Covid-19 Update from Dr. Akiva Bergman

As the weather improves and numbers of infections in our neighborhood continue to drop, B”H, we look forward to

positive developments and better times IY”H.

Entering into Shabbos and anticipating beautiful weather

makes us hopeful and upbeat,

as we should try to always be.

Nevertheless, along with all this we must continue to maintain our vigilance in avoiding health risks

and being careful not to relax the social distancing protocols

that must be kept in place,

in order to save lives. Some of our daveners, have been in

life threatening conditions.

An individual who frequently davened with us, is no longer

here.

There is a lot of confusion and conflicting information about wearing masks, and testing, and other matters. Therefore,

I am sending you an update written by Dr. Akiva Bergman

that provides the correct information in a clear way. I want to add that Dr. Bergman is completely knowledgeable about the subject.

Wishing you a wonderful and safe Shabbos

and missing you all.

Rabbi Yechiel Yitzchok Perr

**********

COVID-19 Update: May 1, 2020

Dr. Akiva Bergman

1)      Masks and face coverings:

The CDC strongly recommends that all people (including children

over age 2)

wear a mouth and nose face cover in public settings

where social distancing measures are difficult to maintain

(e.g., grocery stores and pharmacies).

Masks are not required when you are 8-10 feet away from other

people- as should be the case when walking with your spouse or

family on Shabbos afternoon

. Nevertheless, in situations where

one may end up interacting with others, it’s a good idea to err on

the side of caution and wear a mask.

N95 masks are not needed, as even simple surgical masks or any

cloth covering suffices.

2)      Plasma donation:

After an extensive and thorough investigative process, it has been

decided that there will not be a local drive for plasma donation. In fact,

at the current time, the system has more donors and has collected

more blood than it anticipates needing. If chas v’sholom the situation changes, local Askanim will work to facilitate local screening

and donation.

3)      Antibody testing, Contagion, and Immunity :

There’s a lot of talk regarding various antibody tests that have become available, and if they demonstrate immunity from the disease. Here is a summary of what we know at the current time:

Fingerstick antibody testing is unreliable and should not be done.

People will benefit from a better understanding of the antibody

testing that is performed with a regular blood test drawn in a doctor’s

office commercial labs including Quest Diagnostics and LabCorp with a simple prescription from a physician.

As an introduction- please refer to the following graph:

To fight an active infection, the body forms IgM antibodies which are

detectable 5-7 days after catching a virus and disappear after

approximately 21 days. The body then forms IgG antibodies which

remain in the blood to ward off further infection from that virus.

Depending on the type of virus, these IgG antibodies may confer

immunity for a short term or long term. Doctors routinely use blood

tests to measure levels of IgG as a measure of immunity to Measles,

Chicken Pox, and other viruses. This is different from the viral

RNA PCR nose swab test that detects actual virus.

While preliminary evidence indicates that IgG antibodies to COVID-19

will confer immunity, it is the unanimous opinion of the CDC,

Department of Health, all physicians (and even the labs themselves-

as printed in several paragraphs under the result of the test) that

COVID-19 antibody testing may not yet be used for decision making for individuals or larger populations. While IYH it will be helpful in the future, a positive test for IgG does not yet allow one to relax any social distancing protocols.

While this alone should suffice, I will mention a few reasons for the

consensus opinion:

a)      You may still be contagious to others even if you have formed

IgG antibodies. IgG is just a potential indicator of immunity, not lack of contagion to others. This is certainly true for people who had mild or no symptoms but is true even if for those who had a positive nasal swab

test and have been asymptomatic for several weeks. As a case in point,

several local individuals tested positive again this week for active virus-

a month after their symptoms resolved and at the same time they have

IgG antibodies.

b)      It is possible that one has developed IgG antibodies but not at

the minimal level needed to confer immunity. Furthermore, the blood

tests done by Quest and Labcorp are just “qualitative” tests which give

a “positive” or negative” result without indication of a level of antibody.

