Coronavirus: Is there an end in sight for the pain and havoc caused by a microscopic pathogen?
Photos: AP Images
It started in a far-off Chinese province whose name sounds as foreign as the disease it spawned. But the virus that Wuhan begot is now a looming pandemic, a microscopic pathogen that is spreading panic and death everywhere it lands.
Little is known about this new strain of coronavirus — known as Covid-19, after Coronavirus disease 2019, the year it emerged — aside for the videos seen in China in its early days, at the end of December. People were dropping dead on the street, and healthcare workers were afraid to handle the bodies. On Friday, the number of cases worldwide hit 100,000, and nearly 3,400 have died.
Will this new, rapidly spreading strain rival the deadly Spanish flu outbreak of 1918? Or will it amount to a temporary blip that will disappear as warmer weather arrives?
We just don’t know, said Dr. Reuven D. Cofsky, chief of infectious diseases at Brookdale Hospital in Brooklyn. The only two facts that count, he added, are that coronavirus is much more contagious than flu, and that viruses tend to burn out in the heat of summer.
“The mortality rate for flu is 0.16 percent,” Dr. Cofsky said. “So for the 30 million people in the United States who get the flu every year, the mortality rate is a bit over 30,000. As for the mortality for corona so far — I’m going to mention the numbers in Italy because I trust those numbers more than I trust those from China — Italy so far had about 3,000 cases, with 107 deaths. So you’re talking about a mortality of over three percent. That’s an 18-fold increase over flu.
“Put it this way,” he added. “It’s significantly more fatal than flu.”
Since the conversation with Dr. Cofsky, the number of cases reported by Italian authorities jumped to over 7,000, with over 300 deaths at press time, with the number steeply rising each day surpassing the three percent mortality rate.
“You have to preface whatever you write with the words, ‘That may change very rapidly,’ Dr. Cofsky said. “A lot the things we were told a week ago are obsolete in terms of epidemiology. It may change by the time you finish talking to me and the time you publish. It will, in fact.”
Italian Prime Minister Giuseppe Conte on Saturday imposed a sweeping lockdown on Lombardy, its largest and wealthiest region, and over a dozen nearby regions, putting 16 million people and the major cities of Venice and Milan under the restrictions. The lockdown means that gyms, pools, museums, and ski resorts are shut, and weddings and funerals are postponed.
Fear of the Unknown
Coronavirus is a respiratory disease whose first symptom is usually a fever, followed by a dry cough. It leads after a week to shortness of breath, with some patients requiring hospitalization. More than 95 percent of those who test positive will recover, most of them without suffering anything more severe than a cold. But in the worst cases, coronavirus can lead to pneumonia, severe acute respiratory syndrome, multiple organ failure, and even death.
The virus can lie dormant in the human body for up to 14 days, according to the World Health Organization. Hence, governments are imposing a 14-day quarantine on those who may have been exposed. Covid-19 is spread when those infected cough or sneeze. It also lives on surfaces for days, which means that it can be transmitted to those who touch infected areas. Hand washing — a vigorous rubdown for 20 seconds under soapy water — kills any germs. Not touching the eyes, nose, and mouth also prevents the virus from entering the body.
The virus has already struck New York’s Orthodox community, with an attorney from New Rochelle in Westchester County becoming the second person to be tested positive for the disease in New York. Lawrence Garbuz, 50, is in stable condition, but that illness has since spread to his wife Adina and their two children, a neighbor who drove him to the hospital, a business partner, and that partner’s wife and three children.
Yeshiva University, where Garbuz’s son studies, as well as SAR Academy in Riverdale, the school where his daughter learns, took the unprecedented step of closing for a few days to disinfect their campuses. By the end of last week, the rabbi at the shul where Garbuz davened, Rabbi Reuven Fink, was also infected, as was the rabbi’s wife, who teaches at a Manhattan yeshivah high school for girls.
On Saturday, Governor Andrew Cuomo declared a state of emergency in New York state as the number of cases soared to 89, mostly related to the Westchester cluster.
The virus’s proximity to the frum community has put people on edge. Handshakes have been replaced by fist or elbow-bumps, hand sanitizing dispensers have sprung up in shuls and schools, and there are dozens of reports of downsized simchas and canceled Purim parties. When I was in Albany on the day the Garbuz case was publicized, politicians were fist-bumping instead of glad-handing, and officials were racing out of meetings to take emergency calls.
