A Plea From a Frum Doctor

amother

Fri, Oct 09 2020, 4:56 pm

https://medium.com/@joelehrenf.....93289

A Plea To My Brothers and Sisters
Joel Ehrenfeld MD

As a medical student, the first day on clinical rotations is known to be fraught with nerves and excitement. As students finally start interacting with real patients, they get to put into practice everything they had been studying over the preceding two years, but their actions also start having real-world consequences. When I started my rotations on the surgical service, I was completely overwhelmed. There are so many rules in the operating room, and so many people watching the newbies to make sure we don’t mess up. I got yelled at for walking down the hall without the right hat. I got chastised for not wearing a mask when I was supposed to, and I had to be physically moved (and nearly slapped!) when I came close to breaking the sterile field.

When I started residency training as an anesthesiologist, it was a similar situation. I had to wear my mask ALL the time once the sterile equipment was open in the operating room. I had to learn how to maintain perfect sterility when placing epidurals or needles into spaces that cannot be exposed to germs.

Often it felt really horrible when people were quick to spot my lapses. I thought some of the people were mean in how they pointed out my mistakes. And I resented them for it. But my attitude changed over time, and I have come to appreciate the intricacies and importance of infection prevention.

I have seen the horrible consequences that laxity in these areas can bring. And I’ve gotten better at my job over time. Now if someone alerts me if my sterile glove grazes a non-sterile surface, I am grateful to them as I go change my glove. When I walk into a patient room and a nurse points out that I’m not wearing my hat, I thank them. I realize that everyone is/was looking out for the safety of those in our care, and we all must do our parts.

That is why I’m making this plea. I am calling out my community, not because I want to get anyone in trouble. Not because I want to feel superior. But because we can and need to do a better job at protecting the vulnerable members of society.

When COVID came to town in the spring, the importance of masks and other personal protective equipment (PPE) came to the forefront of everyone’s consciousness. I spent dozens of hours in close proximity to these patients and I was there for many intubations, which is the procedure for putting a breathing tube into a patient’s throat. These are considered one of the riskiest procedures for providers, because we are very close to patients’ airways and we are potentially releasing millions of viral particles from their lungs right into our faces. I wore my PPE religiously, and it worked. Despite all that exposure, I never got sick, and I never brought the virus home to my family.

I did, however see firsthand the devastation this virus did to our communities. I was constantly being contacted by spouses and children of patients from our community who had been brought to the hospital where I work. They were beyond distraught that they could not be with their loved ones, and asked me to liaise with the medical teams caring for their family members. I did the best I could, but my heart broke for them. Some of them never got to see their loved ones again. Many of those who did manage to recover had their lives, and the lives of their families caring for them, forever altered. Many suffered permanent organ damage, and many will never regain the level of function they had prior to infection.
I don’t want to go back to the dark days of March and April.
Which is why I’ve taken it upon myself to talk to everyone in my sphere of influence. I’ve had dozens of conversations with friends and family over the last few months, the crux of which was very simple:
Please wear a mask. Please stop shaking hands, and please take actual precautions to curb the spread of this virus.

I reiterate that now. We need to be much better at doing these things. If we had been doing these things like we were supposed to, we wouldn’t be in the mess we’re in right now.
I walked into a popular Borough Park shul on Wednesday night, just as protestors were gearing up a few short blocks away to voice their displeasure at new restrictions on gatherings being placed by our government. There were at least seventy to eighty people at this shul, only one of whom was wearing a mask. I would not believe that sight if I hadn’t seen it with my own eyes. So I recorded video of the encounter to back my story. I wouldn’t share that footage here however, lest I be branded a Moser (informant) by my community.

I am not a Moser. I would not be considered one even if I were to report on specific people or institutions. There are many rulings by leading poskim of our day that it is permissible to inform on a person or institution that is not following public health guidelines because they are placing people in danger. I am pointing out a systemic failure in our world which needs rectifying.
Yom Kippur was business as usual in every single shul (synagogue) I went to. There were no masks to be seen inside the multiple Borough park shuls I visited, even as people increasingly wore them outdoors because of the press presence in the streets.

