State curfew begins tonight at 10 p.m. The state curfew will be from 10 p.m. to 5 a.m. daily for the next 21 days.

The curfew will not apply to those going to or from work, those who have an emergency, or those who need medical care. The curfew is not intended to stop anyone from getting groceries or going to a pharmacy. Picking up carry-out or a drive-thru meal and ordering for delivery will be permitted, but serving food and drink in person must cease at 10 p.m.

Cuyahoga County announced a new program on Wednesday. The new program run by CHN Housing Partners will be giving out $2 million dollars in utility assistance. This is in addition to the rent relief and utility assistance programs previously announced late last month. Here is what you need to know:

Covid-19 Rental Assistance:

CHN Housing Partners is the entry point for rental assistance, you can apply online, or you can call them at 833-377- RENT (7368).

Some details from the CHN website:

How does it work?

• CHN is the entry point to access rental assistance. Depending on the nature of your financial hardship, you may be referred to CEOGC or EDEN for longer term assistance, at which point you may be asked for additional information and documentation.
• If you qualify, your landlord may receive up to three months back rent.
• CHN will screen all applicants for other assistance programs that may help make your electric, gas, and water/sewer bills more affordable.

Who qualifies:

• Residents of the City of Cleveland and Cuyahoga County who are having difficulty making rental payments due to the economic impact of the pandemic and who meet income eligibility requirements.
• If you qualify for rental assistance, you may be required to attend more in-depth counseling provided by CHN, as a condition for payment of the rental assistance.

CHN Rental Assistance Application

Covid-19 Home Relief Grant:

The CEOGC is processing this program.

Some information from the CEOGC website:

Cuyahoga County residents, who are at or below 200% of the Federal Poverty Level and have fallen behind on rent or mortgage payments, water bills, sewer payments or have any other immediate needs are encouraged to apply for assistance. Funds are available for a limited time and applicants are encouraged to reach out early.

Tip from Gesher staff & clients: You must make sure to fill out ALL fields correctly in order to submit the application!

Covid-19 Home Relief Grant Application

Covid-19 Utility Assistance:

CHN Housing Partners will be distributing funds for all four utilities, gas, water, electric, and sewer. This program will cover past-due bills beginning from March 1st, 2020.

What you must know: The application for all four utilities is the application marked “Water/Sewer Discounts & Sewer Crisis (Disconnection Notice)” located at the bottom of the page.

Quick facts:

• Cuyahoga County households below 120% of the Area Median Income level may apply.
• You will need proof of financial impact by Covid-19 which includes: loss of income, change in child care status (school closures), positive covid-19 test result in the household. (This can be from anytime since March1st.)
• The online system is quick and easy to use. Document upload information and instructions may be found online chn.itfrontdesk.com.
• If you need assistance with this application, please call 216-774-2349.

From Cleveland Jewish News

Under the resolution, residents are advised to only leave their home to go to work or school, or for essential needs such as seeking medical care, purchasing essential items from a grocery store or pharmacy, picking up prepared food or receiving deliveries, the advisory said. Residents are also strongly advised to avoid traveling in and out of the state, and forgo having guests in their homes or residences during the upcoming holiday season.

We wanted to share a few important COVID-19 messages for those that test positive for SARS-CoV-2 or coronavirus, which causes COVID-19 or anyone that is identified as a close contact of someone who tests positive. Those who test positive are advised to isolate themselves from others to prevent transmission of the virus to others for a minimum of 10 days from symptom onset or the date of the test if there are no symptoms. Close contacts quarantine and watch for symptoms of COVID-19 that may develop over a 14 day period.

We recommend that those who are contacts of confirmed cases seek testing to ensure they are not infected; however testing does not shorten the length of the 14-day quarantine if you test negative. Local health departments will call people who test positive for COVID-19 to advise them on isolation guidelines and to identify their close contacts.

Here is a graphic describing the difference between quarantine and isolation.

Here is link to a graphic describing contact tracking.

We are also in cold and flu season, so we are urging people to get a flu vaccine from your doctor, your local drug store or the health department. Flu shots protect you and your family and are especially important during the COVID-19 pandemic. They can help keep others healthy too (learn more here).

You can find a flu vaccine near you here. It’s best to call ahead to make an appointment if necessary.

Help stop the spread of viral illness in your community by following these prevention guidelines: https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop-the-spread-of-germs-11×17-en.pdf

PDF of Cleveland Doctors Letter

As Torah observant Jews, we recognize the obligation to save lives (נפשׁ פּיקוּח (as a value that overrides nearly every other religious obligation. We likewise seek to avoid situations of נפּשׁוֹת סכּנת) threats to human life), even when undertaken for supremely important purposes – tefilla, celebrations of shabbos and yom tov and Torah study. As physicians, we are concerned that over the next few weeks and months our community will see an increase in the local spread of COVID19, which could ו”ח ּendanger the health and lives of many of our friends, neighbors and family. We write what follows both to reiterate basic public health principles and warn the community about specific risks to be avoided.

