Welcome to the weekly newsletter of Igud HaRabbonim, the Rabbinical Alliance of America, in which we share news for and about members, including communal news, announcements, publications, Divrei Torah, press releases and media mentions.
In this newsletter:
• Mazal Tov
• Chaplaincy Newsletter Update
• Rosh Chodesh Sivan Conference This Sunday
• Reopening Shuls
• Divrei Torah: Bamidbar
• Upcoming Yahrtzeits 29 Iyar-7 Sivan
• All That Was Missed, Parts 1-4
• COVID-19 Update May 15, 2020
Please let us know about your family simchos and l"a aveilus, book publications and career changes or milestones, so we can share as chaveirim our life events. Send updates to firstname.lastname@example.org.
Mazal tov to Director of RAA/Igud, Rav Moish and Sorah Schmerler on the bar mitzvah of their son, Yedidyah, celebrated in the privacy of their home. May brocho rest on this bar mitzvah boy whose simcha that was hidden from the public eye.
From the desk of Rabbi Leonard (Yehuda)Blank, MS, BCC
Director of Chaplaincy Commission and External Affairs
Rabbinical Alliance of America/Igud HaRabbonim email@example.com
There is an old cliché’ behind every husband is his wife. My mantra is my wife is my co-pilot. To me my wife has always been my co-pilot and I attribute anything of value that I have done and continues to do to my Ashis Chayil. I am therefore dedicating this article to her. May Keila Lutza bas Tziporah have a refuah shelaima. She has been my guiding light, my inspiration in so many ways. Just this week she gave me the following and with her permission I am sharing this with you. “When things look blue it helps to remember that tomorrow is another day and will be a brighter day”. We all have our challengers and have mentioned many times about emunah and btachen. But, one of the real challenges is the internal fight of “I know whatever the Aibershta does is for the best”. Yet, emotionally, how can a person face the unknown or the “what will be” and still have that emunah and btachen. Yes, we daven and can cry out to the Aibershta our Hailika Tatte. But as I mentioned in previous articles it is wise to seek the advice and brachos from our mentors, our Gedolim and if need be a counselor whether it be a social worker or a psychologist and of course the support of those who are our loved ones. Through the years, I have been zoche to know Gedolim. worked and collaborated professionally with those in the health and mental health field. In addition to my chaplaincy and other positions, I spearheaded the Manhattan Coalition on Mental Health Issues of the Elderly and was the Executive Director of the Lower Manhattan Health Care Coalition. Perhaps one day, I will share with you why she encouraged me to pursue the reasons I spearheaded and co-chaired the Manhattan Coalition on Mental Health Issues of the Elderly. Recently, I gained much insight from Dr. Norman Blumenthal who OHEL’s Director of Trauma and Crises Response. I attribute my achievements to the Aibershta, to my co-pilot who continuously inspires me with all her own btachen, emunah and maysim tovim, family, mentors, and many colleagues in the various fields through the years. My wife discourages me from tooting my own horn, so I surely am not going to share any of my other achievements, but to say she gave me as my co-pilot a meaningful flight plan which always includes Torah, Avodah,Gemilus ,Chasadim, kindness and caring for others. Do not look at what was not accomplished, be proud, look at what was accomplished and take it from there. She continues to imbue hope even when hope might seem dismal at times for we trust in the Ribono Shel Olam. “I trust in Your loving kindness, my heart will exultin Your deliverance, I will sing to the Holy One for He has dealt kindly with me”. Psalm 13. 6
It is not uncommon for a person who is experiencing pain or discomfort -physical or otherwise to cry out to the Aibershta “why, what is happening to me, what do you want from me”. It should not be looked at as a lack of faith. We should try to have feelings and understanding what he or she is going through. Are miracles possible, can things change for the better. We hope as chaplains and as rabbis to utilize appropriate words of hope, of meaning, with proper wisdom, compassion, respect, care, and knowledge together with the holy words of our prayers to bring comfort and hope to that person.
