Dear Chaverim,

With the upcoming Yom Tov rapidly approaching, Rabbi Billet asked me to put together some general guidelines for what to do if, rachmana leztlon, people get sick or are diagnosed with confirmed or suspected COVID-19 over Yom Tov.

We obviously are not intending to provide specific advice which only your physician should do. Indeed, if someone does get sick before Yom Tov starts,

they should link up with their physician, urgent care center or a tele-health physician and decide several things:

1) Do you require prescription medications, and if so when should you start them? Not all COVID-19 patients require treatment, and treatments do have side effects. However, if treatment with oral agents is necessary, it might be better to start therapy earlier rather than later. Obtain the prescription and fill it before Yom Tov if appropriate, but it is absolutely allowed (even required) to fill it on Yom Tov or Shabbos, if indicated.

2) Find out what is the optimal way for you to get follow-up care should you need to do so on Yom Tov or Shabbos. Find out who and when to call before Yom Tov.

If your condition deteriorates even mildly, one should not hesitate to call your provider sooner rather than later to be re-evaluated on Shabbos or Yom Tov.

3) If your condition worsens to the point where you are short of breath or have significant changes in breathing, mental status (e.g. lethargy, delirium or unresponsiveness), or chest pain, call hatzalah or 911 without hesitation.

BH, most patients with COVID-19 do not actually require hospitalization. The trick is to identify as soon as possible those patients who unfortunately are progressing (worsening) and require more intensive care (medications, oxygen and / or going to the hospital).

One of the best guides to COVID-19 illness worsening is a change in breathing. More rapid breathing at rest, shortness of breath on even mild exertion and / or not being able to fully “catch your breath” after movement are strong indicators that you need to be evaluated again by your provider asap.

For those that have the capability, checking oxygen saturation with a pulse oximeter (the little piece of equipment that is wrapped around a finger and gives a number) is an excellent way to follow and assess breathing status.”Normal” values will differ for everyone, but healthy people will “saturate” between 96% and 99%, whereas people with respiratory problems will have lower numbers (in the 92-96% range). As long as the number are stable for you, and not dropping, that is a good sign. If, however, the numbers are dropping, and certainly if they fall below 90-92%, one must get re-evaluated. I stress, if your condition worsens to the

point where you are short of breath or have any other significant changes in breathing, mental state, or chest pain, call hatzalah or 911 without hesitation.

All of this is REQUIRED on Shabbos or Yom Tov because of “safeik sakanas nefashos” (possibility of risk to life). Even the possibility of loss of life overrides all Shabbos prohibitions. No one should have any halachic indecision in calling a provider for help if they are worried. Indeed, one is required to err on the side of being overly cautious. A person is called a “chosid shoteh” – a “righteous fool” – if one does not take risk to life seriously. Our Rabbis tell us it is better to desecrate one Shabbos and live to observe many more than to not desecrate the Shabbos and possibly die.

Our practicing extreme social distancing has already begun to have a significant impact on COVID-19 cases. We MUST not lose our resolve or let down our guard even as the numbers hopefully improve over Pesach. If we are to prevent further loss of life, we must do everything we can to prevent any new cases of illness.

May we all have a safe, healthy chag kasher ve’sameach.

Aaron E. Glatt