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Is it still safe to go on holiday this December?

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OP-EDS

Enraged by the Rage outbreak, and ambivalent about upcoming “simple” travel plans, patients have increasingly contacted me this week, enquiring as to the safety of going on holiday this December.

What a complicated – yet unsurprising – situation we have landed in, as we reach the pot of gold at the end of an isolating and protracted 2020.

Internationally, COVID-19 is still unremitting, and in most countries – even those with the best preventative measures in place – a significant second wave has occurred at a mean of 57 days after the first wave.

We all expected another rise in cases in South Africa. The uniqueness of the South African picture is that this potential second wave coincides with our festive season. With a 2020 mantra of “stay home, save lives” in mind and now apparent proof that those who didn’t stay home and attended the matric Rage celebrations indeed contracted COVID-19, our community members are justifiably asking questions like, “Doctor, am I crazy to be going to Umhlanga next week?”

The April 2020 level-5 lockdown was partly informed by panic. Our understanding of COVID-19 has evolved significantly since then. I clearly remember the WhatsApp video clips I received of citizens in Wuhan seemingly dropping dead from COVID-19 after “breathing in its air” in April. We have since learnt that COVID-19 is spread primarily through respiratory droplets. Its main route of spread is direct contact, at less than 2m, and that simple mask wearing reduces the risk of transmission significantly.

Conversely, in the initial weeks of this pandemic, it was unclear how sick a patient had to be in order to transmit the virus to another individual. We have since learnt that asymptomatic transmission is very real (as seen at the Rage festival). We have, therefore, learnt to take precautions.

Another real shift in understanding has been the shift from sterilising surfaces to sterilising hands. I may not have let my children sit on a public bench in April 2020. Today, I maintain my focus on cleaning hands. These examples of the evolutions of COVID-19 knowledge talk to the point that we are much better equipped to go on holiday in December 2020 than we would have been 10 months ago.

There is no doubt in my mind that the safest way to live through this pandemic is to confine yourself to a room indefinitely. Don’t leave. Ensure you pass sterilised food only through a small crack in the door, and you won’t contract COVID-19.

In reality, the challenges for mental and developmental health on a personal and family level as a direct result of COVID-19 isolation measures has never been higher. Every day I see patients with significant depression, anxiety, loss of income, and relationship break-ups as a direct result of “preventing” COVID-19. We need a holiday more than any other year. Holidays help recover relationships, shift perspectives, and allow for rejuvenation.

Can you go on holiday safely this December? In my mind, absolutely yes. Safe holidays require a return to boring basics though. I have attempted to stratify the following tips in order of importance in my mind:

•     Ventilation during social interaction is vital. Unless you are exposing yourself to family you live with, all other social interaction should happen outdoors or at least in very well-ventilated spaces;

•     Masks work. Pictures with friends look great with masks too. Set the tone of, “It’s cool for us to have fun and wear our masks too – just in case”;

•     Avoid large crowds. Full supermarkets with social distancing and sanitising are not large crowds. Packed night-clubs, clubhouses, or concerts are;

•     Hosting guests for a meal must be done with seichel (wisdom). Ensure that there is at least a >3m distance between you if you are eating, and as for as short a time as possible. Serve the food while wearing masks. Let the host do the serving as much as possible;

•     Alcohol magically washes masks away and closes distances. Take extra precautions if you drink;

•     If you feel unwell, contact a doctor and get tested. Identifying a positive case early prevents major outbreaks. The Rage super-spreader event started with a couple of cases at most.

What’s the safest way to travel to and from your holiday?

Car travel with adherence to festive-season road safety is certainly the safest option. It also allows for a possible return home should you become infected. However, a study published in the JAMA journalin October 2020 showed that with the implementation of new air-travel regulations, the incidence of COVID-19 cases were negligible.

I recently flew. Scrutinising my trip, here are my tips for safe air travel:

•     Wear a well-fitted mask throughout the process. Door-to-door. A three-layer cloth mask (or a medical mask if they are available);

•     Don’t touch your eyes or your face on the flight;

•     Use your hand luggage as a barrier to ensure other passengers don’t come too near to you during embarking and disembarking;

•     Stay in your seat at the departure gate or on the plane until there is ample space for you to move;

•     Keep the air vent above your seat blowing on you throughout the flight. (The air is filtered);

•     Try not to eat or drink on the flight. You can manage a short flight without refreshments.

Lastly, how about hotspots? Should you be anxious if you are travelling to Plettenberg Bay on the Garden Route as opposed to the Magaliesberg?

