The basis for this action is the fundamental idea that respiratory viruses take advantage of our social connection.  They are spread by droplets emitted by coughing, sneezing, or even talking.  Often, much of the transmission takes place in children.  For example: an infected elementary school child may circulate a virus in his or her classroom, infecting many of the other children.  Those children then bring the illness home and infect their siblings, who go on to infect their classes, and the disease spreads.  The illness also then spreads to parents, who may then give it to other adults, both at their generational level and above. 

Coronavirus presents a particular challenge.  As noted in a previous article, most of those who contact the coronavirus will experience it as a common cold, with fever, cough, and runny nose.  Untested, most people will not know whether theirs is a "homegrown" respiratory infection, or one that traveled halfway around the world.  In addition, most viruses are contagious prior to the appearance of symptoms, meaning that an individual can infect others without yet knowing that he or she is infected.  These factors make it even more tricky to limit contact with infected individuals.

The strategy currently being employed in the state of Maryland is called mitigation.  Mitigation is a well studied public health tactic used when community spread of a virus has begun - namely, when one cannot track the cases to direct contact with someone who travelled to an endemic area (such as China, Italy, etc).  Mitigation attempts to disrupt this pattern of infectivity.  Closing schools decreases the likelihood of viral spread at that level.  "Social distancing", which includes things like keeping a distance of 6 feet from others, suspending mass gatherings, and limiting social events, tries to stop the spread on the adult level. 

It is crucial to note that our goal is not only to stop the spread of the virus; perhaps more significantly, we attempt to slow it down.  With a new virus spreading quickly, there is a risk of having an extensive number of cases requiring hospital or emergency care.  An overwhelmed          and overstressed hospital system could lead to more fragmented access to care, limited intensive care availability, and ultimately unnecessary deaths.  While this may sound like an impossibility, it has already happened in built up areas of China and Italy.  There, a lack of intensive care beds and increasing volume of Coronavirus patients has led to overflowing hospital wards, insufficient staffing, and the need to make tough decisions such as which patients get to receive  life saving care. In contrast, many of the eastern Asian countries have already adopted very strict social distancing measures and put a brake on the spread of the virus.

Mitigation as a public health approach has a strong precedent: a quick Google search will turn up a graph which shows the effect of this protocol on the spread of the Spanish Flu in 1918.  It has also been used in countries with recent outbreaks such as SARS, MERS, and Ebola.  With quick implementation, mitigation has been proven to slow viral contagion - saving many from infection, and allowing hospitals and healthcare systems to keep up with what spread did result.

If we think about our own community's social patterns, it becomes very clear why our community is at higher risk for the sharing of these viruses than others may be.  Our strength as a vibrant, caring, and connected group is exactly what makes us vulnerable. Where many in the modern world don't have daily contact with others outside of school and work, we live in close proximity to one another and spend a lot of time together.  Our average family size is larger, meaning that spread can occur more quickly to various age groups.  There are daily shiurim and chesed meetings.  And then, of course, there is shul.

The epicenter of our communal activity is the shul.  As frum Jews, we spend 30-50 minutes at a time, often in a small space, with dozens of other individuals from different neighborhoods and different professions.  Many shuls have multiple minyanim, which can mean contamination of table, chairs, and siddurim.  Many individuals frequent more than one shul on a regular basis - perhaps attending one shul for shacharis, another for mincha/maariv, and a third for a night seder, where chaburas and chavrusas often engage in spirited debate (often accompanied by unintended respiratory secretions).  We, more than any community in the world around us, make the perfect target for such a virus to take hold.

Here is where mitigation becomes extremely important.  If we take these painful measures to limit our personal contact during these weeks, we may significantly slow the rate of illness.  But we need to take it seriously.  And, of course, we need to continue to heighten our use of personal hygiene - washing our hands, covering our coughs and sneezes, throwing away dirty tissues instead of pocketing them, and teaching our children to do the same.

The above may now lead us to the opposite question to the title of this article: Should we panic? 

Absolutely not.  We are still in the early stages of this outbreak in Maryland.  Our Governor, public health officials, and esteemed rabbonim have taken this difficult step early, perhaps well before we are truly feeling the effects of the pandemic.  To review what has been said many times, the disease caused by the virus is trivial for the vast majority of those who contract it, and especially so for children and young adults.  However, the caution warranted by this situation, especially while looking at the rest of the world, behooves us to take this step seriously. 

Mitigation is economically threatening, socially disruptive, and downright inconvenient, but it remains the most important way to keep our loved ones and community members safe and avoid potential disaster.

Dr. Dani Poliakoff is a pediatrician in Owings Mills, MD.