By Meryl Feld / Editor
The world is at war with an invisible foe. Those on the front lines, medical professionals and public health experts, are risking their lives around the world to help those infected with COVID-19 and to protect those that are not. They are determined and dedicated to saving lives, exhibiting remarkable selflessness and bravery.
Many of those experts call the Kansas City Jewish Community home. The Chronicle sought the advice of two with specialties in especially high-demand right now: an expert in lung disease and a public health authority.
Dr. Andrew Schlachter is a critical care and pulmonary diseases expert. He is the Medical Director of Respiratory Care at Saint Luke’s Hospital of Kansas City. He provides high-level critical care services in all ICU settings, with a focus on pulmonology.
Captain Dana Hall works for the United States Department of Health and Human Services. She is the Regional Administrator for the states of Kansas, Missouri, Iowa and Nebraska. She develops comprehensive preparedness and response plans for public health and medical situations at a Federal level.
“We have been engaged with first the containment of disease of Americans returning from the Wuhan Province in China, and now with the containment of the spread of disease through quarantine and isolation measures. We are currently working on setting up community testing sites throughout the country,” Hall said.
Saint Luke’s is taking precautions and preparing as well. “Saint Luke’s is doing an extraordinary job and planning for all potential scenarios of this growing pandemic. Included in this are incident command structures to help with infection control (or) prevention and the triaging and housing of those affected. A part of this effort is ensuring an educated and trained healthcare force that is equipped with both the expertise and equipment to take care of COVID-19 patients,” Dr. Schlachter said.
“Those of us who have dedicated our lives to the field of public health have committed our careers to make decisions based on evidence-based scientific information to protect the health of the community. We often spend our careers quietly improving the quality of life in our communities and our work is almost invisible and something as Americans we just expect — clean air and water, safe food, efficacious medication. What we are doing today is no different than what we do every other day. This is just more visible because it is impacting our lives in a much more apparent way,” Hall said.
The facts
There is a lot of uncertainty surrounding this pandemic, allowing for misinformation to spread like wildfire.
To focus on what we do know, COVID-19 is transmitted person-to-person through droplet contact, such as sneezing and coughing, according to Hall. She has read studies that it can survive on inanimate surfaces for up to nine days.
“This is why it is imperative that we all wash our hands very frequently and clean our work surfaces, door knobs and limit touching spaces in public,” she said.
Lung health is a major concern in one’s ability to fight the virus. “COVID-19 appears to impact people with underlying respiratory illness and the elderly more significantly than younger and healthier populations,” Hall said.
Dr. Schlachter added, “While COVID-19 is considered a ‘novel’ virus, its disease manifestations including severe respiratory failure and Acute Respiratory Distress Syndrome (ARDS) are well established models of disease.”
According to the Centers for Disease Control and Prevention (CDC), people can help stop the spread of COVID-19 by knowing the signs and symptoms: fever, cough and shortness of breath.
As a pulmonologist and critical care expert, Dr. Schlachter’s expertise will be vital in helping those most at risk survive.
“I certainly anticipate that Saint Luke’s critical care teams and I will be on the front lines of this epidemic and be tasked with the care of those most critically affected,” he said. “While there are ongoing efforts at dedicated treatment modalities to limit the spread and impact of COVID-19, the mainstay of therapy right now is what we consider supportive therapy and includes ventilator support for failing lungs along with protective measures to keep other organ systems — heart, kidneys, brain, liver, etc. — working without dysfunction.”
To help clarify some of the misinformation surrounding COVID-19, Dr. Schlachter wants people to know that, “As with other contagious pathogens, COVID-19 is considered pretty infectious. To gauge how easily viruses spread, scientists calculate its ‘basic reproductive number’ or RO. The reproduction number helps describe how the infection spreads to new people and reproduces itself.”
For example, if a virus’s RO is more than one, an infected person will cause more than one new infection. The RO of the 2009 swine flu outbreak, is believed to be between 1.4 and 1.6. The RO of measles is 18. The RO of COVID-19 appears to be around 2-2.5, according to Dr. Schlachter.
According to the CDC, “For most people, the immediate risk of becoming seriously ill from the virus that causes COVID-19 is thought to be low.”
Hall said, “In my career I have worked on the Ebola Outbreak of Western Africa in 2014, Zika Virus in 2015, and H5N1 (Avian Influenza). Each of these diseases is unique in its own way, but infectious disease is very much something we prepare for and why we have such robust local public health in our country, the United States Public Health Service, and agencies like the CDC and NIH.”
What you can do
Dr. Schlachter wants people to know that, “Understanding RO and its importance in a pathogen spreading through a community is not only important but essential and demands each of us immediately take ownership over individual behavior to stop the rampant spread of this disease. Many, rightfully, have assessed their individual risk as being low, but as carriers or vectors of disease transmission we must be ever conscious that our behavior may quite literally have life and death implications for those we love or those in our communities.”
The World Health Organization advises all age groups to make an effort to protect themselves from the virus by utilizing good hand and respiratory hygiene.