The most challenging issue with hotspots is the relative lack of resources for patients who may complicate in that region. For example, intensive-care units in the Garden Route have been saturated lately.

If you are a patient with significant comorbidities and lack the means to be privately transported home early in an infection, I believe you may want to reconsider your choice.

However, it’s important to remember that by adhering to basic principles and keeping in mind daily that COVID-19 is still with us, even in the hottest spots in South Africa, you can enjoy a well-earned holiday and pace yourself for a better and healthier 2021.Dr Daniel Israel is a family practitioner in Johannesburg.

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How to create room to breathe while being constricted

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There is no doubt that our community and wider country are starting 2021 in a meitzar, a narrow place, filled with fear and anxiety. Caught in a second wave which we hoped would never come, we are waiting with trepidation for schools to start, for numbers to drop, for vaccines to arrive. Would it help us to reflect that in Parshat Vayeira this week, we find the Israelites caught in their narrow place, the slavery of Egypt, Mitzrayim!

While the parsha this week describes the unfolding of the larger-scale events of the plagues, it opens with insight into the state of mind of “the people”, b’nei Yisrael. Hashem asks Moshe to reassure enslaved people by telling them that He has heard their cries, and is going to save them. The people will be taken out of Mitzrayim, and will be allowed to pursue their destiny. Moshe brings this message of comfort and hope to the people. And we are told, “The people of Israel would not listen to Moses, from shortness of breath and cruel bondage. (Ex, ch. 6, v 9).” Commenting on the words “they would not listen”, Rashi creates an equivalence between “to listen” and “to receive”, saying, lo kiblu tanchumin (the people weren’t able to receive words of comfort). It’s a deep place of despair where a person isn’t able to receive words of soothing and hope.

What stopped people from being able to be comforted? The avodah kashah describes the cruel bondage of slavery in which our people’s individual liberties and freedom were removed. Indeed, it may feel as if there is little agency or room to move when large forces of power are manipulating one’s life, such as in a pandemic.

However, we are also told that the people weren’t able to listen because of kotzer ru’ach (shortness of breath). The Midrash Aggadah plays on the words kotzer ru’ach, and claims that the people were “short on spirit” meaning emunah, and thus became involved in idol worship.

The Sefat Emet makes a startling interpretation of this midrash, suggesting that the Israelites weren’t actually worshipping idols, but rather were so distanced from themselves and filled with the vanities of the world that they had no inner space to receive this message of hope. Rashi observes that both Mitzrayim and kotzer contain the root “tzar”. He links the two, saying anyone who is in constriction (meitzar), will experience shortness (katzar) of breath. We might understand Rashi’s meitzar or constriction as anxiety, a state of constriction that freezes a person, conjuring up Edvard Munch’s terror-laden image of The Scream. When we are put under undue stress and pressure, we lose our capacity to take deep, long breaths. Thus, two factors prevent the people from receiving Moshe’s tanchumim: external factors linked to oppression and enslavement (avodah kashah); and an inner state of mind linked to alienation, distancing from G-d, and distressing anxiety (kotzer ru’ach).

Like b’nei Yisrael, we find ourselves caught in the powerful currents of history, political power-plays, pandemics, and all sorts of circumstances over which we have very little control. This is our avodah kashah, the larger forces which play out across our world. However, according to the parsha, our constriction and redemption depend not only on external factors but also on the way in which we work with our own kotzer ru’ach. As we begin 2021 gripped by second waves of COVID-19 in many parts of the world, we might be inclined to feel hopeless. This can lead to filling our minds and hearts with pessimism, negative projections onto the year, and anticipatory anxieties about what will be. If our mind is filled with kotzer ru’ach, it won’t have the emptiness to be open to receive the whispers and ripples of hope when they come our way.

In the words of the Sefat Emet, “Hearing requires being empty of everything so that we can hear the voice of G-d.” In times like these, if we are sufficiently attuned, we might be able to receive comfort, connect to feelings of hope, or even feel moments of faith and upliftment. These moments may come as calm, as perspective, as wisdom, as kindness, in the form of poetry, Torah learning, or prayer. Perhaps, quite simply, we will feel less constricted by “shortness of breath”, and more open to neshimah, breath, and expansiveness.

This is a hard time in our world, but we have a tradition of people going through very difficult times and being redeemed from them. We learn from b’nei Yisrael that any redemption requires waiting and is subject to forces beyond our control. However, we aren’t mere victims of circumstance. By working to heal our kotzer ru’ach, we create room for agency in our own narrow places. It might even be that our expanded ability to receive can help usher in the larger-scale transformation and redemption for which we hope and pray.

