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A life-saving friendship that lives on after death

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A Johannesburg doctor is battling to come to terms with the tragic passing of his esteemed colleagues who died in a fatal helicopter crash last week. Had he not been attending the funeral of a close friend and patient who died of COVID-19, he could have been on that rescue flight. He had participated in so many of those flights before.

Dr Ronald Hockman’s longstanding friend, Ian Shapiro, 69, was laid to rest at Westpark Cemetery last Thursday, 21 January, at the exact time his colleagues left Johannesburg on board a Netcare 911 helicopter. He had cared for Shapiro night and day for three weeks as he battled the virus, managing to save his life on two separate occasions. Hockman was distraught when Shapiro, in spite of a monumental effort to try to save him, slipped away, unable to “turn the corner and get over the hump”.

Hockman’s colleague with whom he worked side by side, Dr Kgopotso Rudolph Mononyane, and two other respected co-workers, cardiothoracic surgeon Dr Curnick Siyabonga (Sia) Mahlangu, and specialist cardiothoracic and transplant theatre nurse Mpho Xaba were on the fatal flight. They were en route to a hospital in Hillcrest, west of Durban, to transfer a critically ill patient to Netcare Milpark Hospital in Johannesburg for specialised care.

Filled with mixed emotions, a devastated Hockman said, “I could have been on that flight.”

He was one of four (sadly now only three) cardiothoracic anaesthetists that could have been called on the rescue mission. The close-knit team take care of COVID-19 patients needing critical intubation and ventilation procedures in the intensive-care unit at Netcare Milpark Hospital.

Two of his colleagues were in theatre at the time, which left him and Dr Rudolph, as he was affectionately called.

Now Hockman and two of his colleagues are finding it unfathomably hard living with the heavy burden of survivor’s guilt.

This week, as Hockman together with Netcare Chief Executive Dr Richard Friedland stood at the crash site alongside members of the victims’ families during a special memorial ceremony, he wondered why he was spared.

“I almost wish it had happened to me,” Hockman told the SA Jewish Report. “The pain of losing a dear friend on the one hand who I battled to save, and dear colleagues whose death I cannot make sense of, is unbearable.

“We are all walking around in mourning. Some of us have survivors’ guilt,” he said.

His friendship with Shapiro started when the two were at Greenside High School many years ago. “We became close during our bi-weekly gemara shiurim, which we attended for more than 35 years.

“Ian was the star of the shiur. He had such an inquiring mind. He was a remarkable person. I cannot imagine the shiur without him, in the same way I cannot imagine surgery without Drs Rudolph, Sia, and sister Mpho,” he said.

Shapiro’s son, Daniel, said his father’s relationship with Hockman was special. “Dr Hockman saved my father twice. He is an exceptional doctor who would work tirelessly until the early hours of the morning, keeping us informed of his condition, which helped so much. I only hope that by him coming to my father’s funeral he will have the chance to save countless more lives. This is a small comfort.”

Shapiro was this week described by friends and family as a “warm and caring true mensch”, who treated everyone equally and never “uttered a bad word about anyone”.

The longstanding attorney was the father of three sons and the grandfather of six, and an avid Arsenal Football Club supporter. He had a love of Yiddishkeit, and many varied hobbies including music, history, and sport.

He and his wife, Anne-Louise, contracted COVID-19 while holidaying in Cape Town.

Hatzolah Medical Rescue advised them to drive home, which they did, going via Beaufort West. When they reached Beaufort West, Ian’s condition started to deteriorate, which set in motion a mammoth 36-hour emergency operation to get the couple back home as fast as possible after Ian’s overnight stay in a government facility.

Hatzolah helped to facilitate an ambulance transfer for Ian to Bloemfontein, while Anne-Louise drove ahead in the rented car. In a dramatic twist, the ambulance experienced a blown tyre which delayed its arrival by several hours. In the meantime, Hatzolah volunteers Josh Green and Netanel Azzizolahoff travelled by ambulance to fetch Ian upon his arrival in Bloemfontein. They travelled through the night.

“Hatzolah was incredible,” said Daniel.

They got my dad to hospital, and checked in with my mom several times a day as she remained in quarantine.

“Volunteers even offered to do her dishes and sit with her in full PPE [personal protective equipment] to keep her company. They are on another level.”

Hockman said it was a traumatic time for the Shapiro family, who are picking up the pieces of losing Ian, and for his medical colleagues after the crash.

The helicopter crash sent shock waves through the medical community, which is still reeling from the tragedy.