The following are the basic principles of infection control that remain as relevant now as when this pandemic began:

• COVID-19 is an airborne virus that is spread primarily through respiratory droplets: Talking, coughing, singing, and shouting generate droplets that can travel significant distances and remain on surfaces for hours. This means that our davening and simchas are not risk-free; such gatherings can be the starting point for serious outbreaks.
• Masks (when worn over both the nose and mouth) reduce the spread of these respiratory droplets and decrease the likelihood of being infected and infecting others. This is not a political opinion or ideological fad; it has been an accepted infection control practice in the clinic, hospital ward, and operating room for the past century.
• Physical distancing, even while outdoors, protects you and others from coming into contact with infectious material. By the same principle, coming close to other people – even sharing a l’chaim or leaning in to wish a “mazel tov” – can spread infection. Any crowded event, even if planned carefully and with the best of intentions, can lead to the spread of the virus. This includes such normally benign venues as a beis medrash or men’s mikva during the pre-yom tov rush.
• The virus can spread after the crowd is gone by remaining on one’s hands after touching a contaminated person or surface. If the hands come close to the eyes, nose, and mouth, minutes or even hours later, COVID-19 can enter. Sanitizing the hands thoroughly and often is essential to staying safe.
• You do not need to feel sick to be contagious. Data demonstrate COVID patients can be contagious up to two days prior to exhibiting symptoms, or can be infected without any symptoms at all, making it easy for COVID-19 to spread silently among or between households and communities. That means you don’t have to look or feel sick to get others sick. But if you do feel unwell, it is especially important to protect those around you by isolating yourself.

We ask that every member of our community re-commit to keeping everyone safe by:

• Avoiding creating or attending events in which there is crowding.
• Wearing a mask – properly and consistently – in shul, in the beis medrash and in school – and teaching your children to do the same.
• Isolating or quarantining after exposure to high risk situations, even if it means missing out on shul, school or a simcha.
• Being mindful of the risks when traveling to, or hosting guests from, other communities and geographic regions.

As physicians, we remind you to:

• Consider what we all have to lose: Local schools and shuls have invested enormous amounts of energy, time and money toward the goal of bringing us back in person. Rabbonim, doctors and lay leaders have set aside other projects to devote themselves almost exclusively to this goal. This achievement should not be taken for granted nor assumed to be permanent.
• Trust medicine and science: While there are many uncertainties in medicine, what we have written is based on the best available scientific evidence right now. As doctors, we began our careers with a commitment to “do no harm” and we are now asking the same of our community.
• Remember what this virus is capable of doing: Our friends and family in the New York area have had first-hand experience with the carnage of an out-of-control epidemic. That our community, ה”בּ ,was unaffected a few months ago does not mean that we are immune now. This virus has killed nearly 200,000 people, in the United States and over 1,000 in Israel, and while we may be tired, it is not. This is no time to let down our guard.

We conclude with wishes for year of health, success and safety for our entire community, and with earnest prayers to the Ribono Shel Olam to protect His people.

Names appear in alphabetical order and have been updated as of 9/17/2020, 4:00 PM

