Last month, I wrote about the outbreak of shigella, an intestinal infection, in haredi communities in Brooklyn. The disease spread through poor hand washing and, as I pointed out last month, haredim – especially hasidim – are…
The Health Department today notified Orthodox Jewish residents of the Borough Park and Williamsburg communities in Brooklyn of an ongoing outbreak of shigella, an intestinal infection. So far this year, the two communities have had more than 150 cases of shigella, more than half of them among very young children. In the hardest-hit area – zip code 11219 – 60 people have been infected.
The Health Department is working with community leaders, including rabbis and City Council members, to raise awareness of the outbreak and to provide advice on prevention.
Shigella is a bacterial infection which is spread when food or water become contaminated with microscopic amounts of fecal matter from an infected person. It spreads when people do not wash hands well enough and have a tiny amount of infected stool on their hands, after using the bathroom or changing a diaper. Symptoms include diarrhea, fever, nausea and cramps. Shigella infections can last several weeks, and people typically recover without treatment. Antibiotics should only be given for severe cases as the shigella bacteria causing the outbreak in Brooklyn are already resistant to many common antibiotics. To avoid spreading the infection, people who are sick should drink plenty of fluids to prevent dehydration and should stay home from work or school until they are better. If you think you may be infected, call your doctor.
Because shigella spreads through fecal matter, prevention requires washing hands frequently and carefully with soap and warm, running water. Everyone should wash their hands for 20 seconds after using the toilet or changing diapers, and before eating or preparing food. If residents perform ritual hand washing (Asher Yatsar) after using the bathroom, they should also wash their hands with soap and warm water.…
Warm water on Shabbos? Of course not. Even more so, as I noted last month, what the NYC Department of Health has to contend with is not rational:
…So the [hand washing] cup is used to to remove evil spirits that somehow will not come off with regular hand washing.
People could try to get around this health problem (a.k.a. a sakana) by first washing their hands with soap and water and then washing ritually.
But many haredim refuse to use any soap – even diluted liquid soap – on Shabbat. They consider it a violation of Shabbat law. I remember being told even Rabbi Moshe Feinstein said (and I paraphrase) "I don't see how liquid soap is permissible." I think Rav Moshe then goes on to find a way to, reluctantly, permit it.
So this superstition with no Torah source takes precedence in some corners of the haredi world over real health issues, issues that are governed by clear halakha with a Torah source.
So you're at a haredi family's home for Shabbat. You use the liquid soap. So you're safe, right?
As long as one person there does not use soap and correctly wash their hands, the bacteria, if present in that person, can easily be spread to everyone else.
Note the areas of outbreak are heavily hasidic.
The more Litvish areas seem to have largely escaped the outbreak. This is most likely because, when faced with clear medical evidence, most Litvish poskim (rabbinic judges, so to speak) will choose to heed medical advice and avoid danger, just as halakha demands.
Hasidim and Hungarian non-hasidic haredim, on the other hand, are far more concerned with custom and superstition. Just as these rabbis refused to stop metzitza b'pe despite evidence of clear danger, they will probably refuse to take the steps necessary to stop this outbreak.
The purveyors of toilet tissue, Preparation H and other necessities to Brooklyn's haredim can look forward to a very profitable Spring.
Of course, I was attacked for writing this. The basic claim against me was a perceived lack of proof that the disease was really limited to haredi communities. There was also the idea that, once the disease had been publicized, haredim would take steps to curtail transmission, so I had no right to criticize.
Enter reality in the form of a news report from the Journal News:
More cases of shigellosis infection reported in Monsey, New Square
BY JANE LERNER
THE JOURNAL NEWS • JUNE 25, 2008
MONSEY - When schools that serve young children in the Jewish community closed for the Passover break in April, Rockland County health officials thought an outbreak of a highly contagious bacterial disease would end.
To their surprise, the number of shigellosis cases among children in Monsey continued to rise. The disease is now being reported in New Square, as well as in New York City and in the town of Monroe in Orange County.
As of yesterday, 130 cases of shigellosis have been reported to county health officials, said Dr. Joan Facelle, Rockland's health commissioner.
"Unfortunately, the cycle of transmission has not been broken and we are still seeing more cases," she said.
Only one case of the infectious disease was reported during the first six months of last year, records show. The infection causes diarrhea, often bloody; abdominal cramps; and fever.
All of the current cases occurred in youngsters who attend private Jewish schools in Monsey and New Square. No cases have been reported outside of those communities.
The bacterial disease first was seen among a few children in January, with a majority of the infections occurring in early April.
The bacteria that cause the disease are present in the diarrhea of those infected while they are sick and for as long as two weeks afterward. Most shigella infections are a result of the bacteria passing from stool or soiled fingers of one person to the mouth of another person.
Lack of hand-washing and a failure in basic hygiene -particularly among toddlers who are not fully toilet-trained -cause the disease to spread.
Health officials had hoped that when schools closed for nearly two weeks in late April, no more children would be infected.
The case numbers did go down a little in late April and early May, Facelle said, but the numbers began to rise once children returned to school.
Eighty new cases have been reported since.
Outreach workers with the Health Department have been meeting with community leaders, including rabbis in Monsey and New Square, and visiting schools where cases have been reported.
"Now that the school year is ending, we will make an effort in the summer camps as well," Facelle said.
"We continue to stress the importance of hand-washing," she said, as key to preventing outbreaks.
No deaths have been reported as a result of the infection, Facelle said.
Children younger than 2 who get the infection sometimes develop seizures, according to the national Centers for Disease Control and Prevention.
More than 14,000 cases of shigellosis are reported to health officials nationwide yearly, according to CDC figures.
Shigellosis is more common in summer than winter, according to the agency. Children, especially toddlers ages 2 to 4, are the most likely to get shigellosis. Many cases are related to the illness spreading in child-care settings, and many are a result of the illness spreading in families with small children, according to the CDC.
Another contributing factor to the outbreak is how children think and behave. It is difficult to get any child, religious or not, to properly wash their hands – or even to wash them at all.
But haredi parents face a special hurdle.
Ritual washing, like any other man to God halakha or minhag (law or custom), takes precedence over non-religious requirements. So mitzitza b'peh (the oral to genital sucking of the open circumcision wound by the mohel) takes precedence over fears of disease transmission. Hasidic garb is worn even outside the community, making it difficult for hasidim to find employment.
This emphasis on custom even the face of danger or poverty carries over into other areas of daily life – including how things like hand washing is viewed. In the hasidic view, God did not mandate soap. He did, however, mandate a ritual washing cup.
Soap becomes a concession to the goyyim, an afterthought, or something done to keep the visitors from gagging. And children realize this.
Reluctant to wash at all, haredi children I think are more likely to use a ritual washing cup alone rather than go through the trouble of washing twice.
Add to that the Shabbos problem – bar soap is not permitted to be used on Shabbat and many hasidim dislike using liquid soap on Shabbos, seeing its use as halakhicly questionable – after all, there was no liquid soap in pre-WW2 shtetl life. Zeyde never used liquid soap!
This is a problem not only in hasidic communities. Strict Hungarian neo-hasidic communities share hasidism's dislike for anything that is too "modern" – hadash assur min HaTorah, everything new is forbidden.
And so you have an outbreak of a disease that can kill small children and cause seizures in others – all to rid hands of evil spirits that do not even exist.
How positively primitive.
[Hat Tip: Michelle.]