Monday, July 6, 2020

COVID-19 Update #36

To our dear fellow members of Anash in Crown Heights,

Unfortunately, we have a confirmed new case of COVID here in our community.  It involves someone who went to one of the hotspot states and returned, and shortly after developed symptoms and tested positive. This individual is young and doing well, and has been cautioned to isolate.

On the one hand, it is reassuring that it is not a case of “community spread”, as it was picked up elsewhere. On the other hand, this is how community spread can begin, especially in a framework of questionably waning immunity, and this highlights the critically important message related to travel that we have been addressing these past few updates. 

Bringing in the virus from other communities, at a time when we suspect reinfection may be possible, is a worrisome combination. Purim-time we had no idea of what was happening, and what was to come. Now we stand in a position where in a COVID world of many unknowns, we do need to apply common sense and be aware, in a way that is unique, that we are all faced with the awesome responsibility of taking care of each other. 

We know that travel has from the outset and to this day resulted in significantly increased rates of infection. Ignoring social distancing and not wearing masks when in close contact with others all INCREASE the risk of contracting and hence sharing the virus. Quarantine restrictions are in place, not because they are popular, but as a way of protecting the vulnerable; those that choose to expose themselves have to bear responsibility and follow the rules put in place. This is obviously for the safety of the whole community.

We wish to never forget the lessons that we learned over the past 4 months.  “Vehachai yitain el libo”. We are one family, recovering. Never again can we go through such loss. In the same way that we took care of each other in times of great need, now as things get easier, we need to continue to think of our neighbor first.

Therefore:
  • Take care with social distancing, and mask use when in close contact (particularly indoors).
  • If you don't feel well get tested immediately, and isolate until your status is cleared by a physician.
  • If you are tested positive, then you must isolate, and all those who were in close contact with you must quarantine.
  • Travel less and only when absolutely necessary.
  • If arriving from one of the hotspot states, you must strictly quarantine for 14 days, even with a negative test. 


To clarify some terms:
  • Quarantine relates to one who is not sick or testing positive, but who has been exposed to one who is; quarantine lasts for 14 days from exposure, even if one tests negative during those 14 days. 
  • Isolation relates to one who is sick with COVID or tests positive, and it lasts 10 days after onset of illness AND at least 3 days of feeling well. (In the event one tests positive but has no symptoms, isolation lasts either 10 days from positive test OR after 2 negative tests separated by 24 hours.)
  • Both quarantine and isolation require the individual to stay home and separate from all others who may be susceptible.
  • Please take isolation/quarantine very seriously. Someone’s life may depend on it!


If you have any new COVID symptoms, please fill out this survey: 
For any COVID related questions, please email chcovid@gmail.com.



We remain optimistic that what we are seeing is sporadic in nature only and no cause for general alarm, nevertheless for obvious reasons we wish everyone to pay attention to all of the above.

Looking forward to a healthy and happy summer for all.

Wishing everyone continued good health,
  • The Gedaliah Society, in conjunction with Dr. Rosen

Thursday, July 2, 2020

COVID-19 Update #35


We continue to investigate the issue of reinfection, where a patient suffered COVID back in March, and then recovered fully and developed antibodies. He then became ill again with a COVID like illness after being exposed at work, and had a nasal swab positive for coronavirus. Even more worrisome was that one of his children then also became ill from him, with a positive COVID nasal swab. B”H they are both recovering at this time, seemingly without complication. As this is a fairly unique and unexpected situation, the patients involved are being fully investigated at this time by researchers interested in the immune response to COVID, its durability, and other important issues, which remain to be clarified. A handful of other cases are being actively worked up in the neighborhood, however currently there certainly is NO need for panic that we are witnessing a “second wave”. Nevertheless given the serious nature of COVID and the knowledge that antibodies are rapidly declining in many people, along with the above case, and complicated by many visitors from out of town including from “hotspots” around the country, we find it necessary to issue the following advisory. 

