Q & A with Ari Greenwald: Responding to a pandemic

Ari Greenwald

Ari Greenwald is an emergency physician and the medical director of Hatzoloh Toronto, a non-profit that responds to emergency medical needs in the Jewish community. He spoke to The CJN on April 3 about the community’s response to COVID-19.

What have you been seeing the last few weeks? 

So, in emergency departments, we’re seeing more cases of COVID-19. Some of these people are presenting what might be described as typical symptoms, like fever, shortness of breath, cough or muscle aches, sore throat or diarrhea. And many of them are presenting with quite mild symptoms. We’re also seeing people who are coming in with significant shortness of breath, low oxygen levels, confusion, who are requiring urgent resuscitation and intubation, and those numbers are starting to grow.

Some people are coming in with other medical illnesses like appendicitis or head injuries, and we find that they actually have COVID-19, although they had no symptoms. This is particularly concerning because it means that there are a lot of asymptomatic people who don’t really have any symptoms at all, but who clearly have the disease. We go ahead and test them and treat them accordingly. But they’re not coming in for COVID-19; they’re coming in for other medical issues.

So, this tells us that there are a fair amount of asymptomatic carriers out there. We already know it’s passing between members of the community without them knowing it. This makes us in the healthcare sector very concerned that our numbers are going to start to grow very rapidly over the next short period of time, similar to what we’re seeing in other countries.

What have you seen in terms of the response from people in Toronto, and especially in the Jewish community?

I think the majority of people in Toronto, and within the Jewish community in particular, are getting that message and recognizing how important it is to not go out if not necessary, to keep distance, keep your hands clean, not touch your face. They’re getting that message and they’re taking it very seriously.

There are some people who aren’t getting that message as clearly, so it’s an ongoing effort to make sure that everybody’s getting on the same page with this and recognizing how serious this is. Right now, we’re at a stage where case numbers and people who are getting sick are becoming known. That’s starting to have an impact on people’s behaviors in an important way, to prevent further disease transmission.

But I think some people might still have the perception that this isn’t so bad, that we’re not nearly as bad as other places like New York, and we’re doing well enough that it’s not going to get to that point. That is a false assumption and a scary one, because if we let our guard down now, and we don’t continue to really be vigilant about preventing any potential transmission, we’re going to be seeing the consequences of that in two to four weeks. By that point, it’s going to be too late to do anything about it.

What would you say to the people who aren’t taking it as seriously?

Yes, it’s true that most people who get this will not have severe symptoms. Yes, it’s true that we’ve been doing a good job until now, for the most part, and people have been taking appropriate precautions. But the CDC (Centers for Disease Control and Prevention) and public health recommendations are changing as we learn more about the virus. So, for example, we’ve recently learned that people who have had COVID-19 can be transmitting it for up to three weeks after they become asymptomatic. We also know that there’s asymptomatic transmission going around. We don’t know how much there is because it’s really hard to know who has it when they don’t have symptoms, but we know that you can feel totally fine, yet have the virus and spread it to other people. We also know that the testing isn’t perfect.

So, all those things combined mean that we all need to act right now as if each of us has it. Each of us could be exposed to it from any interactions we’re having with others. Any interactions that we can avoid and any precautions we can take now will have very meaningful effects and will save lives. People who have been inside for 14 days, it hasn’t been easy, but now’s not the time to say ‘OK, I’ve been inside, I feel fine. It’s time for me to go out.’

There is no foolproof way to know whether you are exposing others to the virus that you’re carrying, and vice versa. The only thing that we know that works is physical distancing. It’s not medicine, it’s physical distancing. That is the simple way to keep this from spreading. And it doesn’t mean you need to lock yourself inside and stay home all the time. But it does mean that we need to take every necessary precaution to prevent things from proceeding further than they already have.

What is Jewish leadership saying about our obligations?

I think the rabbinic community has been great, coming out very strongly. There’s unanimous messaging around not going to minyanim. There’s unanimous messaging around not traveling to be with family for Pesach. And there’s very strong messaging around not having Pesach seders with family members and others you do not live with. I hope the Jewish community will hear these messages that are coming from the rabbinical leaders, as they are based on the unanimous guidance of the medical community, which is based on the lessons that we’ve learned from other countries.

I have faith that we’re going to get through this and be spared from everything that’s happening in other places because we’re hopefully learning from them. But it requires us to make difficult decisions. It requires us to not spend Pesach in the ways that we’re used to, and that we would love to. Pesach is a time when we’re used to being with family and telling the story of how we became a nation together. This is an important part of our tradition. Unfortunately, this year, that tradition has to be done with your members of your household only. Some people are going to unfortunately be spending the Pesach seder by themselves.

But everybody who’s making those difficult decisions should know that, in doing so, they’re helping to save lives. It’s really a demonstration of how much we care for one another, how much we care for our loved ones, how concerned we are for our community health and well-being. I can’t think of a more powerful statement to make during the holiday of Pesach, than to say that we are making these very difficult decisions for the benefit of everybody else.


This interview has been edited and condensed for clarity and content.