May all cholim have a refuah shelaima and everyday be filled with much kindness, goodness and comfort. Sincerely, Yehuda Blank
Please take the time to read the following important informational flyers from;
OHEL Children Home and Family Services
TTI= Testing and Training International
CAHE= Center for Allied Health Education
Despite this ongoing Coronavirus pandemic, the Rabbinical Alliance of America will continue its long-standing practice of holding a monthly conference on or near Rosh Chodesh. Therefore, to maintain a sense of normalcy and continuity, lehagdil Torah ulehaadira, we ask you all to please mark your calendars for the Rabbinical Alliance of America’s Rosh Chodesh Nisan Conference which is scheduled to take place on Sunday, May 24, 2020, 1, Sivan 5780, 7:00PM. Due to the current global health crisis, this conference will be streamed online and recorded at Zoom.us Meeting ID 915 0680 5156 Password: igud2020 https://zoom.us/j/91506805156?pwd=dmNTSXJlMmIvMjYvZncrWUkrWDRxdz09&status=success
At the Rosh Chodesh Sivan conference, we will be addressed by our chaver Rav Simcha Green, Director of Chidon of HaTanach (Retired), Rav Zeev Saunders, Rav of Delray Orthodox Synagogue, Delray Beach, FL as well as by our Presidium Chairman, Rabbi Yaakov Klass who will deliver the Administrative report.
Please make every effort to join this important Rosh Chodesh Sivan Igud/RAA Conference during these trying times.
Please remember to complete the Gemara you have chosen to learn for our Chai Ellul Annual Siyum HaShas.
On behalf of the Igud/RAA Presidium and of the Beth Din, I extend greetings of Torah.
Rabbi Mendy Mirocznik
Executive Vice-President, Rabbinical Alliance of America
On Wednesday, May 20, 2020, New York State gave permission to reopen shuls the next day with a minyan metzumtzam — 10 people. Many shuls reopened for Shacharis this morning with strict limitations while others are preparing to reopen on Shabbos or within the next two weeks.
As communities decide when and how to reopen shuls, the following documents can help guide you through the process. Attached are guidance documents from the OU, Agudah and Vaad HaRabbonim of Baltimore, as well as a shiur by Rav Hershel Welcher on reopening and a recent teshuvah from Rav Asher Weiss urging caution and a slow pace.
Question: We are obviously in a very unique situation in this present Covid19 pandemic, which has caused a halt to almost all public gatherings; hence much of Jewish congregational ritual has come to a halt. Is there a way to deal with all that was missed?
M. Goldman Via Email
Answer: Truly, the Corona virus, which has been officially designated by the U.N. as a world pandemic, a serious threat to life and limb. Due to this our President on the federal level, government officials on both state and local levels as well as most other world authorities, have all put in place bans of all sorts and ranges on public gatherings. This has in effect curtailed all public congregational activities. By way of assent the leading Halachic authorities have ruled that there be no minyanim due to the severity of the situation.
Besides our lives being upended, as relates to Jewish ritual everything has been affected if not seemingly nullified. Weddings that had been scheduled, were for the most part not cancelled, but only that couples are now marrying with Spartan guest lists of perhaps ten to fifteen men participating – all spaced apart, due to the high degree of contagion. A similar story describes a current Brit, Bar Mitzvah and Pidyon Haben in this present climate.
Yet all of these are life events that can occur, albeit in much abbreviated form. However, the thrice-daily minyan of Tefillah B’tzibbur – congregational prayer has all been missed. The advantage that Tefillah B’Tzibbur possesses cannot be recompensed. However this being due to matters that are beyond our control, we must rely on the rule anus Rachmona patrei – where the ability to perform any mitzvah is prevented due to matters beyond our control Heaven absolves us from their performance. But what if we can make good on any of these missed opportunities to serve Hashem, would we and could we?
Let us look at some of the matters that have been rendered beyond our control.
