Dear GTA Jewish Community Members,

Coronavirus has now been with us now for a full year. While we all wish and daven for COVID to be over, it will still be with us for many months. Unfortunately, we are now entering a new phase of the pandemic, again, as Purim and Pesach approach. While we are all experiencing some degree of COVID fatigue, we do not have the luxury of complacency.

As you know, the stay-at-home order remains in place for Toronto until at least March 8, but York Region will be transitioning to the Red Zone on Monday. A large number of the currently active variant cases are located in Thornhill so continued and increased vigilance in York Region is called for. **Toronto residents should not go to York Region for Purim and York Region residents should not go to Toronto. The following notes and guidance should be considered minimum safe practices for the upcoming season.

New Variants in Toronto and Thornhill

• There are new variants of the virus that have emerged in the United Kingdom, South Africa, and elsewhere. These variants spread much faster and to more people than the COVID virus we have been dealing with until now. 
• The variants have in fact led to increased hospitalizations and deaths among younger people in Israel – including children, pregnant women and young men. This, despite Israel’s excellent vaccine coverage that is protecting many of the most vulnerable and much of the population at large. 
• The COVID variants are present in US Jewish communities and have now arrived in the GTA. There are currently several shul- and school-related outbreaks of the South African variant in Toronto and Thornhill. Specifically, over 20 cases in several clusters in Thornhill. These variants have the potential of rapid spread in our community, leading to more cillness, hospitalizations and deaths.
• COVID variants are doubling faster than every two weeks in the general population in Ontario, and now make up 11% of all COVID-19 cases. By Purim, just one week from now, it will likely be at least 15%, and by Pesach it may be over 50%. Within some communities the variants may already be dominant.
• There have already been several boys who returned from Yeshiva in the US and Israel who have tested positive for the variants of concern (VOC’s). Ideally, this sort of travel would be limited. Understandably, parents want their younger children to be home. In this case, we urge the young men and women and their families to completely isolate. The new variants can transmit quickly from unknowing family members to others.

What has changed for you?

• With these new variants, what we thought we knew about what is a ‘contact’ has now changed. Masking and distancing are still the most important things you can do to protect yourself, your family and your community. However, the new variants have been shown to spread quickly, even where people believed they were strictly adhering to masking and distancing.
• For example, physicians in full PPE became ill in the first large UK variant outbreak in Ontario, and several people were infected in a shul where masking and distancing were strictly adhered to.
• The best way to protect against transmission is to avoid gathering. Children need to be in the school environment to learn, but all other gatherings outside the household should be avoided.
• Due to the prevalence of the Variants of Concern (VOC’s) in Ontario, as of Feb 4th, you may be considered a contact of a case and must isolate for 14 days, even if you wore a mask, were more than 2 meters away or were in contact for only a few minutes. This does not mean that masking and distancing are not critically important, but they are not enough.

Previous Illness, Vaccines and the New Variant 

• The new variants can infect people who have already had COVID-19. Anyone who was infected with COVID-19 before Feb 4th (ie: with the previous COVID strain), can get re-infected and must isolate for 14 days if they come in contact with a new positive case.
• Individuals with COVID antibodies must also isolate and can be re-infected. 
• There are some signs that the coronavirus vaccines already being used worldwide may be slightly less effective against one of these new variants. However, in practice they are still shown to provide excellent protection against hospitalization, severe illness and death, and remain our best chance at ending the pandemic.

Minyanim

• Some people have continued to daven daily with a regular minyan (10 men only), masking and distancing. This can still be a safe activity as long as there is no interaction with other minyanim.
• Due to increased transmissibility, and the ability of the virus to transmit very quickly to others (second generation transmission) even before a case is identified, if anyone in a minyan does become a case, the entire minyan is considered contacts (regardless of whether they were masked or distant). They, and their families must self-isolate. While this is very difficult, those who do not isolate risk transmitting the new variant to their children’s schools, their workplace and elsewhere.
• Due to the transmissibility of the variants and the isolation requirements that exposures now entail, it is unwise to daven in more than one minyan. 

 School Safety

• We are all excited to have our children back at in-school learning. While many Jewish schools have had very few, or no cases of COVID at all, other schools have been harder hit. 
• It remains true that when vigilant and consistent public health measures are adhered to, there has been very little COVID transmission in schools, and they are a safe environment for children. However, the new variant is making this return to school more difficult. Due to the increased potential for transmission, there are new stringent guidelines for screening and dismissal from school.
• Parents need to be vigilant regarding extra-curricular activities, sports and playdates. The variants have easily spread among children even in outside play.
• Preventing COVID from entering schools is the best way to keep them safe. If any family member is symptomatic or is a contact of a case, regardless of distancing and masking, they should not risk the entire class/cohort by sending their children to school. 

Testing

• Appropriate and timely COVID testing at an authorized assessment centre is critically important to controlling the pandemic in the community. Only Public Health affiliated labs screen can test for the variants. Currently, turn-around time is 24-48 hours at most testing centres.
• The first test done initially after exposure to a variant may be indeterminant. If you get an indeterminate results, test again in a few days. Indeterminant results are not sent for variant screening.
• If you test positive, your self-isolation is only 10 days. If you do not test, you need to quarantine for 14 days.

Purim

• Adults and children alike look forward to Purim more than any other holiday. Unfortunately, Purim comes at a very vulnerable time in the pandemic and we must adhere to public health guidance to ensure that it is a time of joy and not sorrow.
• Prominent Rabbis in our community have issued halachic guidance for all of the mitzvos related to Purim HERE and HERE. This guidance includes strict adherence to public health measures. Community Kinnus L’Chizuk can be found HERE.
• Gathering with others from outside your household is not permitted. This is critically important when the potential for many gatherings is high. 
• While Toronto remains under stay-at-home orders, York Region has transitioned to the Red Zone. Toronto residents should not travel to York Region for Purim and York Region residents should not go to Toronto. Given the cases in the Thornhill community it would be prudent to continue the highest degree of vigilance for Purim, including only gathering in the smallest possible numbers
• Many families will want to deliver mishloah manot to family and friends. Ideally, in-person mishloach manot should be minimized. However, limited delivery can be done safely with vigilant masking and distancing. As you can imagine, one infected person who does not mask and distance, or who gathers with others, could infect hundreds of people on Purim.

Pesach Planning    

• Most of the highest priority groups (long-term care residents and staff, many health care workers) have been vaccinated in Ontario. In the coming weeks, those age 80+ will be prioritized. While it is likely that these groups will be partially vaccinated prior to Pesach there will not be any degree of herd immunity by Pesach time. Optimal protection is only achieved 2 weeks after a second dose of vaccine. 
• As noted above, those who had COVID prior to Feb 4th or who have antibodies are not considered immune to the new variants in terms of the need to isolate/quarantine, or possibility of transmission.
• Unfortunately, the variant is doubling every 9-12 days and by Pesach it will be very likely be the dominant strain in Ontario. We may see rates of spread in Ontario similar to those in the UK and Israel in the past few weeks, but without the benefit of large-scale vaccination. We will need to hope (and work) for the best, but prepare for the worst. We will work to provide an update prior to Pesach, but everyone should begin planning accordingly.

May Hashem protect us, continue to grant us wisdom, patience and health. 

Chaim Bell, MD PhD FRCPC
Ari Greenwald, MD FRCPC
Avi Orner, MD CCFP FCFP
Barry Pakes, MD PhD FRCPC
Andrew Morris, MD SM FRCPC
Moshe Weinstock, MD FRCPC