or people returning home from other regions, be it the East Coast or Israel. Anyone exposed who does not self-quarantine is mazik the rabim; a very grave sin.
May Hashem protect us,
The Va’ad HaRabbonim of Greater Cleveland
Editor’s note: due to formatting issues, italicized words originally appeared in Hebrew.
Re: COVID – 19
v’Nishmartem m’od l’nafshosechem – Devarim
It is with a heavy heart that we notify the city of Cleveland that effective immediately, all shuls and batei midrash will be closed until further notice, in order to protect our community from the virus which is afflicting Acheinu B’Nei Yisroel and others worldwide, r”l.
We instruct the community not to make private minyanim, indoors or outdoors, even ones that abide by the recommendation of the Health Department to practice social distancing.
Certainly, we must all be extremely vigilant in refraining from all unnecessary socializing, and should only leave our homes out of necessity (i.e. to buy food). We must be especially careful around those who are immunocompromised.
May we merit Yeshuos and Refuos soon,
Va’ad HaRabbonim of Greater Cleveland
Scholastic says the site will remain free and open indefinitely. Full article at https://www.wkyc.com/article/news/health/coronavirus/scholastic-learning-website-coronavirus-closures/95-54c8eac3-b8be-4fe5-be5b-acd6ca8447e1.
Scholastic’s website is https://classroommagazines.scholastic.com/support/learnathome.html
Yeshiva Derech HaTorah has announced closure after school Monday.
Hebrew Academy has announced closure after school Monday through Pesach.
Chaviva High School has announced closure after school Monday.
Excerpt from Cleveland.com:
Ohio K-12 schools will be closed from 3:30 p.m. Monday through at least April 3, DeWine said. The order applies to public, private and charter schools.
Full article at https://www.cleveland.com/news/2020/03/ohio-gov-dewine-announces-3-week-spring-break-for-ohio-schools-to-control-coronavirus.html.
The announcement was made Thursday afternoon after Fuchs Mizrachi School had already announced Wednesday they would be closed out of an abundance of caution. As of Thursday afternoon–though seemingly prior to the Governor’s announcement–Hebrew Academy and Chaviva High School remained open per school communications.
Reprinted in full with permission from Dr. Freedman’s blog at mymdmiami.com/coronavirus/
Robert A. Freedman, M.D.
Board Certified Internal Medicine and Infectious Diseases
Chief of Infectious Diseases Miami Jewish Health Systems
Chief of Infectious Diseases Kindred Hospitals of South Florida
email@example.com (Questions submitted will potentially be answered in future articles/updates)
As an Infectious Disease specialist in the community, who has been fielding phone calls over the past two weeks about the coronavirus from hospital administrators, nursing homes, schools, synagogues, businesses, and patients, it is clear there is a lot of misinformation and fear about this disease. I am therefore putting out a statement to try and answer many of the questions I have received, hopefully to provide guidance to our communities, and allay some fears.
Before discussing the history, details and implications about the virus, I want to emphasize one important key fact: at this point, we must practice social distancing. We cannot wait for an index case, because by the time the index case is known, the disease has mushroomed throughout the community.
Coronaviruses have been around for a long time. The majority of them cause a syndrome like the common cold. In the past two decades we have experienced two new novel coronaviruses, and now a third one. All three have originated in China from an animal food market (i.e. animal to human transmission). The first was SARS (Severe Acute Respiratory Syndrome) in 2002 to 2003, MERS (Middle Eastern Respiratory Syndrome) in 2012, and now COVID 19, specifically from an animal and seafood food market in Wuhan, China. These three new viruses can cause a severe pneumonia and sometimes death. SARS killed 770 people out of 8,000 infected, and MERS killed 3 or 4 out of every 10 people infected, according to the CDC. Unfortunately, because COVID19 is a novel/new virus, we have little information on its epidemiology (how it’s transmitted), and have no antiviral therapy or vaccines at this time. Therefore, the majority of my statements will be based on current knowledge that has been acquired over the past few months. As we have more experience with this virus, some of the information and beliefs about contagion, transmission, incubation, and mortality that I am going to discuss, may change.