The aircraft crashed near Bergville in northern KwaZulu-Natal, claiming the lives of all on board including Sinjin Joshua Farrance, an advanced life-support paramedic at Netcare 911, and pilot Mark Stoxreiter, who worked for National Airways Corporation.

“All this takes its toll, but you have to carry on. I feel desperately sad for the families left behind. These people were loved by everybody. They were the cream of the crop. I feel profoundly sad and vulnerable.”

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Israel is open – but should we go?

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Israel has finally dropped South Africa from its red list as COVID-19 numbers surge in the Jewish state while the Omicron wave in South Africa begins to subside. But just because the gates are open, should we be going to Israel, especially with infection rates going through the roof?

“There was obviously tremendous excitement that people who are vaccinated can now travel to Israel without going through any bureaucratic hoops,” says former Knesset minister and current olim advocate Dov Lipman. His organisation assists olim to adapt to life in Israel and cope with its bureaucracy. It has been at the forefront of helping olim and their families navigate Israel’s changing travel restrictions during the pandemic.

“However, among the reasons why this change was made is because of the degree to which the variant is spreading in Israel,” Lipman says. “It reached a point where keeping the doors closed just didn’t make sense. So people have to understand that they’re coming into a country where people are getting corona[virus] regularly. Our statistics last week showed that 10% of those arriving in Israel from overseas were testing positive.

“Yad L’Olim is getting regular messages from people saying, ‘Help, I tested positive at the airport’, or ‘I’m visiting, didn’t feel well, and tested positive’, or ‘I tested positive on my test before my flight home’,” he says. “As much as we want to help everyone, once someone tests positive in Israel, there is an automatic quarantine of 10 days [the government may reduce it to seven days]. The authorities are very strict about this. There is also the possibility that the authorities will mandate that you do this quarantine in a hotel at your own expense if you don’t have your own apartment. You need to know this risk before you come to Israel.

“Anyone coming in has to be aware of the very real possibility that they could test positive on their arrival or while they are here,” he says. “And if that happens, they have to do full quarantine before they can leave. As an organisation, we’re recommending that people consider travelling to Israel only if there’s a need. If there’s a family simcha, or a tragic situation, something that cannot be put off. That’s what I recommend.”

For those concerned that this is just a small window of opportunity and that the borders may be closed again, Lipman says he doesn’t think this the case. “I do believe that we will be able to maintain the open skies moving forward. At Yad L’Olim we are working hard with members of Knesset to create a plan now and for the future so that the gates remain open, especially for olim and their families and those that have a special reason to come to Israel.”

He also wants to remind people that “any Israeli can leave the country if they choose to, and that might also be an option for those looking to unite with their families”.

Johannesburg-based travel agent Shana Chrysler says that travelling to and from Israel right now can be complicated. “I cannot tell you how many people are testing positive and having to change at the last minute,” she says. “A family of seven had to cancel this morning [11 January] who were coming for a wedding here [in South Africa]. We had more clients tonight [11 January] cancel due to COVID-19 results – passengers cannot come home if they test positive. South Africa requires a negative PCR test to return. I now have clients stuck in Turkey.”

According to Israeli media, Israel has now begun authorising at-home antigen test kits, seeking to relieve the strain at overcrowded testing centres, and restricting PCR testing only to at-risk individuals. But the switch to home tests has also led to stores running out. Prime Minister Naftali Bennett is reportedly looking to bring in 50 million tests within 10 days. The government is also planning to add 40 new testing centres, bringing the total nationwide to 300.

Since Omicron and the travel bans hit the world late last year, “Yad L’Olim has been busy literally 24 hours a day”, says Lipman. “This includes answering people’s questions about the new rules, guiding people especially when they test positive here in Israel, and advocating for expanding the rules. We have especially advocated for allowing those who have recovered [from COVID-19] to enter Israel, especially if they have a special reason to come.

“On the ground in Israel, people know that that the virus is spreading very quickly,” he says. “They are choosing to stay out of public environments as much as possible. I wouldn’t say that people are functioning in fear because the number of serious cases and deaths isn’t at a place where it’s causing that fear, but people are certainly being cautious.”

But other olim told the SA Jewish Report that Israelis are tired of the rules and many don’t wear masks or use sanitiser in public. And while Lipman cautions against going to the country, many said they thought it was fine to visit Israel. Says Josh Buchalter (24) in Tel Aviv, “The Omicron wave really seems like annual winter flu, for 20-35 year olds at least. I haven’t really spoken to anyone outside of that bracket.