For the past few weeks we have been operating on “green light” mode, feeling safe that most had experienced the virus and that collective immunity would protect us all, including the vulnerable. This allowed us to  gradually open up and resocialize, even bringing the vulnerable out of seclusion. This “green light”  mode was in distinct contrast to our “red light” mode in the weeks following Purim, when we were in a time of crisis. However, with all of the concerns stated above (given the potential danger of a single vulnerable person becoming ill), we feel it prudent to move to a “yellow light” mode at the present time. We are not in the same state of urgency as we were during the worst stage of the crisis, but we are in a more heightened state of alert than we have been these past few weeks. We must all be exceedingly cautious to ensure that our community does not experience a resurgence. Hopefully these cases are isolated phenomena, nevertheless one case is too much!

Therefore:

  • Please be extremely cautious with respect to social distancing, mask use, and hand washing. This is for everyone in the community, whether or not you’ve been sick already and whether or not you’re in a high risk category. 
  • Please avoid crowded indoor settings. This applies to shuls as well, which according to NYS guidelines should currently be operating at reduced (25%) capacity. In addition, mask use is of particular importance in the indoor setting such as shuls and the like. Large shuls where there is significant crowding, visitors from elsewhere, and lack of mask wearing are a very worrisome phenomenon and should be avoided. 
    • Kiddushim/farbrengens in shul causes an additional concern, given the inevitable crowding, lack of mask use, and potential for shared secretions. These should be avoided at this time. The after-davening kiddush where everyone is finally relaxing and has their guard down is not the place to be for anyone who is safety minded.
  • Those from other communities - please, avoid visiting Crown Heights for the time being. This is even more critical when involving those from the “hotspot” states such as Florida and California, where cases are unfortunately surging. NY State requires a 14-day quarantine for all those from those regions. Similarly, those currently living in Crown Heights are advised to not visit those hotspot states for the time being, and they must quarantine on their return if they do so. 

  • If anyone has any new COVID symptoms (fever, sore throat, cough, loss of smell, muscle aches, etc), regardless of whether you may have had COVID already before, please arrange to get tested for the virus. 
    • Please isolate yourself until the results of the virus test are back, and your close contacts should minimize their going out as much as possible. 
      • If the virus test is positive, please isolate yourself until both 10 days from symptom onset have passed AND 3 days of resolution of fever/symptoms have passed. Your close contacts should quarantine for 14 days from your onset of symptoms.
      • If the virus test is negative and you remain ill, then please continue to isolate yourself and get tested a second time after 2 days, to avoid missing the diagnosis. If again negative then you do not need to isolate yourself, and your close contacts do not need to quarantine.




Wishing everyone continued good health,
- The Gedaliah Society, in conjunction with Dr. Rosen

Friday, June 26, 2020

COVID-19 Update #34

On the issue of reinfection, reactivation and persistent infection


There have been reports of people in our community who appear to have had COVID in the past (evidenced by antibody presence, viral test, or classic symptoms) and have since recovered for many weeks, and who now have covid-like symptoms again. Some of these individuals are now testing positive for the virus. What does this mean; how do we interpret this? 


There are several possibilities:
  1. Their body had completely fought off the virus, and then they caught the virus again from someone else, resulting in the second set of symptoms. 
    • This is the most worrisome possibility, and what people typically mean when they say “reinfection”. These people lend credence to the possibility that protection acquired from the original infection is indeed short lived (as witnessed by IgG antibody levels falling quite rapidly as we see), and that given a sufficient exposure to another infectious individual, they may become reinfected and sick with COVID all over again, and may themselves be infectious. They would need to quarantine fully for at least 10 days after the onset of symptoms, just in case this truly is a new infection (even if they have antibodies).
  2. Their body did not completely fight off the virus; some virus remained dormant. That remaining virus was somehow reactivated, causing those second set of symptoms. 
    • This is less worrisome, as it does not necessarily imply community spread. As of this time we have tended to think of people who have the virus as not being infectious 2 weeks after symptom onset. Whether patients with “reactivated infection” truly exist, or this is either option 1 above or 3 below remains to be proven. 
  3. Their body completely fought off the virus, but some viral particles remained in their secretions for many weeks, presumably dead/inactive. Their second set of symptoms was in fact not due to active infection with coronavirus but possibly is a delayed immune response or other infectious cause, however when tested for the virus, the test sensed those remaining viral particles and returned a positive result. 
    • This is the least worrisome, although there is a limit to how long we think dead viral particles hang around for. 
    • In addition, if they had tested negative for the virus (twice ideally) while they were recovered, and then the test turned positive on their second set of symptoms, this option is no longer a reasonable consideration. 