  • Adina Roth is a Jewish educator at B’tocham Education, and a clinical psychologist in private practice in Johannesburg. She is studying online at Yeshivat Maharat in New York.

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Second wave like a tsunami

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We have emerged from the eye of the storm to confront a second wave that is significantly worse than we anticipated. It feels like a tsunami.

Once again, SARS CoV2 has proven to be unpredictable, and has mutated to a new strain which is more contagious, involves a higher number of people, and is less discriminating. We have easily slid back into our roles in a well-remembered dance.

Once again, we are working long hours and spending a lot of time on our feet. Stress levels are very high again, and there is a constant feeling of anxiety as one waits for the next crisis.

Last time, the patients were older, and it was easier to be more philosophical in accepting their deaths. In a complete deviation from pattern, this wave of COVID-19 has affected younger people to a much greater extent. They are often younger than us, and we all know a lot of people who have COVID-19.

As with the first wave, there are more men in hospital than women, with 60% of the patients being male and 40% female. This time, however, all population groups seem to be represented.

When looking at intensive-care units (ICUs), which are a critical resource under huge pressure, it’s startlingly obvious that not only have we had to accommodate more patients in ICU, but that they are significantly younger and much sicker this time. Fifty percent of the ICU cohort are under the age of 60, and 80% are on more than usual oxygen therapy.

Our ICU is full, and we are using all our ventilators for one form of ventilatory support or another. It is a surreal experience to look around and see the vast majority of our patients with masks of various shapes and sizes strapped tightly to their faces in an attempt to keep their blood oxygen levels adequate. It’s difficult to communicate, and all one sees are the eyes looking at you with fear, anxiety, distress, and sometimes calm acceptance.

The mood is sombre, and there’s little humour this time around. Patients with comorbidities still raise a red flag in that they are more likely to have severe COVID-19 with a higher mortality rate, but this time around, there are significant numbers of young, fit, healthy individuals with no comorbidities who are desperately ill. The staff are more fearful because of this. After all, you can’t allay your anxiety by listing the patient’s comorbidities which have resulted in severe COVID-19 if there are none.

Another unique feature is the number of young individuals presenting with severe cardiac disease that has proven to be rapidly fatal. There are also a few confirmed cases of reinfection now, some far more severe than the initial episode of COVID-19.

In addition, we are called for far more acute deteriorations in clinical condition, and seem to be running to many more resuscitations than we ever dreamt we would be. Often, patients have young families, and a desperate desire to live for their children.

There is definitely a higher number of patients who require mechanical ventilation and as such, there is enormous pressure on ICU beds. We are contacted on a daily basis by hospitals looking for ICU beds for young patients with severe COVID-19 pneumonia.

It’s not only the beds that are under pressure, but the units are often understaffed as the healthcare workers contract COVID-19 themselves or simply burn out.

This past weekend, I was told of a physician who contracted COVID-19 and landed up on a ventilator in his own unit and was cared for by his friend and colleague. This is all very hard to deal with.

The fact that many of the patients in hospital are well into the pulmonary phase with significant inflammatory changes in their lungs means that it’s a juggling act, with ICU beds being filled as soon as they are emptied and patients yo-yoing between ICU and the wards, and back to ICU.

There are times when ambulances wait patiently to offload their patients while space is made in emergency, or they are diverted to another hospital.

We are aware of private hospitals which have actually run out of oxygen for a time period. We are aware of hospitals in which they have started using anaesthetic machines to ventilate patients in their theatres.

We have seen photos from a hospital in Gauteng which has set up tents in its parking lot to treat patients with COVID-19.

Resources are limited, and a strict criteria for ICU admission will have to be implemented, a task we are dreading.

In the meantime, as we deal with this unprecedented surge in numbers, elective surgery has been cancelled and, other than COVID-19 cases, we are admitting emergencies only. People are scared to come to hospital and as such, are waiting until they can’t wait anymore, being admitted in extreme conditions.

Our physical discomfort is worse with long hours in personal protective equipment in the summer heat with no air conditioning in the wards. Our fingers are cracking open again, and the emotional toll is huge.

This past weekend, we witnessed the compassion with which our staff cared for a patient with Down’s Syndrome and how happy they were when it seemed that she would survive. We have taken wives to say goodbye to their husbands who are dying of COVID-19. We had to tell five patients that their parent/spouse had died of COVID-19 while they were lying in a hospital bed. I also had to call a lady who was isolating at home with COVID-19 to inform her that her husband had passed away on their 56th wedding anniversary. We also celebrated two birthdays here.