“My girlfriend tested positive and I tested negative. We live together, so it made no sense that I was negative. But either way, our symptoms were really like flu and nothing else. For one to two days we were clearly sick, sneezing a lot. But we rested, and by the third day, we were much better. By the fourth or fifth day we were 100% fine.

“Although it’s a personal decision, my opinion is that if someone is double vaccinated and not a high-risk individual, there’s nothing to fear,” he says. “Besides the 15-degree weather, everything in Israel is sababa (cool)!”

At this point in time, foreigners can enter Israel with no permit provided they are vaccinated with a second or third dose within 180 days of their visit. They must be 14 days from the vaccination date. If more than 180 days have passed since the traveller’s booster (the third dose), Israel will honour it until the end of February 2022.

There’s no automatic allowance for unvaccinated children of any age. If you need to travel with children, you can try to get a permit, but these will be granted only in extreme emergencies.

To enter Israel, you must complete the pre-flight form within 48 hours of your flight. You must get a negative PCR test within 72 hours of departure to Israel or a negative lab-based antigen test within 24 hours of departure. You are exempted from this requirement if you fit the criteria for entry and you have a positive PCR test to show from between 11 days and three months before your flight.

The quarantine period exists until you receive your negative PCR test back from Ben Gurion, or after 24 hours, whichever comes first.

“Recently recovered COVID-19 patients may continue to test positive upon arrival at Ben Gurion,” notes Lipman. “If this happens, please be aware that you must apply for release from quarantine, and it can take time and effort to secure that release.”

To get updates on Israel’s changing travel restrictions, visit yadlolim.org/corona-update

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Experts cautiously optimistic about Omicron

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A 73-year-old Jewish woman with dementia in Johannesburg tested positive for COVID-19 this week, but after 48 hours of being a bit sleepy, she was back to her usual self.

Though she’s one of many people of all ages contracting the highly transmissible Omicron variant, this new mutation may lead to less hospitalisation and death and fewer disruptions to daily life than previous variants, experts say.

Speaking to the SA Jewish Report on Tuesday, 7 December 2021, Netcare Group Chief Executive Dr Richard Friedland said, “What we are seeing across the Gauteng province, which is the epicentre of this new variant, is that the vast majority of patients are presenting mild to moderate flu-like symptoms. We have been treating these patients symptomatically through our Medicross primary care clinics and emergency departments. We have 270 COVID-19-positive cases across our 53 hospitals in South Africa. Seventy-five percent of cases are in Gauteng. About 20% of the cases are in KwaZulu-Natal. We have less than 10% of patients on any form of oxygenation, which is in stark contrast to the other waves when the vast majority of COVID-19 cases were on some form of oxygenation and ventilation. As we speak, we have only six cases being ventilated.”

Friedland thinks this variant is “highly transmissible, but at the moment there’s no evidence of severe illness requiring hospitalisation and leading to death. It’s very early to speculate, but this is the pattern we’re seeing throughout the country. I want to re-emphasise that given that it’s highly transmissible, we still need to continue vaccinating, and most importantly, ensure that everyone is wearing a mask. This is an airborne virus, and mask wearing is incredibly effective.”

“The virus seems to be spreading faster than ever before,” says Dr Darren Joseph, specialist physician at the department of internal medicine at Steve Biko Academic Hospital, on 6 December. “We have seen a high number of re-infections. The feeling on the ground, though, at this stage, is one of cautious optimism. Though we are seeing ever-rising numbers of suspected cases and confirmed positivity, this hasn’t yet translated into a dramatic increase in hospitalisation.”

He points to a recent report authored by Dr Fareed Abdullah of the South African Medical Research Council, “which outlines our hospital complex’s experience very well. At the Steve Biko Academic and Tshwane District Hospitals complex, we saw 166 new admissions with confirmed COVID-19 between 14 and 29 November 2021. Of those still admitted, the vast majority remain out of our critical-care units and roughly two-thirds of our admissions aren’t oxygen requiring. This is in stark contrast to what was experienced at this point in previous waves. Fortunately, vaccination still offers protection, with the report showing that all the current admissions with pure COVID-19 pneumonia were unvaccinated individuals.

“We have also seen a much younger demographic so far in this wave, including a high number of paediatric infections and admissions,” Joseph says.