Which one of these possibilities is the true answer, or indeed whether the true answer is a combination of these three possibilities, is still unknown. This is currently one of the most pressing questions about the virus, and one which is being actively researched.  


A somewhat related question is how long antibodies last for. Meaning, even if we assume that someone who interacted with the virus indeed does have protection, we are still studying how long that lasts for, and whether the antibodies are the sole measure of this protection, or does immunity possibly rest elsewhere in a profoundly complex human immune system (and not necessarily dependent on antibody levels). Again, this is something being studied, and we hope that for the majority of people protection lasts at least several months and more. 


Practically: 
  • If someone already had covid (by antibodies, viral test, or classic covid symptoms) and is now experiencing a second set of typical covid-like symptoms, please do get tested for the virus. If the test is positive, please isolate yourself until 10 days have elapsed from the beginning of the symptoms and your fever/symptoms have resolved. 
  • If someone already had covid (by antibodies, viral test, or classic covid symptoms) and then later has a positive viral test but is not having any covid symptoms, they do not need to quarantine, however they should be very careful with mask use and social distancing.



When we speak of the possibility of NEW covid cases in Crown Heights, we are referring to individuals who have never had covid symptoms and never had positive antibodies/viral test, who then develop covid-like symptoms and test positive for the virus. Such a situation would truly be a new covid case. Boruch Hashem, after speaking to the various primary care offices and medical practices in the community, we still have not had a NEW case in many weeks. The more sobering news is that we may be currently dealing with a case of reinfection locally, with all its possible ramifications.


As we go from Gimmel Tammuz, where there surely were visitors from states that are going through surges in infection rates, we urge everyone to be particularly attentive to any symptoms suggestive of COVID, and immediately to see your health care professional, or one of many free city testing sites, so that we can protect all those who may be vulnerable.


PLEASE DO NOT GO TO SHUL OR OTHERWISE SOCIALIZE IF YOU FEEL ILL IN ANY WAY!


If anyone has any new COVID symptoms, regardless of whether you may have had COVID already before, please fill out this survey:  


Summer camps:


We have been attempting to create a unified approach to overnight camp policy, in particular with respect to screening campers/staff before camp, although the effort is limited by local policy and guidelines, as well as the inherent uncertainty that remains about the virus and its spread. The greatest risk revolves around campers and staff from out of Crown Heights who have not had the infection, and particularly those from “hotspot” states, such as Florida. The safest option would be to limit travel from out of town for those who have not yet had the virus.  If travel is necessary from these “hotspot” areas, then for the safety of all campers and staff, these individuals must not come to camp without the required testing and quarantine period. In addition any camper/staff who has had first degree contact with an individual suspected of COVID should quarantine for 14 days at home and be tested twice for the virus (nasally) before coming to camp. Double testing is a higher standard that we consider reasonable under the current circumstances. It goes without saying that any camper/staff member who in any way feels ill should receive proper care and testing prior to going to camp.


We wish to once again reiterate the appeal for limited travel to and from Crown Heights, in order to reduce the possibility that vulnerable people may become infected, as they increasingly come out of shelter in order to resume normal life. We would like to urge all those who remain vulnerable and at risk to continue to be mindful of strict social distancing and mask use. 


Wishing everyone a Good Shabbos, and a gezunten zummer,
  • The Gedaliah Society, in conjunction with Dr. Rosen

Friday, June 12, 2020

COVID-19 Update #33

We have been in touch with the local primary care offices and urgent care, and boruch Hashem we have not heard of any new confirmed COVID cases in the Crown Heights Jewish community. We hope that at some time in the near future we will have developed an effective vaccine and we'll all be equally protected, but until that time there will remain an element of danger whilst socializing with others. That risk is not equal for all. Both the individual as well as the situation, along with the extent of social distancing and personal protection, will determine any one individual’s risk of ch”v contracting the disease.