We are familiar with the vagaries of this disease, and write the treatment charts by rote, monitoring individuals intensively. We make therapeutic adjustments according to various clinical and blood parameters, desperate to prevent severe pneumonia or the cytokine storm.

We feel enormous relief if it looks as if the inflammatory process is reversing. And yet, in spite of all the knowledge gained over the past few months, there are patients who you know cannot pull through. At those times, kindness and compassion are all we can offer.

The stories are familiar. A minority of our patients (often the elderly) contracted COVID-19 through no fault of their own. But the vast majority know exactly where they picked it up – a dinner party, a function, on holiday, at a picnic, in a friend’s home, etc. The equation is simple to me: socialising without respecting the COVID-19 rules of social engagement = COVID-19 (for yourself or some unlucky individual that you come into contact with).

If you’re lucky, you get away lightly, and if you’re unlucky, you become critically ill (with the attendant risk of dying) or you develop long COVID-19 or one of the unusual late complications.

It’s going to get a lot worse, and we are going to run out of hospital beds, medication, and potentially oxygen. There’s no magic cure, and the vaccine is on the horizon. It behoves everyone to be respectful of COVID-19 and behave responsibly, respecting the sanctity of life.

  • Dr Carron Zinman is a pulmonologist at the Linksfield Clinic.

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Why it must be cool to be a Jew on campus

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My first year at the University of the Witwatersrand was in 2017 and it was a strange year.

There was no Jewish establishment. Each student came with a radically different background and perspective, almost none of them had ever met a Jew, seen a Jew, or even heard of a Jew. But many had heard of “apartheid in Israel”.

I remember how 500 people filled the lecture hall. There I was, a naïve 18-year-old Jewish guy sitting with my new Muslim friends. The professor was running 15 minutes late. We were all chatting until one girl, Akeela, came to the topic of Israel, and that’s when things start getting heated. With a slight hiss in her voice she whispered, “You’re not a Zionist, are you?”

Shocked and intimidated, I looked away and didn’t know what to say. She pressed me, and repeated “Are you?” Without thinking, I quickly mumbled ”no” just as the lecturer walked in and began the class. I begin questioning who I was, and what I believed.

I can tell you countless stories of antisemitic/anti-Israel attacks, but this vignette sums up what Jews are dealing with on campus in some shape or form. Students feel unsafe to express themselves. There is no sense of pride in being a Jew, only fear or even shame. Like a friend of mine in her Philosophy 101 module who was literally laughed out of the class when she said, “Of course I believe in G-d! I’m a Jew”.

Internationally, Jewish students and their leaders are insecure about what they stand for, be it their unique cultural values or their indigenous homeland. At every corner, there is external pressure, which has created a deep sense of doubt about who we are and what we represent.

Throughout the Book of Kings, the g-d Ba’al plays the foil of the Jewish nation. King after king, they each fall to this Ba’al. It’s like a cycle. A new king of Shomron (modern-day Samaria) takes over, he is fair and good, next he gets too close to Ba’al, and loses everything. His throne, friends, family, and eventually his life. Out of the 19 rulers of Shomron, this sequence happens a lot. What does this mean?

The simple understanding is that the leaders at that time were serving the idol Ba’al. But our sages saw a more relatable message, and explain that translated literally, the name Ba’al means master. So the problem was that those generations were allowing a Ba’al-master, in other words a force other than their own internal set of ethical guidelines, to dictate their actions. Or it could be thought of as external pressure – this “master” was forcing a foreign lifestyle on the kings.

It was only when the leaders of the time rejected the false g-d and embraced their natural moral compass that they succeeded in ruling.

A similar idea might be applied today. It’s unpopular to be a Jew/Zionist. It’s hard to stand your ground when the world is blaming and shaming you. And it’s easy to give in to all the negative rhetoric which is thrown at you. But we cannot compromise our moral and ethical high ground to please the external pressures of pop culture.

We must fortify ourselves by embracing what makes us unique – our Jewish heritage. Students shouldn’t feel ashamed to say they are a Zionist or believe in G-d. We should be confident in who we are and what we represent.

We must empower the global student community by reminding it that it’s cool to be a Jew and do Jewish things, to stand out as a proud member of our supernatural nation.

That’s a future worth fighting for.

There couldn’t have been a better place for this work than the 47th annual World Union of Jewish Student (WUJS) Congress that took place in the last week of December as we said goodbye to 2020. No flights necessary, no headaches or hotels, we simply signed up on the website and were amazed by the inspiring sessions, broad networking capability, and a fair dose of fun. WUJS Congress 2020 – “inside your home & outside the box”.

  • Shimshon Fisher is the vice president of the South African Union of Jewish Students.

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