Kramer quits COVID advisory over “community flouting protocols”
One of the community’s top COVID-19 advisors this week lashed out at the community for flouting rules and putting lives at risk. Professor Efraim Kramer said he could no longer contribute to the safety of the community during the pandemic in light of this brazen behaviour.
“In a nutshell, I’m fed up,” Kramer told the SA Jewish Report. He said while the first surge “brought out the best in the community”, the second wave “brought out the worst in us”. His frustration has been mounting for some weeks in light of the number of deaths in the community. Last week, two members of his family passed away from COVID-19.
“I don’t care if I upset people. My aim is just to save lives. I don’t want to implicate anybody. The final straw came this week when President Cyril Ramaphosa allowed faith gatherings to take place, and people went to shul the next day. Where was the consultation? No meetings were held on how best to re-open shuls.”
Kramer is the head of the Division of Emergency Medicine at the University of the Witwatersrand (Wits), and Professor of Sports Medicine at Pretoria University. He has specialised in emergency medicine for 30 years, and was FIFA’s tournament medical officer at the Soccer World Cup in 2018. Along with other experts, he has advised the office of the chief rabbi on matters related to COVID-19 and shuls.
“I have written at least eight different protocols for things like weddings, Barmitzvahs, yom tov [gatherings], and shuls and it seems that everyone is doing what they like,” he said. “Come December, in the middle of a raging pandemic, people got in their cars or on flights and headed straight for hotspots. They flew home knowing they were infected. The results have been devastating, people have died. We’ve done this to ourselves. We’re doing it to our own.”
He said the communal leadership was “paralysed”. In a strongly worded message he sent to Chief Rabbi Dr Warren Goldstein and members of the Union of Orthodox Synagogues, he wrote, “Please note, with regret, that I have withdrawn from all community COVID-19 commitments and communications due to the total disregard and ignoring of the various safety protocols developed for the shuls and the community by many. I will no longer consult on any COVID-19 issue because it generally amounts to nothing as most people are still intent on doing their own thing anyway, in spite of advice to the contrary. But then, who am I to give advice anyway.”
Kramer said he had received countless complaints from members of the community afraid to attend large simchas which had been taking place “as if things are normal”. On Wednesday, he received another complaint from a community member who lamented that while a caterer was following protocols, guests were dancing, hugging, and behaving as if it was a pre-COVID-19 wedding.
“I drive past a shul every day and see countless cars outside. There have been minyanim taking place. The shuls have relaxed their protocols. I went into a bakery last week, and things were haywire. People were on top of each other using the same tongs and there was no safe distancing. It was a disgrace. As a doctor, I can’t fight this anymore. I’m going back to hospitals where at least the patients appreciate what I’m doing.
“While many people are being very careful, there are those who don’t care about the next guy. They think they are ‘holier than thou’ and Hashem will listen to their prayers. When you add up all the incidences, you get a picture of a community that doesn’t care for one another anymore. And where is the leadership when this is happening? How come nothing was said when shuls continued to open when it was against the law to do so and unsafe?”
Barry Schoub, emeritus professor in virology at Wits and the former director of the National Institute for Communicable Diseases, said, “This is very disappointing news. Professor Kramer has been an absolutely invaluable member of our community medical advisory team and has devoted an incredible amount of his time and energy in drawing up protocols, inspecting shuls, and looking after the safety of functions. He is an international authority on mass gatherings and has world-class credentials which have been so valuable in managing the COVID-19 epidemic. I’m sad at the decision he has taken, but I do understand the intense frustration he is feeling at the attitudes he has come across in a small minority of our community and the disregarding of protocols to safeguard our community by a small minority of shuls and minyanim.”
Leading pulmonologist Dr Carron Zinman said she understood Kramer’s frustration. “We’re all frustrated by people’s complete disregard for safety protocols as it’s so simple to follow the rules. We’re absolutely exhausted, and are tired of watching people struggle for each and every breath knowing that they should have worn a mask/should have kept a safe distance/should have avoided the gathering, and could have avoided getting COVID-19. You realise that you can give the same advice till you’re blue in the face, and people will choose to do what they want. We don’t act as judge, and never compromise our standard of care, going all out to fight for our patients’ lives.”
Said Chief Rabbi Dr Warren Goldstein, “I was disappointed and surprised to receive Professor Kramer’s resignation on the eve of the president’s announcement allowing for the reopening of shuls, which have been closed for more than a month. I have asked to meet with Professor Kramer to understand his specific concerns because the reports I have received since the reopening of our shuls in August 2020 indicate that the overwhelming majority of shuls have been outstanding and totally dedicated to the implementation of the health and safety protocols drafted by our full medical team.
“As a community, we will continue to be guided by Professor Barry Schoub and Dr Richard Friedland, who remain on our medical team, as we go forward to ensure the highest standards of safety for our community. On behalf of our community, I want to thank Professor Kramer for his months of tireless volunteer work to train and prepare our shuls to function safely in this pandemic.”
Wendy Kahn, the executive director of the South African Jewish Board of Deputies, said, “We have no knowledge about Professor Kramer’s resignation or the reasons for it. We commend him for his amazing contribution to our community.”
Rabbi Yossi Chaikin, the chairperson of the South African Rabbinical Association, said he was “shocked, surprised, and upset” when he received Kramer’s message. “We are so grateful for his service, and he is so respected. He sat with every rabbi and advised us. And even though he was very strict, we listened to him!