Rabbi Aaron E. Glatt, MD, Director of RAA/Igud Halacha and Medicine Commision
With last week’s release of both the OU/RCA and Agudah guidelines, there has been much debate within the local and national Jewish world about what will now happen. Practically, not much has really changed as the official state statute still prohibits religious gatherings:
Pursuant to Executive Order 202.10, all non-essential gatherings of individuals of any size for any reasons (e.g. worship services, parties, celebrations, or other social events) are canceled or postponed.
Further, individuals should not gather in houses of worship, homes, or other locations for religious services until the end of this public health emergency. If possible, religious leaders should consider alternative forms of worship, replacing in-person gatherings with virtual services, such as phone or conference calls, video conference calls, or online streaming.
In other words, the Governor has to first permit us to return to any sort of public religious life (minyanim, weddings, levayos, etc.) as well as educational life (schools and camps) before our rabbonim can decide what is halachically allowable. In the words of a great talmid chocham – we can be more machmir than the governor, but not more meikal. More to come about that at our 9:30 PM Motzei Shabbos Zoom conference.
What have we learned in the past week about the virus and immunity?
A lot! An excellent summary from the CDC published in JAMA stated that viral “burden” (the amount of contagious virus) typically peaks early in illness, and declines as antibodies develop. Antibody titers rise over the subsequent 2 to 3 weeks and then level off. Virus declines quickly during the first week of illness, however the absolute duration that a patient might shed infectious virus is unknown – but is probably not much beyond 7-10 days. Persistent detection of viral RNA weeks after recovery from COVID-19 does NOT represent a meaningful clinical or public health risk, especially in the absence of symptoms. Indeed this is one of the most common questions people ask me – am I still contagious. The NYC Department of Health just declared that COVID-19 positive patients (except those severely immunocompromised) who are feeling better, are at least 14 days from symptom onset, and have no fevers for at least three days, are considered non-contagious. And this is even if they are tested and still have a positive COVID-19 swab test! Therefore, there is NO NEED to get repeat tests.
Most importantly, to date, no human reinfections with COVID-19 have been confirmed. Plus, there is also no evidence at present that such persons transmitted COVID-19 to others after they had clinically recovered. However, this possibility of transmission cannot be ruled out, especially for persons who may be predisposed to prolonged shedding due to immunocompromised states.
Finally, existing limited data on antibody responses to COVID-19 and related coronaviruses, as well as one small animal model study, suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily. The durability of neutralizing antibodies (antibodies that seem to provide immunity) against COVID-19 has yet to be defined; persistence up to 40 days from symptom onset has been described. However, the immune response to COVID-19 is not yet fully understood and definitive data on immunity are lacking.
Bottom Line: We are learning more every day, and our understanding of immunity to COVID-19 is beginning to materialize. But we all must still socially distance for the time being.
What have we learned in the past week about the disease?
Three new findings of interest to discuss here. The above section was quite technical. But low tech works very well too!
1) A just published paper in Nature Medicine showed that loss of sense of smell and taste were among the most reliable early screening findings to identify COVID-19. Among more than 18,000 participants using a smartphone-based app to report COVID-19 symptoms in the U.K. and the U.S., about two thirds who tested positive for COVID-19 had as one of their first symptoms (and sometimes the only symptom) loss of taste and / or smell.
They concluded: “This could be used as a screening tool to help identify people with potential mild cases who could be recommended to self-isolate”. We have been recommending this since early in the pandemic, and now we have solid proof that this is a very smart epidemiologic and public health SIMPLE method of preventing spread of COVID-19. Maybe, in addition to checking temperatures before going back to work, we should give everyone a rose and only those who pass the sniff test get to enter.
2) In a cohort of 1,590 patients in China published in JAMA, a predictive model of severe disease was proven in a validation cohort of 710 patients. What does that gibberish mean? Well, they looked at 72 potential variables, and determined that 10 parameters were indeed independently predictive and could be put into a simple statistically valid scoring system to calculate who will have a better or worse prognosis. Included in the risk score were personal data, symptoms, lab values and x-ray findings.