Mark Aeder MD General and Transplant Surgery
Josh Arbesman MD Dermatology
Daniel Asher MD Anesthesiology, Cardiothoracic Anesthesiology
David Bar-Shain MD Pediatrics, Clinical Informatics
Akiva Berger DDS General Dentistry
Nate Bergman DO Internal Medicine, Geriatrics
Yael Dahan MD Anesthesiology
Joel David DO Internal Medicine
Francine Erenberg MD Pediatric Cardiology
Ben Esraeilian DPM Podiatry
Daniel Fleksher MD Internal Medicine
Elisha Fredman MD Radiation Oncology
Rachel Garber MD Pediatrics
Sara Goldman MD Psychiatry, Adult Inpatient Psychiatry
Jessica Goldstein MD Emergency Medicine
David Gottesman MD Gastroenterology
Dovid Gutman MD Internal Medicine
Adam Haas MD Anesthesiology
Rafi Israeli MD Emergency Medicine
Avi Jacobs MD Cardiology
Lawrence Jacobs MD Cardiology
Daniel Kahn DO Nephrology
Saul Kane MD Gastroenterology
Fred Kessler MD Gastroenterology
Jonathan Klein MD Emergency Medicine
Michael Kurin MD Gastroenterology
Jeffrey Lautman MD Nephrology
David Lever MD Gastroenterology
Yehudah Lindenberg MD Neurology
David Liska MD Colorectal Surgery
Rebecca Lowenthal MD, MPH Family Medicine
Leon Margolin MD Pain Medicine
Shmuel Margolin MD Internal Medicine
Yael Mauer MD, MPH Internal Medicine, Primary care and hospital medicine
Bryan Michelow MD Plastic Surgery
Howard Nathan MD Internal Medicine, Hospitalist
Joel Peerless MD Critical Care
Meir Pollack MD Gastroenterology
Moshe Prero MD Pediatrics
Michael Rothberg MD, MPH Internal Medicine
Yosef Rudolph MD Neurology
Samuel Salamon MD Ophthalmology
Yehuda Salamon MD Anesthesiology
Amy Schechter MD Internal Medicine
Gila Schiowitz DO Pediatrics, Hospitalist
Steven Schwartz MD Geriatrics
Seth Sclair MD Gastroenterology, Transplant Hepatology
Shelly Senders MD Pediatrics
Anna Serels MD Physical Medicine & Rehabilitation
Marina Shpilko DO Emergency Medicine
Warren Sobol MD Ophthalmology, Retina
Benjamin Spinner MD Psychiatry, Child Psychiatry
Josh Sunshine MD Neurology
Ira Taub MD Pediatrics, Pediatric Cardiology
Yael Taub MD Emergency Medicine
Philip Toltzis MD Pediatric Critical Care, Infectious Disease
Franky Weinberger DO Rheumatology
Rachel Weinerman MD Reproductive Endocrinology and Infertility
Ari Wiesen MD Gastroenterology
Carly Wilbur MD Pediatrics and Adolescent Medicine
Brian Wolovitz MD Internal Medicine

At his 2pm press conference today, Ohio Governor Mike DeWine announced that Ohio schools will remain closed through the rest of the school year.

Printable PDF of Agudah Guidance for COVID Information and Preparation from Medical Professionals

Our committee of physicians has prepared the following guidance for our community. Please read this entire document. We would have made it shorter if that was possible. This information can
make the difference.

As many of us have seen and heard about the devastating effects of COVID-19/Coronavirus, we present an initiative to help support the community manage under these very trying and stressful
times.

This initiative is based on Healthcare Access, Contact and Observation, and Preparation of an Action Plan.

The information provided below is NOT meant to be a substitute for professional medical advice, diagnosis, or treatment from your treating physician. We recommend that you seek the advice of
your primary health care provider with any questions you may have regarding the COVID virus or any other medical condition. You should not disregard such professional medical advice or delay in seeking it because of the information provided in this document.

For any non-medical assistance please contact covid19@agudathisrael-oh.org or call 216-848-0379.

If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.

Quick Guide

Do you think you may have Coronavirus (COVID-19)?

1. If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.
2. If you have any concerns, even on Shabbos or Yom Tov, call 911. Paramedics will come & they can take any necessary vitals
3. If you are having any one of the following symptoms: fever above 100.4 (or above 99.6 for patients above 60 years of age or immunosuppressed), cough, diarrhea, fatigue or shortness of breath
   1. Call your Primary Care Physician
   2. Cleveland Clinic Express care online  download from http://www.CCF.org  24/7
   3. Virtual visits through UH  http://www.uhhospitals.org
4. Once you are COVID positive
   1. If you are at home – set up a buddy to check up on you (or call us & we will provide one to you)
   2. If you are under the care of a physician and have been advised to use an oximeter to monitor your pulse and oxygenation levels  contact Agudah to get oximeter via covid19@agudathisrael-oh.org or 216-848-0379
   3. Provide name of your physician
   4. Confirm that you have instructions for use
   5. We will make arrangements to get an oximeter to your home.
5. Advance Planning
   1. Prepare PCP phone numbers & download virtual visit app
   2. Keep on hand Pedialyte or other electrolyte solution in case of illness & need to rehydrate.

In Depth

Healthcare Access

If you are having chest pain, shortness of breath, dizziness, a severe headache or other potentially life-threatening problems, go to the nearest emergency department or call 911.