Can someone explain how we’re protesting shul closures if we’re still not taking any precautions at this stage in the game? How are we in good conscience blaming anti-Semitism for the shutdowns if we still can’t do the basics.
And the issue is not strictly a Borough Park one. The latest trend in our communities is organizing testing drives of healthy individuals so as to artificially lower positivity rates. This phenomenon may have begun in Chasidic enclaves, but has made its way to the Flatbush/Midwood area:
Image for post
Image for post
Yiddish Poster by one of the largest sects in Brooklyn urging testing of healthy individuals in an effort to drive down positive rates and “keep houses of worship and schools running”
Image for post
Similar ad by large urgent care center in the community
Why are we still trying to game the system? I’m sad to say that I’ve been to multiple shuls in Flatbush (which again I won’t name because I don’t want to be that moser), and they are not close to anything resembling compliance. My regular shul had maybe 10% compliance on Yom Kippur
Maybe, just maybe we could focus our efforts on interventions which actually lower transmission, instead of disingenuously trying to artificially lower rates of positivity as evidence that we’re supposedly doing our jobs?

And please spare me the apologetics about how our community has such large families in the small apartments of New York City. While I’m certain that demographic factors did play a role in the pressures we felt to re-open schools and the like, this in no way explains how we completely shunned mask wearing, shook hands with everyone, and did not social distance one iota in shops.

Furthermore, how would this excuse explain the identical behavior we witnessed in the Monsey/Rockland community? Do they also have small New York City apartments there? I am sad to report that resistance to mask wearing was higher in the Rockland shuls I’ve frequented over the last few months than that in Brooklyn.

I have been mocked and ridiculed wherever I’ve gone in my mask over the last few months: “There’s no COVID. We’ve been living life without restrictions for months and nothing happened”
Well this is what’s happening now:
Image for post
Case and hospitalization chart for NYC. Source
Hospitalizations are going up. There are people from our communities in ICUs again throughout the NY/NJ area. A good friend’s father, who was a young 70 years of age, died from COVID over the first days of Sukkos. Did we really need to get to this point?

Experts have been warning to expect a resurgence in the fall. It’s what happens with many common respiratory illnesses. And that is the point of gradual reopening, to allow for quick scaling back if we need to. And unfortunately, because our communities have not been following the rules to this point, we are the first in line to scale back.

Many of my friends (myself included) were traumatized by events in the spring. We have PTSD from watching helplessly as so many died alone. If you won’t do it for those at risk of dying or suffering serious complications from the virus, please take precautions for me and my family. I haven’t hugged my father in over 6 months. He hasn’t been able to kiss his grandkids that entire time

This stuff is real to those of us taking care of these patients. All you need to do is look in the eyes of my co-residents when they realize that patients are being intubated for COVID in our hospital again. There is real fear here.

All this arguing happening now about shutting down schools and shuls could have been avoided, if we had just followed some guidelines. But somehow we knew better.

Instead of blaming officials in charge of protecting public health for doing their job, maybe we can place the blame where it belongs.
Our leaders failed us.
Our Moisdos (institutions) failed us.

Our Askanim (community organizers) failed us.

Our politicians failed us.

And our political pundits and social media influencers failed us.

Our leaders and institutions could have encouraged compliance like they do on other matters they deem important.

They could have made us filter our mouths and noses like they make us filter our smartphones.
They could have said shaking the hand of your neighbor was like exchanging money directly from the hand of the cashier of the opposite gender in the grocery.

They could have encouraged wedding takanos (regulations) to protect the lives of their people just as they encourage takanos to protect their hard-earned money.

If our local politicians (you know who they are) had led campaigns to raise awareness about this as quickly as they did when they broke into shuttered playgrounds in the spring, we wouldn’t be in this mess.

These politicians could have threatened to stop working to secure funding for the offending institutions if they really cared about you as much as they profess right now.

If your social media influencers (not naming names, but again, they know and you know who they are) would really have cared about you, they would have used their positions to popularize mask wearing and to encourage compliance. Instead we got sound bites about standing up for religious rights and about “our hypocritical authoritarian leftist government”.
People are dying and will die because of negligence on our part.
Not because of a lack of warning.

Not because of anti-Semitism.

