The most recent political maneuver of Prime Minister Benjamin Netanyahu, who is threatening to disband the national unity government while deliberately violating the agreement he signed, is also likely to have a negative effect on the battle against the coronavirus. The slowing of the rate of the spread of the virus in Israel in recent weeks is creating a misleading impression that the problem will soon be solved. However, that is far from the truth.
In effect, although there has been a decline in recent weeks in the daily number of confirmed new patients, many of them are young and asymptomatic carriers. The number dropped to about 1,600 each weekday (the number of tests on weekends is smaller), compared to over 2,000 on a weekday in mid-July. But that is the only significant recent change for the better. An average of about 10 Israelis have been dying every day from COVID-19 in recent weeks, the daily number of patients is still high, the number of those seriously ill is gradually climbing – and perhaps worst of all, the economic crisis is only beginning and is expected to worsen.
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The new national coronavirus czar, Prof. Ronni Gamzu, has adopted a policy that is necessary under the circumstances. In light of the economic damage from the virus, the government’s frequent zigzagging and the people’s growing lack of trust in the leadership’s considerations, Gamzu has declared publicly that he is not interested in another lockdown. He wants to impose a series of alternative steps, based on differential treatment of cities depending on their rate of illness, in order to avoid imposing a full lockdown.
But Gamzu is operating under the shadow of two target dates: the opening of the school year at the beginning of September and the start of the winter season, about two months later. The Education Ministry’s plan for renewing studies is still far from completion, full of obstacles, and expected to lead to a series of clashes between the government on the one hand, and the parents and the teachers’ organizations on the other.
We can also reasonably assume that as was the case in June, a limited opening of the educational institutions will lead to a certain increase in illness. Moreover, in winter there may be a significant increase in the burden on the hospitals due to expected illness from the flu. In order to reach these two junctures with reasonable conditions, there is a need for a genuine decline in COVID-19 cases.
Pressure on government
And here lies the catch: The small decline in illness reflects a drop in the contagion coefficient, which has apparently fallen to slightly below 1 (in other words – one patient infects slightly less than one person on average). But with the current political and economic pressures, for every additional decline in the daily illness rate, the government will immediately be expected to lift a few of the serious restrictions on the economy.
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The government and the coronavirus cabinet are in any case busy counting trees (discussions about opening fitness clubs and swimming pools) instead of looking at the forest (formulating an overall policy for fighting the virus). In every such discussion, the tendency will be to reward the public for the success in lowering contagion coefficient by an additional removal of restrictions.
This is a tendency that will be exacerbated if Israel really does enter a fourth election period within a year and a half. When the legitimacy of the government is questioned, tens of thousands of people are demonstrating every weekend with a demand for the resignation of the prime minister, who is also involved in criminal proceedings, and on the backdrop of another crucial political decision – it will be very difficult to convince the Israeli public to believe in the policy and to obey directives.
We can reasonably assume that all these things will result in a tango of one step forward and two steps backward with the virus. At the same time, there will be no aspiration or ability to once again lower the daily infection rate to dozens of patients a day, as happened during the May lull at the end of the first wave in Israel. The rate of illness will rise and fall, and the government will vacillate between a few leniencies and a renewal of certain restrictions, without being able to bring about a breakthrough. That is likely to affect the effort to break the chain of contagion in particular.
In recent weeks there has been a belated effort to establish the epidemiological investigations system, this time under the responsibility of the Israel Defense Forces. But in order for breaking the chain to affect the contagion coefficient, we have to reach almost half the chain in time and isolate anyone who came into contact with a confirmed patient. When the daily number of confirmed patients is so high, that seems like a mission impossible.
The government is worried about the number of seriously ill patients. On Sunday morning there were 394 such patients in Israel, compared to 334 a week ago. In the past, the Health Ministry warned against reaching 600 to 800 seriously ill patients, claiming that such numbers would impose an impossible burden on the hospitals, adversely affect the level of medical care, and increase the mortality of COVID-19 patients (which is less than 1 percent of confirmed patients, in the second wave).
Burden on hospitals
The health care system is still far from that, but the focus on the high number of patients is somewhat misleading. It ignores the burden on the system since March. Even without reaching the threshold number, the burden on the staffs and the burnout rate are high. There is a danger that the hospitals and the community HMO clinics will be in a state of attrition by the time winter arrives, just when the challenge is likely to increase. That would probably require, as the hospitals and the doctors’ organizations are demanding, a significant increase in job slots in the hospitals before winter.
At the moment it looks as though Israel’s dance with COVID-19 will continue. The main hope for an exit lies in the success of the global effort to develop a vaccine, rather than the steps to be decided on by the government.