As discussed in previous updates, the presence of antibodies OR a clear history of the illness indicate a significant interaction with the virus, and we suspect and hope that these individuals are protected at least in the short term. These individuals are also unlikely to be infectious to others for the time being. In addition, current thinking is that children probably do not play a major role in transmitting the illness.  Of course, applying general principles of virology in the face of a truly “novel” virus is tricky at best. However we must move on from here (whilst we are still learning) and we thus make the following suggestions, hoping that all will be well.

It is unclear what percentage of children with symptoms develop antibodies (given how mild their symptoms are and lack of clarity concerning antibody response in children), although an initial analysis of 300 Crown Heights children suggests that about 50% of children in our community have antibodies. In the adult population, the majority in this community have interacted with the virus (evidenced by their illness, antibodies, or both). This therefore leads us to reasonably assume that there is a substantial degree of immunity locally within our community. Given what we know about the infectivity of this virus at this time, the population of “immune” members of the community will hopefully provide protection for those who are older (or have underlying health issues) and have not been sick. We are therefore no longer advising these at risk individuals to strictly isolate and remain indoors. However, there remain many unknowns about this virus, and therefore these at risk individuals should be very careful when they do socialize or leave their homes.  While they may associate with family and Crown Heights residents, perform errands, and go on other necessary outings, we strongly encourage them to observe strict social distancing, mask use, and frequent hand washing, especially while interacting with people who may not have had the illness. 

It is this immunity perspective of our own local community which cautions us against mingling with those from other communities to the extent possible, particularly where there is active virus and/or many individuals who have not been sick. This is the basis for our request asking people not to come visit Crown Heights for the foreseeable future, including gimmel Tammuz, as outlined in the recent letter. It is for this reason as well,why indoor weddings with out of town guests causes us such concern - the general risk of a crowded indoor gathering is significantly compounded by the presence of visitors from other communities and countries.

In a similar vein, when it comes to local day camps over the summer, we are advising that only local Crown Heights children attend. Under those circumstances, the risk is very low and we are therefore not advising that children be tested for antibodies or the virus prior to day camp (and neither is such testing mandated by NY state law).  

Overnight camps have been prohibited from operating in New York State. With respect to overnight camps occurring in states where they are allowed, we believe once again that if Crown Heights children are in attendance, antibody or virus testing in these children would not be necessary. The relatively low prevalence of antibodies and very uncertain history of illness in children make it difficult to assess risk in this group, although we remain reassured by the relatively mild course in the vast majority of children. 

With respect to shuls, many shuls have begun reopening in limited capacity. Given the indoor nature and potential for crowding, we continue to advise appropriate distancing within the shul to the extent possible, and discourage older at risk people from attending for the time being. (For this reason, kiddushim/farbrengens in shul pose a challenge, due to the significantly increased chance for breakdown of distancing, with no masks.) A similar approach is advisable with respect to the men's mikvaos, to operate in a way that optimizes distancing while discouraging those older at risk individuals from attending. 

Anyone with new COVID-like symptoms, please log that here New COVID Registry. It is critical that you contact your doctor and arrange to be tested, and isolate yourself and any contacts that have not been sick. We will continue to update the community as things evolve and hope and pray that the reassuring trends continue.

Wishing everyone a good Shabbos, 
- The Gedaliah Society in conjunction with Dr. Rosen

Friday, June 5, 2020

COVID-19 Update #32

To the best of our knowledge, there remain no new cases of confirmed COVID within our community over the past few weeks. Presumably, this is due to the large percentage of Crown Heights that has been already affected, conferring a substantial degree of immunity to us as a community. We hope and pray that this trend continues, and that we see no cases in the future. 

Given these continued reassuring trends, we are encouraging people to attend to all of their social needs, especially ensuring that children and the elderly receive what they need for their physical and mental health. Those who are older and at risk can associate with their immediate family, and leave their dwellings if necessary; when interacting with others, the vulnerable should still practice “social distancing”.  Children and younger families (as well as others who have already been sick or have antibodies) may associate together, particularly in smaller groups, and outdoors. 

We as a community are all in this together, and share a mutual responsibility for our continued wellbeing. At this point in time, the single most effective thing we can do for our continued health as a community is to ensure that we identify any new cases quickly and effectively.  To that end, it is crucial that anyone who develops new COVID-like symptoms call their doctor and arrange to be tested, and strictly isolate themselves.  The importance of this cannot be stressed enough, and it is each of our individual obligations to this cause that will keep us protected as a community. In addition, anyone with new symptoms should please report them here New COVID Registry.