Because the major political organization in our circles is more concerned about how the media portrays us than how people have been actually acting in the shuls and schools they represent in all matters political. Yes, they can and have put out “guidance”, but they could have easily encouraged actual compliance by threatening to cease working for those organizations who don’t implement mitigation measures against viral transmission. They are somehow very efficient at “defending our rights” but apparently inept at protecting our lives.
Because our political leaders are quick to jump on the airwaves to denounce “oppressive” regulations, but have been silent in the face of all their constituent shuls and schools flouting the rules for months which were intended to keep us safe.
Because we are organizing testing drives of healthy people and those with antibodies in order to artificially drive down positivity rates, instead of taking the steps necessary to truly lower transmission.
Because people were told by their shul leaders that masks were important to wear outside where reporters lurk, but no one was asked to wear them in shul. And they are not wearing them to this day.
It is not too late. Simchas Torah in two days has the potential to be another Purim super spreading event. Please wake up. Please protect me. Please protect my family. Please protect our community.
120

Joel Ehrenfeld MD
WRITTEN BY

Joel Ehrenfeld MD

Amalia

Fri, Oct 09 2020, 5:08 pm

Thank you for posting this. But will it make any difference? Will anyone - even one person - take this seriously enough to even consider changing their attitude and behavior?

amother

Bisque

Fri, Oct 09 2020, 5:20 pm

Quote from the article - "Because we are organizing testing drives of healthy people and those with antibodies in order to artificially drive down positivity rates, instead of taking the steps necessary to truly lower transmission."

I'm not understanding what is wrong with having test drives where healthy are testing, those who are sick are also testing themselves just not as part of the test drives. The percentage that they are looking at to determine closures is based on the number of positive out of the total number tested. I saw a billboard from the city flashing that said wear a mask, wash hands, get tested. The city wants everyone to get tested so why not? Personally I think the percentage they should be looking at is either positive out of total population, or positive admitted to hospital of total population, definitely not positive out of total tested, that only works as a metric if everyone is getting tested! I would have expected a higher positivity rate given it is of total tested, wouldn't most people testing be positive?

-Fed up

amother

Gold

Fri, Oct 09 2020, 5:48 pm

amother [ Bisque ] wrote:

Precisely because we don't understand how the metrics work, is why we shouldn't be interfering with it. It's almost YT, so I can't explain it in detail, but here's some explanations why they are using the number of positives out of the numbers being tested as a metric for an uptick.

https://covidtracking.com/blog.....etric

We can't test the entire population on a daily or weekly basis. So they need to have some sort of metric to keep track of the disease spread. So using such a metric gives them insights to where cases are rising.

If we try to fool them, it may work short term. But in the long run, we will only be harming ourselves.
If the metrics won't match up to what will be going in the actual medical situation, they'll pick up on that in no time. And when they come back with some even more restrictions to counter that, what will we say then?

amother

Ginger

Fri, Oct 09 2020, 6:32 pm

If only the communities that need to listen would listen to him.

amother

Fri, Oct 09 2020, 6:54 pm

amother [ Bisque ] wrote:

The problem is that rabbis and community leaders are asking those with symptoms NOT to get tested and those who feel fine to GET tested. They are trying to mask the positivity rate by not testing any of the sick people who actually need the test!

Fed up.

Laiya

Mon, Oct 12 2020, 1:24 pm

amother [ OP ] wrote:

The mayor himself said he wants everyone in hot zones to get tested, regardless of symptoms or exposure.

Mama Bear

Mon, Oct 12 2020, 7:09 pm

The reason there's nothing wrong with these testing drives is, that in most non-Jewish areas, healthy people regularly get tested for school, work, etc. In our communities healthy ppl are not going out to get tested, ever. Therefore so many tests come back positive, bc only sick people run out to get tested. People got afraid to test, bc they dont want to contribute to the rising number & hence the closure. By running a testing drive we try to present a more balanced number. It's imbalanced if only people with symptoms test.
There are constant ads to the general public to get tested, it's even in the frum magazines. But stam azoi ppl dont get tested. I, for example, never tested. I don't need an ice pick going through my brain for no reason. So getting a decent amount of healthy people tested presents a fairer picture of how bad covid is in that area. Just having sick people test gives a skewed answer.