The score has been translated into an online risk calculator that is freely available to the public (http://220.127.116.11/). An easy tool for physicians to use and help guide treatment to COVID-19 patients and their families at the time of admission.
3) What is known about how COVID-19 is spread? “Superspreading” events involving COVID-19, have been reported. One only has to think about how fast the virus spread within some families and some neighborhoods to appreciate the importance of certain activities / gatherings in promoting illness.
An elegant paper in the MMWR discussed one specific choir practice (think communal shul singing and chazzanus) and the subsequent spread of COVID-19 there, demonstrating the serious potential for spread in tightly packed indoor public gatherings.
Following a 2.5-hour choir practice attended by 61 persons, including a symptomatic index patient, 32 confirmed and 20 probable secondary COVID-19 cases occurred (attack rate = 53.3% to 86.7%); three patients were hospitalized, and two died. Transmission was likely facilitated by very close proximity (within 6 feet) during practice and augmented by the act of singing.
The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission. Very scary indeed.
When will the Governor loosen restrictions and open businesses?
The governor is expected to open up 4 upstate regions in NY today, but none of the downstate regions have met his preconditions for easing restrictions at this time. To follow these criteria yourself, go to the following websites:
The Regional Monitoring Dashboard can be accessed at this link:
What have we learned in the past week about treatment?
Also, a lot! Four important studies demonstrated efficacy using four different treatment regimens.
1) In a retrospective cohort study of COVID-19 patients with severe lung disease (but not on a ventilator), treatment with high-dose anakinra, an interleukin-1 inhibitor, was safe and associated with clinical improvement in 72% of patients. Confirmation of efficacy will require controlled trials.
2) Treatment with interferons may significantly improve virus clearance and reduce levels of inflammatory proteins in COVID-19 patients, according to a new study in Frontiers in Immunology.
Researchers in Wuhan found that treatment with interferon (IFN)-α2b significantly reduced the du-ration of detectable virus in the upper respiratory tract and reduced blood levels of interleukin-6 and C-reactive protein, two inflammatory proteins found in the human body. Such inflammation is assumed to cause many of the complications of COVID-19 illness.
3) A three drug combination – kaletra (a well-known HIV medication), ribavirin and interferon – was shown to improve outcome in patients with milder COVID-19 disease. Kaletra alone has not been shown to be effective but in combination it may be another useful modality.
4) The first US data on plasma therapy were published and are promising. The safety profile of plasma was excellent, and it appeared beneficial in a small group of patients in Texas. Our own plasma experience is now at 100 patients, and we will be completing our analysis in the near future.
How do you think COVID-19 will end?
I was asked this question by a national ID news magazine and this was the answer I supplied.
“It is impossible to predict with any accuracy when we will see the end of this horrific COVID-19 pandemic. I will go out on a limb and provide predictions for the U.S. and globally. We currently are fighting a lethal enemy with our hands tied behind our backs. Without a vaccine, or a safe, oral, effective treatment; and with still insufficient easily available noninvasive rapid testing; the only tool we have to control COVID-19 is social distancing.
While social distancing is an effective tool, it comes with a very high price tag – essentially uprooting society as we knew it.
Social distancing is causing spiritual and economic upheaval (that has not peaked yet); massive unemployment; delaying non-emergency medical care and disease screening; and is disrupting our educational system. In short – it has very negatively impacted people’s lives.
At this point in time, we are struggling to even control spread of disease with these draconian distancing measures. I do not think society as we know it can continue in this fashion for a long period of time. Ultimately, I believe technology will be the only solution besides prayer. My hope is that a efficacious and safe vaccine will be developed for use in early 2021, which will be our best chance for bringing COVID-19 to its knees. Short of that, we will be constantly counterpunching with only moderate success.”
Below is a table put out by Express Scripts updating where we stand today with vaccine development. Human trials have begun and over 70 companies are competing at warp speed for a successful shot. Whether it will take 12-18 months or half that time remains unknown. Be’ezras Hashem it will work.