“I know that all shuls have followed his protocols with proper distancing, screening, hand sanitising, and masks – this is being enforced. I also know there have been private minyanim not under our jurisdiction where I believe there were minimal to nil protocols. On behalf of the rabbonim and shuls, I say that we are doing the best we can. It’s sad that people have acted this way leading to this decision, but we will continue to be vigilant.”
Hostage crisis hits close to home for Cape Town rabbi
It was the middle of the night when Cape Town Progressive Jewish Congregation’s (Temple Israel’s) Rabbi Greg Alexander (Rabbi Greg) heard that a fellow faith leader was being held hostage in a Texas shul on Saturday, 15 January.
Although the shocking event was unfolding across the oceans, it hit hard as he realised he knew the rabbi being held hostage.
“Suddenly the world felt small again. It took a moment to register that this was happening,” says Rabbi Greg. Rabbi Charlie Cytron-Walker and his congregants escaped around the same time that an elite FBI (Federal Bureau of Investigation) hostage rescue team breached the Beth Israel Synagogue in Colleyville, Texas, after an 11-hour standoff. The hostage-taker, Malik Faisal Akram, was killed.
“My wife, student rabbi Andi, and I met Rabbi Charlie in 2001 when we lived in Jerusalem,” recalls Rabbi Greg. “Andi and Rabbi Charlie’s wife, Adena, studied together at the liberal Bet Midrash on King David Street. Rabbi Charlie was a rabbinical student. We spent some Shabbatot together, and stayed in touch when they went back to the United States and we moved to London.
“We met them at the height of the Second Intifada when there were bombings in Jerusalem,” he says. “It was a time of fear and uncertainty then, and I can’t imagine what it must have felt like now to be in that synagogue, or for her watching and waiting…”
“We haven’t seen Charlie or Adena for nearly 20 years even though we have followed each other online, and have gone in similar directions in our rabbinic work,” he says. “They are such amazing people, and are working every day for a better world. It’s so important to know in talking about this attack that of the many social-justice causes he initiated, his synagogue has specifically reached out to local Muslim communities and hosted them for Ramadan.” Temple Israel has done the same.
As the hostage crisis unfolded during an online Shabbat service, Rabbi Greg was alerted to the news a million miles away in time and place, late on Saturday night (South African time).
“We found out while Rabbi Charlie was still being held with the other hostages in the synagogue. The network of progressive rabbis around the world were all sharing what little information they could find, and we watched with horror to see what would unfold. Many people davened for their safe release. Of course, you immediately think of your own shul, wondering if it could happen to you. We are blessed in South Africa not to have experienced the levels of antisemitic violence we have seen in Europe or America, but that doesn’t mean it can’t happen here. Please G-d it won’t, ever.”
At times like this, “his synagogue could be any synagogue”, he says. “When something happens to one of us, it happens to all of us.” In fact, when Rabbi Greg posted on Facebook that he was praying for the safety of Cytron-Walker, a local Chabad rabbi commented on his post, “We are all praying for their safe release. Please G-d we will hear good news soon.”
Rabbi Greg says Cytron-Walker is “the definition of a good guy – a mensch of the first order. He’s kind, generous, and quick with a smile. As a rabbi, he has always emphasised peace work, social justice, and interfaith work. Everyone has commented on how calm and unflappable he was throughout the crisis.”
He says this isn’t the time to lose hope in connecting with other communities. “We will continue to reach out to our interfaith partners to build bridges of understanding in our local community.”
Asked if he ever imagined something like this happening in the shul of a fellow rabbi, Rabbi Greg says, “I’m well aware of how incidents of unapologetic Jew-hatred have increased in the world in the past decade. Ten years ago, nobody thought we would be living through this kind of violence and verbal attacks, but it’s now sadly commonplace.”
In fact, after the deadly Pittsburgh attack in which 11 Jews were murdered in the Tree of Life Synagogue on 27 October 2018, Cytron-Walker wrote to people from other communities who had supported his congregation by expressing their grief.
“When I heard about the deadly attack in the middle of our Sabbath service, the feeling was all too familiar,” he wrote at the time. “The emptiness and the pain, the anger and the helplessness. Too many times in Jewish history we faced tragedy without love or support. Too many times to count, we were left to pick up the pieces of tragedy and destruction. Believe me, the love and support matters. It’s something we all should be able to expect of each other. Thank you for helping us through these dark times. Thank you for standing together. When it comes to hatred and violence, we must all stand together.”
In the aftermath of his own ordeal, he once again thanked others for their support. “I’m thankful and filled with appreciation for all the vigils, prayers, love, and support, all the law enforcement and first responders who cared for us, all the security training that helped save us. I’m grateful for my family. I’m grateful for the CBI [Congregation Beth Israel] community, the Jewish community, the human community. I’m grateful that we made it out. I’m grateful to be alive.”
His words echo that of a psalm which Rabbi Greg says is one to remember at this time. “Psalm 116: 7-11 from the full Hallel in Rabbi Edward Feld’s beautiful translation in Siddur Lev Shalem reads: “‘Be at ease,’ I said to myself, ‘for Hashem has done this for you.’ You have saved me from death, my eyes from tears, my feet from stumbling; I shall walk in G-d’s presence in the land of the living.”
“I hope Rabbi Charlie and the congregants taken hostage can ease their hearts with Hallel psalms,” Rabbi Greg says. “There’s nothing like tehillim for articulating how it feels to be freed from terrible danger.”
Israel is open – but should we go?
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
Experts cautiously optimistic about Omicron
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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