ChanieMommy

Mon, Oct 12 2020, 7:15 pm

amother [ OP ] wrote:

https://medium.com/@joelehrenfeldmd/a-plea-to-my-brothers-and-sisters-2957e7393289

A Plea To My Brothers and Sisters
Joel Ehrenfeld MD

As a medical student, the first day on clinical rotations is known to be fraught with nerves and excitement. As students finally start interacting with real patients, they get to put into practice everything they had been studying over the preceding two years, but their actions also start having real-world consequences. When I started my rotations on the surgical service, I was completely overwhelmed. There are so many rules in the operating room, and so many people watching the newbies to make sure we don’t mess up. I got yelled at for walking down the hall without the right hat. I got chastised for not wearing a mask when I was supposed to, and I had to be physically moved (and nearly slapped!) when I came close to breaking the sterile field.

When I started residency training as an anesthesiologist, it was a similar situation. I had to wear my mask ALL the time once the sterile equipment was open in the operating room. I had to learn how to maintain perfect sterility when placing epidurals or needles into spaces that cannot be exposed to germs.

Often it felt really horrible when people were quick to spot my lapses. I thought some of the people were mean in how they pointed out my mistakes. And I resented them for it. But my attitude changed over time, and I have come to appreciate the intricacies and importance of infection prevention.

I have seen the horrible consequences that laxity in these areas can bring. And I’ve gotten better at my job over time. Now if someone alerts me if my sterile glove grazes a non-sterile surface, I am grateful to them as I go change my glove. When I walk into a patient room and a nurse points out that I’m not wearing my hat, I thank them. I realize that everyone is/was looking out for the safety of those in our care, and we all must do our parts.

That is why I’m making this plea. I am calling out my community, not because I want to get anyone in trouble. Not because I want to feel superior. But because we can and need to do a better job at protecting the vulnerable members of society.

When COVID came to town in the spring, the importance of masks and other personal protective equipment (PPE) came to the forefront of everyone’s consciousness. I spent dozens of hours in close proximity to these patients and I was there for many intubations, which is the procedure for putting a breathing tube into a patient’s throat. These are considered one of the riskiest procedures for providers, because we are very close to patients’ airways and we are potentially releasing millions of viral particles from their lungs right into our faces. I wore my PPE religiously, and it worked. Despite all that exposure, I never got sick, and I never brought the virus home to my family.

I did, however see firsthand the devastation this virus did to our communities. I was constantly being contacted by spouses and children of patients from our community who had been brought to the hospital where I work. They were beyond distraught that they could not be with their loved ones, and asked me to liaise with the medical teams caring for their family members. I did the best I could, but my heart broke for them. Some of them never got to see their loved ones again. Many of those who did manage to recover had their lives, and the lives of their families caring for them, forever altered. Many suffered permanent organ damage, and many will never regain the level of function they had prior to infection.
I don’t want to go back to the dark days of March and April.
Which is why I’ve taken it upon myself to talk to everyone in my sphere of influence. I’ve had dozens of conversations with friends and family over the last few months, the crux of which was very simple:
Please wear a mask. Please stop shaking hands, and please take actual precautions to curb the spread of this virus.

I reiterate that now. We need to be much better at doing these things. If we had been doing these things like we were supposed to, we wouldn’t be in the mess we’re in right now.
I walked into a popular Borough Park shul on Wednesday night, just as protestors were gearing up a few short blocks away to voice their displeasure at new restrictions on gatherings being placed by our government. There were at least seventy to eighty people at this shul, only one of whom was wearing a mask. I would not believe that sight if I hadn’t seen it with my own eyes. So I recorded video of the encounter to back my story. I wouldn’t share that footage here however, lest I be branded a Moser (informant) by my community.

I am not a Moser. I would not be considered one even if I were to report on specific people or institutions. There are many rulings by leading poskim of our day that it is permissible to inform on a person or institution that is not following public health guidelines because they are placing people in danger. I am pointing out a systemic failure in our world which needs rectifying.
Yom Kippur was business as usual in every single shul (synagogue) I went to. There were no masks to be seen inside the multiple Borough park shuls I visited, even as people increasingly wore them outdoors because of the press presence in the streets.