Though there is cause to be optimistic, “my real concern is that if the narrative around this current wave is that the virus has somehow become less virulent and that this signals the end of COVID-19, we will be sending out the wrong message. The vulnerable remain vulnerable, and if we throw caution to the wind, we still run the risk of having sick patients rapidly overwhelm our limited resources.”

Hatzolah Operations Manager Uriel Rosen says, “Our numbers are rising by 100 a day. We are currently at 1 071 active cases, with 454 new cases this week.” At the same time, “only 1.6% of our cases are on oxygen or need more intense treatment or hospitalisation. This is compared to 10.4% in the last wave. However, we are learning about this variant, and it’s difficult to say categorically that it’s weaker. It doesn’t mean because the numbers of critical are low, there’s no issue.

“Every event where all the protocols aren’t fully observed is a super-spreader,” says Rosen. “It’s spreading like crazy. We need to take precautions.”

Rosen says a lot more children are getting COVID-19. “The highest age group of active cases right now is from 11 to 20. It could be related to children not getting vaccinated or teens having only one vaccination, or it could be how this variant works. No person under 20 on our wellness programme has been hospitalised.”

Regarding holidays, “Go on holiday, but be safe. If anyone from the Johannesburg Jewish community contracts COVID-19 on holiday – even overseas – contact Hatzolah, and we will look after them. We have 115 wellness volunteers and eight staff members that are 1 000% dedicated. They do it with passion and care, with at least 150 to 200 calls a day. We also have eight nurses for intensive cases. There are about 139 nurse rounds per day. We are the luckiest community in the world. At Hatzolah, we are doing it for our brothers, sisters, and family. No Yid gets left behind.”

CSO (Community Security Organisation) Cape Town has witnessed a dramatic rise in cases, from two on 27 November to 127 on 7 December. “They mostly have moderate symptoms, with no one yet requiring hospitalisation,” says director Loren Raize. “This is a drastic change from last year this time, when we had 12 patients already hospitalised out of a total of 47. Close to 90% of our current patients are fully vaccinated, and 5% are partially vaccinated.

“Current patient demographics show that the majority are between the ages of 21 to 30 (30%) followed by 51 to 60 (18%),” she says. “We are expecting an influx of holidaymakers which we have prepared for. We hope that people won’t avoid testing to avoid holiday plans being changed or cancelled.” At the same time, “rushing out to get a test as soon as you are informed of a positive contact is counterproductive and can result in a false negative. This only compounds the problem. Anyone who has had high-risk exposure should isolate for the full period and test only if they develop symptoms.”

Still, the community is being cautious. In Cape Town, the Highlands House Home for the Jewish Aged was locked down to visitors on 26 November. Within the home, it’s business as usual. In Johannesburg, Chevrah Kadisha Chief Executive Saul Tomson says, “We have had some new cases in our residential facilities. We caught most early. Many originated from people who were at public hospitals. I think the big differentiator is that virtually all of our staff and residents are vaccinated. We’re seeing very mild COVID-19. We’re still allowing vaccinated visitors to come in. We’ve implemented measures to curb the spread inside facilities. We’re also doing our best to fast-track boosters for our residents.”

Also in Cape Town, general practitioner Dr Orit Laskov who practices in the heart of the Jewish hub of Sea Point says, “We’re seeing many positive cases again, including kids. Cases I have seen so far have been mild. It’s disheartening still to need to convince patients to get vaccinated.”

In Johannesburg, general practitioner Dr Sheri Fanaroff says, “People who are fully vaccinated and have had COVID-19 before are still getting Omicron. We are also seeing shorter incubation times and a lot of asymptomatic cases. Another trend is that people who are positive with classic symptoms are testing negative initially, both on PCR and in antigen tests. They must still isolate.

“The majority – if not all – the cases I have seen have been very mild,” she says. “I have a number of COVID-19 patients over 70 or even 80 years old who are fully vaccinated. We are monitoring them, but so far, none have required hospitalisation or even home oxygen. Most of the blood parameters and oxygen levels remain good. But what we saw with Delta was deterioration from day eight, so I’m hesitant to say that it’s definitely milder. We must remain cautious.”

So, where to from here? International expert in emergency medicine, Dr Efraim Kramer, says, “Before vaccination, the main strategy was ‘virus evasion’ by social separation, face masks, hand sanitation, limited mass gatherings, and lockdowns. But in the current era, things are different. Especially in the Jewish community, the rate of vaccination is exceptionally high and many people are post-COVID-19 infection.