The CDC recommends in order to keep yourself and others healthy you should wash your hands with soap and water for at least 20 seconds frequently, avoid touching your eyes, nose and mouth with unwashed hands, stay home when you are sick and cover your cough or sneeze with a tissue that you then throw in the trash.
For those who are still not taking precautions or changing their behavior, Hall said, “There is no vaccine at this time and there is no immunity. This virus can impact all of us — some to a lesser extent, but some can be affected to a more significant level. It is important for us to take measures that will protect the entire community to the greatest extent possible.”
What does a public health expert want you to know about this world-wide health emergency? “It is more than just about you. We are working to keep everyone healthy — the elderly, the immunocompromised, people with co-morbidities and people at increased risk due to underlying respiratory illness,” she said.
Many are concerned about a lack of respirators and hospital resources in general. In response to this concern, Dr. Schlachter said, “All hospitals, systems and regional networks are in active and constant communication with each other about resource allocation and utilization. Again, many of the concerns can be markedly impacted by the general population’s effort at social distancing. I would say strongly that the number one effort in ensuring resource allocation is to prevent in all ways possible the rampant community spread of COVID-19.”
Looking ahead
“The fact most critical to focus on is the idea of social distancing and its impact on mitigating healthcare crises related to overrun and under sourced healthcare systems,” Dr. Schlachter said.
He wants to emphasize the importance of social distancing, hand washing and avoidance of others or isolation if you feel ill. He encourages people to remain “an arm’s length from the acute care arena of health care” unless there is an emergency. He also wants to remind our community that if they’re experiencing COVID-19 symptoms, to call their primary care doctor for a pre-screen before utilizing emergency rooms.
Hall said that the United States Department of Health and Human Services is always working to be prepared and to conduct Threat and Hazard Identification and Risk Assessment (THIRA) that help our communities understand what threats and hazards can affect our community, as well as what impact those threats and hazards may have.
“We have exercised and practiced for this scenario for many years. We are also using mitigation techniques — social distancing, no mass gatherings, cancelling social events to reduce the spread to the community of the disease. This is known as “flattening the curve” and reducing the amount of people ill at any one time allowing us to use our hospital beds, ventilators and medical staff for more people,” Hall said.
Hall noted that Israel’s response of limiting large gatherings and taking aggressive action should have similar positive effects in the KC Jewish community.
“I believe there is a stark difference between planning and panicking. Choosing to stay home with your children, away from gatherings, is responsible planning, not panicking. To quote my rabbi’s wife, we are fortunate to live in a world where we can be ‘apart’ but never ‘alone.’ Sacrifices of today like cancelling a bachelorette party or postponing work events may seem like immediate tragedies, but all will be thought very little about in comparison to a widespread pandemic with an overrun health system,” Dr Schlachter said.
Judaism in the wake of a pandemic
The Jewish community’s response has been in line with what Dr. Schlachter recommends, “For the time being I think it seems wise to consider cessation of community events and crowd gathering, even if for the purpose of religious observance.”
In terms of balancing keeping mitzvot and protecting our health, Dr. Schlachter said, “I would hazard to ever be someone’s moral or religious compass in response to the act of mitzvot, but I would emphasize how you have the Judaic importance of protecting human life. I think there are many ways to do well and ‘tikun olam’ but still be safe. For example, make a meal for those in need, but leave it on their doorstep. FaceTime your visit with the ill. If minyan must be kept try to maintain separation of 6 feet and stay home if you yourself are ill. I do not think we will see a ‘point of halt,’ but need to take the ownership ourselves for our communities to do our part in disease mitigation.”
The Jewish value that comes to mind for Hall when considering how people should look at this outbreak is: “The Talmud, Sanhedrin states that if you save one life it as if you saved the entire world. These are our Jewish values. We are a community and we need to survive and thrive as a community.”
In response to finding the balance between mitzvot and being responsible members of society, Hall said, “The beauty of Judaism is that we value additive thinking. By that I mean we don’t have to limit doing one mitzvah to do a different one. So although we can no longer visit the sick in person, we can still visit through technology like WhatsApp or FaceTime. We can buy groceries and drop them off at someone’s door. We can send old fashion snail mail. Although it might be sad to postpone a wedding, weddings still can occur with immediate family with a big simcha to happen in the future.”
Dr. Schlachter’s Jewish values play a role in his COVID-19 preparations. “Like all other major religions, Judaism teaches and instils the principles of helping others, making a positive change, and being a good friend and neighbor to those in need. It also emphasizes the importance of protecting human life if at all possible. I feel blessed to have a strong religious and culture base to lean on as the potential of difficult scenarios becomes a realistic possibility.”
Hall said, “I find my work meaningful because I am able to help people on what may be one of the lowest times of their life. I enjoy that I get to work in a dynamic and fluid situation that allows me to improve outcomes in an otherwise chaotic environment.”
Captain Dana Hall has been married to David Horesh for 27 years. They are the parents of Divya (22), Ilan (21), EliNoam (19), Raviv (19) and Yair (9). They have welcomed a Parisian exchange student, Gabrielle (15), into their family. They are members of BIAV and attend shul at TLC, as well.
Dr. Andrew Schlachter lives in Leawood with his wife and children.