“It’s the fear of the unknown,” conceded Councilman Mark Levine, who chairs the New York City council’s health committee and who represents the district where Yeshiva University—where the biggest cluster in the region first hit—is located. Levine wondered at the level of panic that has taken hold, noting that the number of confirmed cases is fairly small. “We shouldn’t panic that the worst case scenario is about to pass,” Levine said. “But this certainly is cause for concern and caution.”
Most countries that were hit by the virus have seen a rapid buying spree of gloves, face masks and hand sanitizers, leading to a shortage of these goods. Gourmet Glatt in Boro Park added sanitizing wipes to the store’s entrance, and its baggers and cashiers wear gloves. The Boro Park Center, a local rehabilitation home on 10th Avenue, issued strict rules for visitors. And Chai Lifeline published a two-page pamphlet explaining how to talk to children about the quarantines.
Rav Shmuel Eliezer Stern, head of Rav Wosner’s beis din and rav of Israel’s western Bnei Brak neighborhood, distributed a detailed halachic guideline to address coronavirus questions.
“Whoever must be under quarantine by orders of the doctor,” the brochure states, “should not leave his house, even to perform a mitzvah, in order not to harm others.” He must stay home even if that entails missing parshas Zachor or the Megillah, wrote Rav Stern. Anyone with a temperature of above 100.4 Fahrenheit (38 Celsius) and a shortness of breath may call a doctor on Shabbos. If there is fever but no difficulty breathing, the person should ask a rav, he added.
As confirmed cases in China reached the lowest number since the onset of the outbreak — 44 new cases on Saturday, including 27 deaths — the number in other countries is steadily rising. On Sunday, South Korea reported 367 new cases in just 24 hours, bringing the total cases there to 7,134. In Iran, 49 people are reported to have died on Saturday, and over 6,500 people are reported infected. In Israel, Prime Minister Binyamin Netanyahu called coronavirus a pandemic more severe than any other outbreak in the past century.
“First of all, this is a global pandemic, whether the CDC [the US Centers for Disease Control and Prevention] calls it such or not,” Netanyahu said. “It is a matter of days or hours. It is doubtful whether there has been a similar pandemic in the last hundred years. It seems that the rate of infection is greater than we figured.
“The virus is currently spreading to Africa,” he added. “There is no vaccine, and antiviral drugs are ineffective. Economies are starting to be hurt. Governments are ordering their gates closed. This is important for the supply of products for all economies. Nobody knows how the pandemic will end.”
The number of cases in Israel and New York have been similar, with several dozen each, but the reaction each has taken has been anything but. New York has placed more than 2,000 people in quarantine — healthy people who were in contact with those who have symptoms. Israel, as of the end of last week, has 100,000 people isolated, according to Yaakov Izak, a spokesman for Health Minister Yaakov Litzman.
The health ministry has issued a number of different directives. All of those who traveled in China, South Korea, and Italy, (and 12 other locations) must commit to home quarantine. As well, those returning from international conferences must also quarantine. Israeli citizens who returned from the AIPAC Policy Conference, where three cases of the virus have been confirmed as of this writing, were also ordered to isolate themselves. However, for now, there has been no quarantine placed on tourists from the United States. “There is another order that anyone who comes from outside Israel by airplane — regardless of which country he’s coming from — are not permitted to be in public spaces or events,” Izak added. “This is since we can’t know who else was on the plane with him in such close quarters. But he’s allowed to go wherever he wants.”
The Israeli government is enforcing the quarantine — or the dreaded “bidud,” as it’s called in Hebrew — by performing spot checks and issuing fines. There is technically a threat of imprisonment, but Izak said he doesn’t believe matters will come to that. On Thursday of last week, the government opened eight criminal investigations into people supposedly in quarantine who were not found at home during inspection. “We can’t run after everyone,” Izak said. “We’re talking about tens of thousands of people.”
Gatherings of more than 5,000 people have been banned in Israel. Large kehillos such as Ger and Vizhnitz have canceled the annual mass Purim tish and will be holding smaller ones or none at all, Izak said. Belz, a member of that kehillah confirmed, will be holding the tish as usual since fewer than 5,000 people attend. “All kehillos are in contact with us,” Izak said. “Many of them hung the ministry’s orders on the wall of their shul.”