Wishing everyone a good Shabbos, 
- The Gedaliah Society in conjunction with Dr. Rosen

Thursday, May 28, 2020

COVID-19 Update #31

Following the previous updates, we’ve received many questions as to the parameters of cautious resocialization, and we’d like to further clarify and outline some of these guidelines.  As stated many times, although we are reassured by the current lack of new cases in Crown Heights, there is much about this virus that remains unknown, and this must be balanced against the psychosocial considerations, of which there are many. The following comments pertain to our community here in Crown Heights only. 


On the individual level: 

With respect to resocializing, the following principles apply:
  • The younger and healthier one is, the lower the chance of getting dangerously ill.
  • Those that have already been ill with COVID, either with convincing symptoms OR with positive antibodies, to the best of our knowledge are: 
    • More likely to be protected from getting infected, at least in the short term
    • Less likely to be contagious if they have not had symptoms recently
  • At least to some degree, masks and social distancing decrease the spread of the virus.
  • All else being equal, outdoors is safer than indoors


It is with these principles in mind that we attempt to put out guidelines, as a general frame of reference. There remains many unanswerable gray zones, and at some level, individuals will have to use the guidelines to make their own individual risk assessments. 
  • To those above 65 (or who have significant underlying health issues such as diabetes and lung disease) who have NOT been sick and do NOT have antibodies, please continue to take significant caution. 
    • If it is beneficial for you to have family members visit, then masks and social distancing should continue to be maintained, and family members who have already been sick pose a lower degree of risk than family members who have NOT been sick. 
    • If it is beneficial for you to go outside for whatever reason, then it is  important to wear a mask and maintain strict social distancing. This includes outdoor minyanim as well, which are discussed below. 
  • To those above 65 who have already been sick OR have antibodies, you are at a lower risk for getting ill than those your age who have not been sick yet. 
    • You can socialize with those close to you, but please be aware that you should take steps to minimize the risk if you can, including distancing and masks to the extent feasible, and preferentially socializing with those who have already been ill. 
  • To those who are relatively young (children, or those in their 20s or 30s):
    • Overall we think the risk of your beginning to resocialize is low. We still advise common sense precaution - avoiding crowded areas, particularly indoors, and avoiding those that are ill, have been recently ill, or have been in close contact with someone ill. 
    • Similarly, we still ask that you wear a mask when going outdoors, to protect those around you. 
  • To those in the middle group, which as a rough approximation is between 40 and 65:
    • When looking at the NYC data on those who have been seriously ill, this group (40-64) has been more seriously affected than the younger group, and therefore a higher sense of caution is advised. 
    • If you have not been sick and do not have antibodies, you should continue to take precautions - you can socialize with those close to you if you feel this would be beneficial, but the attempt should be made to restrict this to those unlikely to be infectious. Social distancing and masks should continue to be adhered to.  Similarly, going outside and on errands should be done as needed, with those similar precautions of masks and social distancing. 
    • If you have been sick already or have antibodies, you may socialize, and please practice the same common sense precautions as the younger group - avoiding crowded areas, particularly indoors, and avoiding those that are ill, have been recently ill, or have been in close contact with someone ill. Similarly, we still ask that you wear a mask when going outdoors.
  • As a general rule, where there is possible danger, one should err on the side of caution to the extent feasible. 


It goes without saying: Even with those low risk groups that are beginning to resocialize, crowded indoor places, such as indoor weddings where there is dancing and mingling in close quarters and a complete breakdown of social distancing, remain potentially dangerous to those unprotected, who may be swept along into a “makom sekana”.  

We must continue to be exceedingly vigilant as to the possibility of new cases in our community, G-d forbid. If anyone has new COVID-like symptoms, please fill this out in the registry: New COVID Registry.  