In many cases, you may have any one of the following symptoms: fever above 100.4 (or above 99.6 for patients above 60 years of age or immunosuppressed), cough, diarrhea, fatigue or shortness of breath and will need to know your options for getting care. You cannot currently go to a site to get tested for COVID-19 without an order from a physician. If you have a Primary Care Physician, please call them first as they have the best knowledge of your medical history and can provide the best possible care. If you do not have a PCP or would like a virtual visit you can get one through the Cleveland Clinic Express care online. This visit gives you the opportunity to speak with a medical professional on your smart phone or computer without having to leave your home (during the virtual visits, medical professionals will be able to order COVID testing if they feel it is medically necessary and can guide you on next steps). You can access an online virtual visit through http://www.CCF.org. Click on “start a virtual visit” to start the process. There is an app to download onto your computer or smart phone and from there you can start your visit.

Advance preparation is ideal so you have what you need when you are not feeling well. Find your PCP’s phone number and leave it by your phone or enter it as a contact in your phone while you are still feeling well. Download the CCF Express care app in advance in case you need it – it is easy to put on a phone or computer and it is open 24/7 for care. You will need to enter your name address, email address & insurance information. At this time patients will not be charged for the virtual visits over and above what is covered by insurance. Once in the site, there is a list of physicians whom you could choose & it details the number of patients waiting for a visit before you. It only takes a few minutes to set up and is very easy to use.

Virtual visits are also available through University Hospitals – follow the links for same day care on http://www.uhhospitals.org

It is recommended that if you have to go to the ER, you stay in the same hospital system as your primary care provider for more cohesive care.

Contact and Observation

It will be important for our community to connect with those in quarantine so they do not feel isolated. In particular, our friends experiencing symptoms from the virus, may require additional attention. Toward this end, a team of healthcare professionals in the community have advanced an initiative to help prevent potentially dangerous consequences of isolation. This is especially helpful for individuals who are living alone.

Buddy System

The committee recommends the creation of a buddy system for our friends who test positive for COVID 19 and find themselves in mandatory quarantines. Each person who is positive for COVID 19 should ask a friend (outside of the household) to establish twice daily contact via telephone or (preferably) video chat. The buddy will act as a “second set of eyes” in addition to any family members who are in the home. It is challenging to evaluate a patient’s medical condition, but some basic indicators certainly include common sense determination of whether a person is eating, drinking, and breathing properly (is the patient breathing faster than usual). Additionally, community volunteers who are willing to perform this role with confidentiality and discretion have been identified for anyone who has trouble identifying their own “buddy”. Please let us know if you need a buddy (covid19@agudathisrael-oh.org or call 216-848-0379).

Equipment

Once you are COVID positive and under the care of a physician, you may be advised to monitor your pulse & oxygenation levels. This is a device that is easy to use. A probe that is placed on a fingertip, and painlessly, without penetrating the skin, measures heart rate (pulse) and oxygen in the bloodstream. The exact details for how to use the device, management and expectations for oxygen will be determined by your physician because readings are to be interpreted differently for each individual person, their particular health needs and medical condition. It would be ideal if every household has a functioning thermometer for each quarantined person in the home – for those in self-quarantine after exposure as well as those in mandatory quarantine and known to be COVID positive.

Agudah has acquired a limited number of pulse oximeters. If needed and recommended by your health care provider, please email covid19@agudathisrael-oh.org or call 216-848-0379 with your request, the name of your physician and confirm that you have instructions for use & we will make arrangements to get an oximeter to your home.

Change in Condition

If there is a noticeable change in the observed condition or pulse oximeter readings of a quarantined person, a buddy can help (encourage) the person seek medical care.

Preparation of an Action Plan

Prepare

Everyone should develop a plan of action upon learning of his or her COVID 19 diagnosis. It is important to recognize that only a very small percentage of people infected by COVID 19 will require emergency medical care, but if such care is required, it can be engaged more effectively when there is a pre-specified plan of action.

Calling 911

Anyone experiencing a true medical emergency should call 911 for immediate attention. If you have any concerns, even on Shabbos or Yom Tov, call 911. Paramedics will come & they can take any necessary vitals.

Individuals should be aware that no will be able to accompany the patient to the hospital (unless the patient is a minor). DO NOT let that prevent the patient from going to the hospital and getting the care they need.

Hydration

We would also like to encourage and emphasize maintaining hydration if you are ill. Everyone should consult their rav for any shaila, but we are sharing that per the psak of Rav Boruch Hirschfeld as well as information verified by Cleveland Kosher the following options are available and are OK for use on Pesach for Cholim, although they do contain kitniyos. First choice would be Pedialyte as well as WHO oral rehydration solution. Other options would include Gatorade or Powerade. There is also an at home rehydration solution. Recipe: 8 teaspoons of sugar, 1 teaspoon of salt, 1 liter of water (approximately 5 cups). Stir the mixture until the salt and sugar dissolve.

It is our prayer and hope that everyone will stay healthy and have a Chag Kosher V’Sameach.