Quarantines are strictly regulated. Visitors from overseas must find a house where they can spend the 14-day period. A dormitory room is not acceptable, declared the office of Knesset Member Yisrael Eichler, dashing the hopes of bochurim or girls who are returning to yeshivah or seminary. “Only those who can present proven ability to stay in quarantine according to the regulation will be permitted to enter Israel,” Eichler’s memo said.
The first mass quarantine of the social media age has led to exchanges of dark humor, such as “I’m not in quarantine. I just don’t feel like interacting with anybody.”
“They are not permitted to go out of the house but are allowed to leave the room,” Izak explained. “They must be in a room for themselves which no one else is allowed to go into. They must have their own utensils and clothes. No one should hand them anything. If they go to the bathroom, they must sterilize everything before and after. And we are prepared for any eventuality. If there will be 10, if there will be 100, if there will be 500, if there will be 10,000, we are preparing for everything. Every hospital has a dedicated space for a corona outbreak.”
“It’s a bummer,” said one Israeli who was quarantined after returning from AIPAC. “I’m supposed to stay in my room, I can’t kiss my kids, and I basically miss minyan, shiurim, and everything else. Not to mention that I can’t go to work. I have no symptoms, but who knows? You can’t take chances with things like this.”
In New York, authorities are working with some old-fashioned sleuthing to tackle the sudden health emergency, Councilman Levine said. These include specialized “disease detectives,” who work for the health department. They pursue clues to determine with whom someone with a confirmed virus has been in contact. There is also a surveillance element. Anyone who tests positive for coronavirus or is under a quarantine order is entered into a photo database that will pick him up if caught in public areas.
“We have really good data here and good ways of tracking those who might have come in contact with corona patients,” Levine said. “It’s part of why the public should have confidence in the quality of the public health infrastructure in New York City. We have health professionals, whom I believe are top notch, who say that they don’t believe we need to wholesale avoid large gatherings.”
But that could change, he added.
“We are certainly ready to take aggressive steps to enforce what’s called social distancing — to close the public schools, to close mass transit, to ban large gatherings. We have the capacity as a city to do that. We have the legal means to do that. But that’s a very weighty decision. Experts are monitoring it hour by hour, minute by minute. And they’re not afraid to make that call when necessary. But not yet.”
Feeling the Crunch
World stock markets have been on a roller-coaster since panic over the coronavirus hit the United States hard last week. The Dow-Jones Industrial Average lost 12 percent in one week before slightly recovering.
The Covid-19 outbreak has the potential to affect every sector of the worldwide economy. Bloomberg News reports that the outbreak could cost the global economy $2.7 trillion and may lead to a recession in the United States, Europe, and Japan. China, the epicenter of the outbreak, has been the hardest hit. So far, automobile sales have dropped 80 percent, and China’s first quarter gross domestic product is expected to contract to 1.2 percent, the lowest on record. As the world’s most populous country, many international corporations – from Starbucks to Caterpillar – do business there. Their sales will surely suffer as China attempts to right itself.
As Pesach approaches, hotels and trip organizers are already feeling the crunch. Benjy Isenberg, CEO of PesachIsrael.com, said that he’s only had one cancellation so far for his program at Hotel Nir Etzion near Haifa, but he is already informing guests of their options if the situation worsens.
“So far, we’ve only had one person cancel due to flight difficulties, and even they still want to come and have said they will rebook if they can arrive safely at the end of March,” Isenberg said. “But we have received quite a lot of questions about ‘what-if’ scenarios, which is why we released guidance notes. Much is dependent on the impact to plane travel and whether passengers will have a quarantine placed on them.”
Strengthen or Weaken?
With so little information about the virus, medical professionals have been looking back at history for corollaries. Epidemiologists vividly recall the MRSA eruption of 1991 and the SARS outbreak of 2002. Those did not really affect Western countries, although fears and the cost of quarantining and isolating suspected cases had a deep economic impact. The big one, by far, is the Spanish flu outbreak of 1918 that killed up to 40 million people worldwide.
“That was a new strain,” Dr. Cofsky said. “Young, healthy people were dying from basically bleeding into their lungs. They had no immunity.”
In all probability, Dr. Cofsky said, we will know within two weeks whether Covid-19 will strengthen or weaken. “If this dies out in the summer we’re going to be okay,” he said. “If not, we’re going to be much worse.”
