Health Ministry Deputy Director General, Prof. Itamar Grotto, is known as someone who doesn’t hesitate to say what is on his mind. Grotto, today the most experienced professional at the top of the ministry, feels freer than ever to speak because he has already made it known that he plans to step down. He will keep his job for a few more months only because his expertise is needed as the coronavirus vaccine drive gets underway.
That may explain Grotto’s surprising confession last week that retail and other commerce doesn’t contribute significantly to the spread of the coronavirus and that he supports a complete reopening of the retail sector. That stands in complete opposition to what other top ministry officials are saying.
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“The fact is that the morbidity rate rose before most retail business reopened,” Grotto told TheMarker. “Experience teaches that inside stories, people wear masks. In any case, the worst thing is to force people into a small number of shops and thereby create crowds. Either all retail should be open or all retail should be closed. The halfway solution is the worst of all possible worlds.”
Grotto’s unusual position, which many experts disagree with, illustrates one of the toughest problems Israel faces in coping with the coronavirus: We still don’t have a very firm idea of how the virus spreads and in the absence of information, experts are divided about how to contain it. Without clear policies that everyone agrees on, the Israeli coronavirus boat veers every which way.
The confusion isn’t unique to Israel. All over the world, there are serious debates over the correct policy. Morbidity rates vary greatly between similar countries and even inside a single country. Can anyone explain Belgium, the country with the world’s hugest mortality rate, or why the second wave in Belgium was so much worse than in Spain or France?
Why are countries with strict policies and high levels of observance, such as Switzerland and Austria, now suffering much higher mortality rates than neighboring Germany? And what happened in Italy, which became the coronavirus poster boy in the first wave and is now seeing a second no less powerful wave?
The longer we’ve been living with the coronavirus, the less we seem to agree about it. On the eve of the arrival of the long-awaited vaccine, we can be pretty confident that even years from now, the medical and scientific establishment will continue to argue about what actually happened in 2020 and what would have been the right steps to take.
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“Philosophically speaking, I am not sure that the world took the right steps,” says Ran Saar, the CEO of the Maccabi Health Services. “The world chose to impose lockdowns to prevent the spread at any price. They chose lower mortality at a very high economic and social cost. Was it necessary? It’s hard to know.”
Difficult to estimate
The problem is that it’s difficult to estimate the cost or agree on how much we are prepared to pay.
Earlier this month, the Central Bureau of Statistics released data on mortality rates in Israel during the coronavirus crisis – in other words, how many more people died in 2020 in Israel compared with years past. The answer is 2,259 people through the end of October, about 6 percent more than in the same period in 2019.
However, this is a misleading figure, because the flu outbreak at the beginning of the year was mild and the mortality rate was low. If you break off the figures from the middle of March until the end of October, the excess deaths numbered 2,586 compared with the same time in 2019 – almost the same as the number of death attributed to COVID-19. The mortality rate was 10.4% higher since the outbreak of the virus, compared with previous years.
That figure is important for several reasons:
In most countries, the rate of excess deaths was higher than the number of reported coronavirus deaths. It appears to be this way because many COVID-19 deaths were misreported. Israel had an excellent record in identifying carriers because of its high testing rates.
All the excess deaths in Israel this year were due to coronavirus. If we previously thought that a large number of the coronavirus deaths would be of people who would have died anyway (elderly people with low levels of immunity, where “the first germ that gets to them kills them”), the numbers show otherwise. Coronavirus didn’t kill people who would have died otherwise. Sadly, 3,000-3,500 will have died this year only because of COVID-19.
This is especially the case for Israeli Arabs, whose mortality rate for people over age 70 was double that of Jews. Without a doubt, Israel’s Arab citizens paid a heavy price for the coronavirus, a function of their poor health profile and a failure to widely observe social distancing rules.
The excess mortality rates vary greatly by age group. Up to age 19, the rate actually fell 23 percent. Up to age 70, the excess is small and in fact lower than the number of reported COVID-19 deaths. Most of the excess deaths occurred among the elderly – 17 percent more for ages 70-79 and 11 percent for those 80 and above. In other words, fewer younger death occurred at the expense of more elderly deaths, the result being that Israel’s life expectancy rate will not have changed much this year.
Although the overall number of deaths exceeded what could have been expected this year by 10.4 percent, the rate varied a lot over the months. It peaked in the period from the middle of September to the middle of October, when the rate of excess death climbed to 24 percent. The second lockdown reversed that and strengthens the argument for its effectiveness.
It’s still too early to reach a final concussion on excess mortality. It could turn out that the excess mortality rate this year will be offset over the next few years by a lower rate. That is what happened in the wake of the 1918 Spanish flu pandemic. There were fewer tuberculosis deaths in the following years because sufferers had already died from the flu.
Even if the mortality rate is a concrete fact, its meaning is open to interpretation and debate. Assuming there are no surprises in the next few months now that a vaccine is being administered, the excess deaths Israel will have suffered will reach 4,500, or 10 percent more than what we should have expected without COVID-19. That’s a high price, but much smaller than had been feared at the start.
Given what we know now, coronavirus didn’t become the national disaster that had been widely feared. That being the case, the debate over what measures should have been taken, in particular the draconian lockdowns, will remain with us for some time to come.