“Then came Omicron, and its supersonic transmissibility yet low virulence and illness severity. The huge question with this new threat is how to manage it: COVID-19 evasion versus COVID-19 cohabitation. That is, do we evade the virus, or do we learn to live with it – a new strategy, based on ‘get vaccinated, get infected, get on with your life’, preferably in that order. This becomes a reality when there is a highly transmissible virus but its mild infective illness results in low hospital admission rates and complications, especially amongst the vaccinated vulnerable.”

Kramer says this means factoring COVID-19 into everything one does. “For example, at any wedding, adults exercise their personal autonomy by attending the event, fully conversant of the COVID-19 infective risk. Whichever strategy one chooses – evasion or cohabitation – it’s a personal choice and both are correct.”

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“Let my people in” – chief rabbi takes on travel ban

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South Africa’s chief rabbi, Dr Warren Goldstein, has taken on the Israeli government over its sudden blanket travel ban in light of the new variant discovered by South African scientists.

He has been interviewed in Hebrew across multiple national radio stations, TV stations, print media, and online media in Israel.

In a plea to Israeli leaders, he said that shutting the door on world Jewry was a mistake for a number of reasons.

Many South African Jews were turned back in transit between 25 and 26 November, and others are desperately trying to get there because of important family commitments. But the chief rabbi emphasises that “Israel is home to all Jews, especially in times of crisis, and a total closure signals a separation between Israeli and diaspora Jews. The new variant doesn’t distinguish between Jews who have Israeli citizenship and other Jews.”

To him, there are two issues at stake. “The first is the relationship between Israel and the South African Jewish community. Our relationship with Israel is very much part of our value system, and we are a very Zionist community. This is expressed in many different ways, for example, our aliyah numbers, which proportionately are really strong. It’s also expressed in the high percentage of our community who have visited Israel, the fact that so many of our youth study in Israel, and especially in how so many of us have family in Israel. The connection goes very deep.”

To be blocked from entering Israel is therefore “a real blow to the South African Jewish community – spiritually and emotionally”. This latest blanket ban comes after almost two years of very intermittent access to Israel, and the new extreme levels of restriction were a tipping point for him.

“I felt I needed to make my voice heard in Israeli society. This is why I went to the Hebrew media, so that this plea would be heard by society and decision makers. I wanted to send a message on behalf of our whole community.”

He says he has seen the pain of these restrictions reflected in many ways. For example, specific incidents, like a father not being able to attend his son’s Barmitzvah, and a general sense of loss and distance.

The other reason he has spoken out is “for the sake of Israel itself, and for all Jews. Is Israel an ordinary state, or a Jewish state?” he asks rhetorically. “This is a direct plea to the Israeli government and goes to the heart of Israel’s identity. Israel is the only Jewish state, and we are deeply connected to it. In light of that unbreakable bond, if the state says some Jews can’t enter, it’s drawing a divide between the state of Israel and communities across the diaspora. That partnership between diaspora Jewry and the state of Israel is crucial, and if you break that bond, it will hurt Israel and world Jewry.”

He isn’t asking Israel to jeopardise the health of its citizens. Rather, he’s asking that the same criteria be applied to Israeli citizens returning to Israel and Jews needing to visit. Israeli citizens who want to return are allowed to do so if they are fully vaccinated, do a PCR test, and go into quarantine.

“If you combine these three strict requirements, the Israeli authorities have deemed that the risk becomes negligible. If they are good enough for Israeli citizens, any Jew in the world should be allowed to enter on the same basis.”

Goldstein is speaking up now in particular because “vaccines have completely transformed the risk profile. We can see this in the current wave in South Africa.” He has written about it before, but not as extensively as now. “I’ve learnt that one needs to use multiple platforms and address Israeli society directly.”

He says the message has found “tremendous resonance with journalists. I haven’t spoken to one Israeli interviewer who wasn’t sympathetic. They have challenged me, and I have clarified that I’m not asking for more than what’s granted to Israeli citizens. There has been a lot of support and interest.”

He says the incident in which South African Jews were forced away from Israel on Friday 26 November and made to fly on Shabbat was “an absolute disgrace and totally unacceptable for any state, but for a Jewish state, was unthinkable and beyond the pale. This is especially considering the circumstances of two of these Jews going to comfort the Kay family, whose son gave his life for the state of Israel. At the very least, the Israeli government must apologise for this conduct and promise its citizens and Jews around the world that such a thing will never happen again.”

Finally, he says “vaccination is everything. It’s a blessing. Thank G-d for it. Take it with both hands: it is a big mitzvah to protect yourself and others.”

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