Even the “qualitative” tests that were done by Mount Sinai as screening

for plasma donation which provide a level of antibody may not be used,

as we don’t yet know what level is needed.

c)

It is also important to keep in mind that it has not been

definitively proven that people become immune to COVID-19, and,

as the virus is only four months old, there is no way to know how long

any immunity will last.

d)

It is too early to tell the rate of “false-positive” tests- which could

incorrectly be interpreted as a sign of immunity. This can be the result

of cross-reactivity with other coronaviruses or lab technique. These

tests are just too new to rely on them for decisions that can affect lives.

Again- we certainly hope and expect that IgG antibody testing will be

able to be used on an individual basis in the right clinical context by

physicians in the near future – but it is crucial to understand that this

time has not yet come.

4)      Recurrent symptoms:

There are growing numbers of people who experience recurrent

symptoms several weeks after fully recovering from COVID-19. The

significance of these symptoms is not known. While they likely are just

the result of a delayed inflammatory or neurological process and do

not indicate active disease, (and there is no evidence of multiple strains

of the virus), we can’t be sure that such people are not contagious. It is therefore best to for such individuals to quarantine themselves until

these recurrent symptoms resolve. If you have fully recovered and later

develop shortness of breath you should contact your doctor as this may

be the sign of a different disease process.

5)      Prolonged symptoms:

It is very common to remain easily fatigued with mild shortness of

breath after minimal exertion for weeks after recovering from COVID-19. This is assumed to be the lasting effects of the virus and not active infection.

The significance of prolonged loss of smell or taste is not known.

6)      Public events:

It is incumbent upon all in the community to refrain from organizing

events that may lead to challenges with social distancing. Offers of free

food at local establishments, community Lag B’Omer events, or outdoor concerts will naturally, albeit unintentionally, lead to violation of required

social distancing protocols. Rabbonim are not aware of every planned

event; we all share the responsibility for ensuring a safe environment

in the community.

7)      Cleaning and Household help:

Current social distancing protocols do not allow visitors any type- even

family members who do not live in your home, even if the guests

“had it,” are post-isolation, and are asymptomatic. It is therefore

obvious that outside cleaning help is strongly discouraged. This is

true even if she wears a mask and gloves and frequently disinfects

all surfaces. Even if you and the cleaning help don’t mind exposing yourselves to risk in your home, they very often work in other homes, and therefore your decision affects others as well.

8)      Blood clots:

It has been known for several weeks that COVID-19 appears to increase

the risk for developing blood clots. There are no specific

recommendations for avoiding this. I mention it only to heighten your awareness so that you can contact your physician should a family

member develop an unusual symptom that can be an early sign

of a clot or stroke.

9)      Difficulty sleeping:

Many people recently began to suffer from insomnia and difficulty

sleeping. This is likely not a symptom of COVID-19, but rather is a

natural result of low-level anxiety, alteration of schedule and poor sleep

habits. This will go away on its own, especially with a regular sleep/wake schedule and a relaxation time before going to bed.

10)  Skin rashes and “COVID toes”:

Skin rashes are a newly discovered symptom of COVID-19, particularly

in teenagers and young adults who may exhibit no other symptoms.

The rash can be anywhere on the body and can take any form. One

unique skin finding is red or purple spots on the toes or feet, which

can be itchy or painful and may be the result of micro blood clots.

Skin changes are likely a delayed manifestation that appears after the contagion period, but their significance is not yet understood.

11)  Well-visits:

Several people have inquired about scheduling routine well-visits with

a physician. While social distancing is of paramount importance, and it

best to delay any non-essential medical or dental visits when appropriate to do so, you certainly should heed the advice of your physician or pediatrician if they feel it is important for you or your child to be seen even under the

current circumstances. It is especially important for childhood vaccines

to be administered at the proper time.

12)  Shor Yoshuv medical facility:

A medical facility called “Lawrence Ambulatory” has opened in

Yeshiva Shor Yoshuv under the auspices of Northwell Health. It is no

t a hospital and Hatzalah may not transport patients there. Although

this is subject to change, its sole function is to triage those who

believe that have symptoms of COVID-19. Please note that they do

not offer antibody testing and do not perform COVID-19 tests on

asymptomatic patients. One may schedule an appointment Sunday-

Friday between the hours of 10am- 7pm by calling (718) 316-6868.