COVID19 as of Wednesday 3/11/20 has been declared a pandemic by the World Health Organization. This essentially means it has spread worldwide. Transmission is believed to be from respiratory droplets from people coughing or sneezing which are inhaled by another person or “hand to mouth”. If you shake somebody’s hand or touch a surface that has the coronavirus, and then you touch your mouth, nose, or eyes, you can contract the virus. You are essentially placing the virus onto one of your mucosal surfaces (mouth, nose, or eyes). This is why you hear all the recommendations about repeatedly washing your hands or using hand sanitizer. People would be surprised how many times they touch their mouth, nose, or eyes throughout the day. This is also why they recommend not shaking hands. The most recent data suggests that respiratory droplets carrying coronavirus can remain in the air for up to three hours, which would increase the contagion. They can also stay alive on surfaces such as plastic and stainless steel for up to 3 days, copper surfaces for 4 hours, and cardboard for up to 24 hours. There is also some data that suggests if it is like SARS and MERS, it could remain on metal, glass, or plastic for up to 9 days. In contrast, our knowledge of flu/influenza reveals that it can only remain on surfaces for 48 hours. In a study published in the Journal of Hospital Infection, it was suggested that Coronaviruses could be effectively inactivated by disinfectants that contain 60-71% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite within 1 minute.
The current incubation period is believed to be between 5 to 14 days. This is why people are being quarantined for up to 14 days. Additional concerns with respect to transmission are that it appears people can be contagious prior to developing any symptoms. This is very dangerous, since if someone is well, the individual and his contacts assume that he or she is not contagious. This contributes to the rapid spread we have been seeing. While we are still acquiring more information about transmission, there is some data that suggests that once the patient resolves from their infection, they’ve still been able to isolate the virus from their secretions up to 50 days!
Although the illness can infect anyone, it appears that the disease and its complications are more severe in the elderly and people with immune compromised conditions. Young people seem to fare well with the illness and recover. With respect to disease course, in approximately 80% of the patients the symptoms are slightly milder than the flu, that is: runny nose, sore throat, cough and fever. In severe cases, people can have difficulty breathing. 20% of the patients will develop complications such as Covid 19 pneumonia, and 15% of those will die. As stated above, this mortality is more in the elderly and people with pre-existing immune compromised conditions.
Although the current mortality rate is quoted as 3.4% when compared to the flu which has a 0.1% mortality, I personally believe that the mortality rate from this disease is much less than 3.4%. This is because a majority of patients have a mild illness similar to a cold or mild flu, and they do not come to clinical recognition, that is, they never see a doctor. Mortality rates are calculated based on putting the number of deaths in the numerator and the number of people with the illness in the denominator. Since a large proportion of people are not reporting their illness, because they’re not very sick, the denominator is actually much larger than the current data suggests, which would bring the mortality rate down significantly. I believe as we get more experience with this virus, and have more testing, we will see a fall in the mortality rate.
The classic teaching in Infectious Diseases is to isolate contagious diseases. This is why, travel has been restricted, schools have gone to virtual classrooms, parks and museums have closed, and the NBA has cancelled the season, etc. Social distancing is extremely important. We need to isolate this virus and let it “burn out” within each community, not allowing anyone else in who could carry the virus back into the community. Unfortunately, these decisions are extremely costly, which has delayed the decision to practice social distancing. As leaders however, we have a higher responsibility, not just to ourselves, but to the entire community, and I believe these tough decisions need to be made. This is classical Infectious Disease principles, and if they are adhered to properly and in a timely manner, we will be able to stop the spread. Waiting for an index case to occur in the community before we start practicing social distancing is very dangerous. By the time the patient is diagnosed, they’ve had contact with multiple people, those people have had contact with multiple people, and the disease has already mushroomed and spread throughout the community. Therefore, one should not wait for an index case. There are currently no recommended/approved antivirals (medications) to treat this illness, nor is there a vaccine at present. But we are currently studying some antivirals that may have some promise, and are trying to develop a vaccine as well.
I want to ensure the community that the United States of America has the best healthcare system in the world. We have an infrastructure that is unparalleled. There is a Department of Health in every major city in the United States. We have the CDC, and the National Institute of Allergy and Infectious Diseases, headed by one of the most prominent physicians in the world, Dr. Anthony Fauci. By following the recommended principles and guidelines, we will be able to stem the tide of this pandemic.
I hope this has been informative and educational, and that I have answered some of your questions and concerns.