On the communal level: 

  • Outdoor minyanim are preferred to indoor minyanim
  • Indoor minyanim should follow the guidelines previously posted, which include social distancing (6 feet apart), mask wearing, and other guidelines. 
  • Outdoor minyanim should likewise continue to follow social distancing and masks are advised. Once again high risk individuals (defined above) need to be particularly cautious with mask use and distancing. It behooves other members of the minyan to recognise another’s vulnerability and keep their distance. 
  • Many men’s mikvaos are in the process of reopening. Without strict oversight and guidelines, this poses an unacceptable degree of risk and should not be done. However, with proper oversight, the risk can be significantly minimized. 
    • Those over 65 should not attend the mikvah at this time. Similarly, those ill or recently ill should not attend. 
    • Those who use the mikvah must be particularly vigilant to observe social distancing at all times in the mikvah, as well as hand washing/disinfecting and other issues pertaining to personal hygiene. 



Related to travel (for the foreseeable future, including Gimmel Tammuz):

  • At this time we do not regard air travel as safe for anyone except the lowest risk individuals on essential business.
  • Susceptible individuals who travel outside the community are at risk of becoming ill in a setting where cases are still prevalent. Thus when they return to Crown Heights they should continue to separate themselves from vulnerable others, and monitor themselves closely, immediately reporting any suspicious symptoms.
  • Particularly concerning are those travelling to Crown Heights, who may not have had the virus and who live  elsewhere in places where there may still be sporadic cases occurring, and who are inadvertently carrying the illness with them. In order for all the members of our community (including the vulnerable) to attempt a cautious return to socialization, we must ask those intending to visit Crown Heights to postpone their trips for the foreseeable future. This might not work out with your plans, but it is for our protection. Thank you in advance for being considerate.



For any further COVID related questions, please email chcovid@gmail.com. In addition, if you have not yet filled out the general community survey, please do so here: COVID/Antibody Survey 

With best wishes for a safe, healthy and enjoyable Shavuos. May each and everyone receive the Torah anew, in a joyful and meaningful way! 
  • The Gedaliah Society, in conjunction with Dr. Rosen

Wednesday, May 27, 2020

Indoor Minyanim

Guidelines for indoor minyanim in Crown Heights, current as of 3 Sivan 


  • Every shul must appoint a “COVID memunah” to ensure the following guidelines are kept
  • Only 10 people total inside at a time, in line with current NYS law. 
  • Anyone above age 65 who has not been sick yet (or does not have antibodies) should not attend an indoor minyan at this time.
  • Nobody currently ill or recently ill may attend
  • People who choose to attend an indoor minyan should not “minyan hop” between different indoor minyanim; they should stick to the same group of 10 wherever feasible
  • At least 6 feet distance should be maintained between all those inside
  • All those inside should wear masks
  • Everyone should use Purell/disinfectant on their hands upon entry and exit. 
  • Garbage cans should be available for dirty tissues and the like
  • No refreshments (coffee, mezonos) should be served
  • Time spent in shul should be purely for davening/layning. There should be no speeches, socializing, farbrenging, etc.
  • Only one person should use the restroom at a time
  • There should be no kissing the sefer torah, mantel, etc. The oleh l’torah can touch his tallis to the klaf and then kiss the tallis. 
  • The baal koreh should be the one to take the Sefer Torah from the Aron to the Bimah. The magbiah takes the Sefer Torah back to the Aron. 
    • A mask should be worn by the magbiah and golel.  Although everyone is asked to wear a mask, this is being reiterated here for emphasis.  
  • Regarding someone getting an aliyah:
    • A mask should be worn by the oleh letorah.  Although everyone is asked to wear a mask, this is being reiterated here for emphasis.  The baal koreh should wear a mask as well, to the extent feasible.
    • Only someone who has already been sick or has antibodies may get an aliyah
    • The oleh letorah and baal koreh should, to the extent possible, not face each other during the layning. 

If you do not think your shul can adhere to the above guidelines, an indoor minyan should not be conducted. 

Outdoor minyanim (with safety guidelines followed), in particular porch minyanim, are still preferable from a safety point of view, if feasible, and should be maintained wherever possible. In addition to the safety issue, this will assist with the overflow of those who won’t be covered by the indoor minyanim based on the NYS law.

If NYS law changes after the writing of these guidelines, they will be updated accordingly. Similarly, if the situation in our local community changes (we begin to see new cases, chas veshalom), these guidelines will be updated accordingly. 

בברכת קבלת התורה בשמחה ובפנימיות