Can someone explain how we’re protesting shul closures if we’re still not taking any precautions at this stage in the game? How are we in good conscience blaming anti-Semitism for the shutdowns if we still can’t do the basics.
And the issue is not strictly a Borough Park one. The latest trend in our communities is organizing testing drives of healthy individuals so as to artificially lower positivity rates. This phenomenon may have begun in Chasidic enclaves, but has made its way to the Flatbush/Midwood area:
Image for post
Image for post
Yiddish Poster by one of the largest sects in Brooklyn urging testing of healthy individuals in an effort to drive down positive rates and “keep houses of worship and schools running”
Image for post
Similar ad by large urgent care center in the community
Why are we still trying to game the system? I’m sad to say that I’ve been to multiple shuls in Flatbush (which again I won’t name because I don’t want to be that moser), and they are not close to anything resembling compliance. My regular shul had maybe 10% compliance on Yom Kippur
Maybe, just maybe we could focus our efforts on interventions which actually lower transmission, instead of disingenuously trying to artificially lower rates of positivity as evidence that we’re supposedly doing our jobs?

And please spare me the apologetics about how our community has such large families in the small apartments of New York City. While I’m certain that demographic factors did play a role in the pressures we felt to re-open schools and the like, this in no way explains how we completely shunned mask wearing, shook hands with everyone, and did not social distance one iota in shops.

Furthermore, how would this excuse explain the identical behavior we witnessed in the Monsey/Rockland community? Do they also have small New York City apartments there? I am sad to report that resistance to mask wearing was higher in the Rockland shuls I’ve frequented over the last few months than that in Brooklyn.

I have been mocked and ridiculed wherever I’ve gone in my mask over the last few months: “There’s no COVID. We’ve been living life without restrictions for months and nothing happened”
Well this is what’s happening now:
Image for post
Case and hospitalization chart for NYC. Source
Hospitalizations are going up. There are people from our communities in ICUs again throughout the NY/NJ area. A good friend’s father, who was a young 70 years of age, died from COVID over the first days of Sukkos. Did we really need to get to this point?

Experts have been warning to expect a resurgence in the fall. It’s what happens with many common respiratory illnesses. And that is the point of gradual reopening, to allow for quick scaling back if we need to. And unfortunately, because our communities have not been following the rules to this point, we are the first in line to scale back.

Many of my friends (myself included) were traumatized by events in the spring. We have PTSD from watching helplessly as so many died alone. If you won’t do it for those at risk of dying or suffering serious complications from the virus, please take precautions for me and my family. I haven’t hugged my father in over 6 months. He hasn’t been able to kiss his grandkids that entire time

This stuff is real to those of us taking care of these patients. All you need to do is look in the eyes of my co-residents when they realize that patients are being intubated for COVID in our hospital again. There is real fear here.

All this arguing happening now about shutting down schools and shuls could have been avoided, if we had just followed some guidelines. But somehow we knew better.

Instead of blaming officials in charge of protecting public health for doing their job, maybe we can place the blame where it belongs.
Our leaders failed us.
Our Moisdos (institutions) failed us.

Our Askanim (community organizers) failed us.

Our politicians failed us.

And our political pundits and social media influencers failed us.

Our leaders and institutions could have encouraged compliance like they do on other matters they deem important.

They could have made us filter our mouths and noses like they make us filter our smartphones.
They could have said shaking the hand of your neighbor was like exchanging money directly from the hand of the cashier of the opposite gender in the grocery.

They could have encouraged wedding takanos (regulations) to protect the lives of their people just as they encourage takanos to protect their hard-earned money.

If our local politicians (you know who they are) had led campaigns to raise awareness about this as quickly as they did when they broke into shuttered playgrounds in the spring, we wouldn’t be in this mess.

These politicians could have threatened to stop working to secure funding for the offending institutions if they really cared about you as much as they profess right now.

