In Israel last week, Dr. Chana Adler Lazarovits and Rabbanit Sarah Segel-Katz ruled that women should not attend mikvah if they cannot ascertain that the required hygienic standards were followed.
This should give us pause to re-evaluate mikvah attendance in the United States and especially in the highly impacted cities and states. This is made more urgent in light of the impending peak in cases predicted for 2-3 weeks from now in NYC, a crest that can lead to medical rationing of the already scarce supplies and ventilators, more cases of infected health care providers, and an increased burden on an overtaxed health care system. Reviewing data that has been published recently can also inform practice and assist in appropriate decision making.
“There is no evidence that COVID-19 can be spread to humans through the use of pools and hot tubs. Proper operation, maintenance, and disinfection (e.g., with chlorine and bromine) of pools and hot tubs should remove or inactivate the virus that causes COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/php/water.html).”
To their credit, these guidelines made sure to limit attendance to the mikvah by using strict criteria for who could use the mikvah, limiting attendance to just the mikvah space by having women prepare at home, and ensuring the safety of the mikvah lady or shomeret by having her maintain proper distance at all times and abiding by an appointment-only schedule.
Recent data from the New England Journal of Medicine (NEJM, 3/17/20) has found that the coronavirus can survive in the air in small particles known as aerosols for hours and on surfaces for days. In this data set, the virus could be aerosolized for up to 3 hours. Though most transmission is likely from larger droplets from sneezing and coughing (especially in hospitals), these results can also provide evidence for the high rate of spread (EB, 3/23/20). The mikvah is a closed space, and though there are strict guidelines in place on cleaning the handrails, door knobs, how do we best clean the air should an asymptomatic carrier sneeze or cough in the mikvah? And though there is vigorous cleaning, the fact that the virus lives on surfaces for a long time calls into question the too often heard label of mikvaot currently being “really safe.” We must not only consider the safety of the attendees but also the dedicated mikvah lady and cleaning staff that are putting themselves at real risk on a nightly basis.
In addition, counter to the widely held medical belief that COVID-19 is especially serious in the elderly and immunocompromised, recent data from the CDC reports that younger patients ages 20-44 currently make up 20% of hospitalization rates and 12% of ICU admissions. What is reported anecdotally is that some of these patients have no underlying disease, further emphasizing how lethal this virus can be to even the healthy young. This is the age group that predominantly attends mikvah and who may be under the false belief that if they do get sick, it will be mild.
In truth, just like much else about the SARS-CoV-2 (COVID-19) virus, it is novel, which means it has never infected humankind until now. We only have a couple months’ worth of data on which to support our decision making. We should be ready to pivot, pull back, and, as data evolves, adjust our current guidelines. There are mikvaot in the Tri-State area that are highly trafficked, with a minimum of 40 women on a quiet night, and there is just no way to keep that waiting room or mikvah completely safe. Remember, it is believed that non-symptomatic carriers may well spread disease as efficiently as those with symptoms. Let us consider the real risk for all the women and staff involved and consider shutting down our mikvaot for a period of time to protect the lives of our mothers, daughters, and friends. For those that consider the risk to be less at the mikvah than in other spaces such as supermarkets or pharmacies, then at the very least women should be informed that based on the current CDC recommendations, there still exists a small but real risk of infection. No public place is coronavirus free (CDC Take Steps to Prevent Getting Sick). Let women choose to attend mikvah with the knowledge of all the facts. Let us consider other safe halachic options for those in need (for example, women experiencing fertility issues) until we can safely reopen our mikvaot. Shutting down our mikvaot in the face of the coming peak may be the most responsible and urgent communal response necessary for this moment.
A previous version of the reference I used from the Jerusalem Report article gave an erroneous figure for the number of cases of coronavirus thought to have been contracted in mikvaot and JP 3/31/20 now has revised that number to three persons infected in mikvaot.
I have decided to not include the numbers from Israel as the piece makes the relevant points with the peer reviewed data I have referenced.
Dr. Abraham is an internist who currently works in Oncology Medical Affairs for a pharmaceutical company. Dr. Carmella Abraham graduated Yeshivat Maharat in 2017.
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