So, here’s the big question. Should I panic?
“Other than those associated with New Rochelle,” Dr. Cofsky said, “we don’t have a lot of cases. So the chances of you getting it are relatively small.”
One enigmatic component of the virus is that children, usually considered a vulnerable population in diseases such as the flu, are not getting coronavirus at the rate adults are, and when they do, it is in a milder form. Dr. Cofsky has been fielding many questions, including whether people should travel or change their routines because of the outbreak. One young dad called to inform the doctor that he is making a bris on Purim and wanted to know whether he should make the seudah in shul or at home.
“I see more and more people are deciding — no Purim parties. I can’t really justify that if we don’t have any cases. I’m not doing anything different on Purim. You probably don’t need anything other than being smart, handwashing, and avoiding people who cough.”
“But,” he hastened to add, “that may change.”
In America, No Panic — Yet
watch the news from Israel every evening: Passengers at Ben Gurion who have coronavirus symptoms are instantly tested for the disease. People returning from countries where the virus has spread are immediately quarantined. Guidelines are tough, and the health ministry encourages the population to inform on neighbors and acquaintances who are violating them.
Meanwhile, Prime Minister Netanyahu is promising that young people on vacation will be recruited to disinfect public areas; hundreds of telephone receptionists are manning the MDA hotline around the clock; sport events are restricted to under 5,000 people; and indeed all public gatherings, as well as flights abroad, are strongly discouraged. By any measure, this is an emergency situation. You can call it hysteria, but there’s no contesting the facts: Israel has managed to keep the rate of infection low and prevented a mass outbreak that could have overwhelmed the health system.
And in America?
Here everything’s cool. Mass sports events continue being held every evening. Tourists from just about anywhere in the world, except China and Iran, can enter undisturbed. There’s no proper system for guaranteeing that people don’t violate quarantine, and there’s insufficient testing.
It turns out that coronavirus is the vehicle for showing the extent of the partisanship in Washington. The division in America runs so deep that even the means of fighting off a pandemic has become a political issue between the right and the left.
President Trump has hitherto enjoyed an excellent economy, with a booming stock market, record low unemployment numbers, and encouraging growth figures. The last thing he wants in an election year is a setback to the economy.
This is what’s behind the president’s conflicting messages over the past weeks. On the one hand he’s treating the matter seriously, appointing Mike Pence to lead the corona task force. On the other hand, he’s said at least once that the corona is a “hoax,” and that he doesn’t believe the official mortality figures.
The administration’s considerations are obvious: Project business as usual in hopes that the markets remain stable and the economy doesn’t slow. But take Italy: Two weeks ago the country had nine confirmed cases. In 15 days, the number has surged to 5,800, forcing authorities to impose lockdown on a quarter of the country’s population.
As of this writing, more than 500 cases have been confirmed in America. But the only official guidelines are to wash your hands and avoid touching your face. Trouble is, it’s difficult to identify cases when so many Americans don’t have health insurance. If getting tested for the virus can cost thousands of dollars, poorer people may prefer to stay put. Under these circumstances, it’s hard to see how a mass outbreak can be prevented.
The result is profound uncertainty. You have no way of knowing whether the man who’s coughing next to you in the supermarket has corona or seasonal allergies. Based on what we know about this virus, the infection rate is extremely high, and so we’re likely to see a massive upsurge in cases over the coming weeks.
I asked a few American friends if they were worried about the virus. “What’s to be afraid of — it’s basically just flu,” said one with typical American optimism. That means the worst is probably still ahead of us.
If the number of infections soars as predicted — remember, there isn’t nearly enough testing in many states — the American health system will become the key issue of the election. People will want to know how it is that so many people can’t afford to be tested for the virus, risking themselves and everyone they come in contact with.
On the surface, this could play into the hands of Bernie Sanders, who has long promised to get rid of private insurance and create a Medicare-for-All healthcare system like in Scandinavia. This message might not carry him to the White House or even to the Democratic nomination, but it will ensure that Trump faces a Democratic nominee offering increased coverage to the poor (whether it’s Biden and Obamacare or Sanders and Medicare-for-All), a promise that will interest many Americans in the lead-up to the elections.
(Originally featured in Mishpacha Issue 802)
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