If your social media influencers (not naming names, but again, they know and you know who they are) would really have cared about you, they would have used their positions to popularize mask wearing and to encourage compliance. Instead we got sound bites about standing up for religious rights and about “our hypocritical authoritarian leftist government”.
People are dying and will die because of negligence on our part.
Not because of a lack of warning.

Not because of anti-Semitism.

Because the major political organization in our circles is more concerned about how the media portrays us than how people have been actually acting in the shuls and schools they represent in all matters political. Yes, they can and have put out “guidance”, but they could have easily encouraged actual compliance by threatening to cease working for those organizations who don’t implement mitigation measures against viral transmission. They are somehow very efficient at “defending our rights” but apparently inept at protecting our lives.
Because our political leaders are quick to jump on the airwaves to denounce “oppressive” regulations, but have been silent in the face of all their constituent shuls and schools flouting the rules for months which were intended to keep us safe.
Because we are organizing testing drives of healthy people and those with antibodies in order to artificially drive down positivity rates, instead of taking the steps necessary to truly lower transmission.
Because people were told by their shul leaders that masks were important to wear outside where reporters lurk, but no one was asked to wear them in shul. And they are not wearing them to this day.
It is not too late. Simchas Torah in two days has the potential to be another Purim super spreading event. Please wake up. Please protect me. Please protect my family. Please protect our community.
120

Joel Ehrenfeld MD
WRITTEN BY

Joel Ehrenfeld MD

Thank you, Joel Ehrenfeld and OP...

Reality

Mon, Oct 12 2020, 7:31 pm

amother [ OP ] wrote:

I got an email from child's school about doing mass testing.

The letter was very clear ONLY healthy at the test drive so as not to expose people. If you have symptoms or have been exposed test at your doctor or urgent care center.

Nothing wrong with that. Why the negativity?

Fave

Mon, Oct 12 2020, 7:45 pm

I think every jewish physician wants to get spot in the limelight.

Mothers

Mon, Oct 12 2020, 7:51 pm

amother [ OP ] wrote:

Apparently, it is backfiring.

From Hefkervelt:
-A group called vaad to save the yeshivos and Mosdos hatorah of Lakewood took out ads to stop the mass covid19 testing, claiming there are false positives and it is driving up the numbers of positive cases.

(FTR - I think false Negatives are much more common than false Positives, so the increased testing is just revealing greater positivity levels than they had expected . . .)

southernbubby

Mon, Oct 12 2020, 8:01 pm

Mothers wrote:

We were told that a positive rapid test is 97% accurate but a negative result is only 50% accurate.
I suppose that someone who tests positive can be asymptomatic.

amother

Dodgerblue

Mon, Oct 12 2020, 8:03 pm

https://www.podbean.com/eu/pb-zwmg4-ee8af2

Headlines by r' Dovid lichtenstein.
You will hear the robocall that went around telling healthy people to test, and people with symptoms not to test. R' Dovid explains why that's a terrible idea. Very interesting show (as are all his weekly podcasts.)

youngishbear

Mon, Oct 12 2020, 8:15 pm

Mothers wrote:

I thought this might happen.

The tests will also pick up the positives from people who are no longer contagious but still have viral RNA in their system.

These games are so fun.

Not.

amother

Bisque

Mon, Oct 12 2020, 8:22 pm

amother [ Gold ] wrote:

Can you explain it now? I am really curious? I don't understand how this metric is being used at all, to me it does not make any sense. Are they also looking at positives out of total population?

amother

Seashell

Mon, Oct 12 2020, 8:26 pm

Is Dr. Joel Ehrenfeld Chiili Eherenfeld's son?

amother

Ginger

Mon, Oct 12 2020, 8:33 pm

Mama Bear wrote:

That’s not really true. In our communities people mostly get tested when feeling sick with few exceptions.

NotLazySusan

Mon, Oct 12 2020, 8:35 pm

Mama Bear wrote:

I, for example, never tested. I don't need an ice pick going through my brain for no reason.

This is me, exactly! I wear a mask, social distance, stayed home Simchas Torah...

chestnut

Mon, Oct 12 2020, 8:45 pm

This Dr is right, on every single count.
I was so confused by "please don't come if you're showing signs of covid or were exposed". Hello, who are you testing for covid, then? It's about a testing site in Flatbush.