Israel Reverses the Trend: More Coronavirus Recoveries Than New Cases

The number of people on ventilators is dropping too, as number of tests rise, and experts estimate the peak is behind us

Ido Efrati
Aaron Rabinowitz
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Medical staff at the Rambam hospital emergency room in Haifa, April 7, 2020.
Medical staff at the Rambam hospital emergency room in Haifa, April 7, 2020. Credit: Amir Levy
Ido Efrati
Aaron Rabinowitz

The number of people who have recovered from COVID-19 in Israel was greater than the number of new cases diagnosed over the past three days, the Health Ministry reported. On Sunday, 226 new cases of people diagnosed with the coronavirus were reported and 298 Israelis recovered from the disease, according to the ministry statistics.

For the first time since the crisis began in Israel the number of people recovering from COVID-19 has exceeded the number of new patients for three consecutive days; On Saturday, 283 new cases were found and 330 people recovered; and on Friday 224 new cases were diagnosed while 308 more people recovered. 

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Bibi's got the perfect exit strategy - just not for the coronavirusCredit: Haaretz

In other good news, the number of coronavirus patients needing ventilators is also dropping. Over the past four days, the number of those on ventilators has fallen from 137 to 109, the first time these numbers have dropped consistently since the outbreak of the disease in Israel. Some of the decrease can be attributed to patients in critical condition dying, but so far, the patients who died were replaced by even greater numbers of people needing ventilators.

Over the past four days, the spread of the disease has been halted in ultra-Orthodox communities too. The data may well point to the beginning of the end of the first wave of the spread of the disease in Israel, and a number of experts say the peak of the outbreak is behind us.

The conclusions as to the ebbing of the disease are strengthened by the growing number of coronavirus tests being carried out in Israel – along with what is known so far about how COVID-19 spreads: Most of those who fell ill showed symptoms in the first week after they were infected – and 97 percent of those who fell ill showed symptoms within 11 days of infection. In general, they were diagnosed with the disease a short time after the symptoms appeared.

In comparison, the recovery period takes a long time and lasts four to six weeks. This means people “enter” the disease quickly but “leave” it much slower, so the number of people in recovery rises at a much slower rate than the number of new patients. This is why having a greater number of people recovering than falling ill is such an important indicator of the improvement.

A coronavirus testing station in Jerusalem, April 19, 2020.
A coronavirus testing station in Jerusalem, April 19, 2020.Credit: Ohad Zwigenberg

Fewer people testing positive

This change can also be seen when we compare the percentages of those testing positive for the virus to the number of tests conducted daily. The tests for diagnosing COVID-19 in Israel are carried out – in most cases – according to two basic criteria: The existence of suspicious symptoms, combined with contact with a confirmed patient, or arrival from a country infected with the disease. 

The number of coronavirus tests conducted in Israel in early March was only a few hundred per day, and reached a one-day high of 11,908 in the past few days. The basic assumption is that the more people who are tested, the more people in the early stages of disease can be identified and they can then be prevented from infecting others – and it will be possible to stop the outbreak more quickly.

But the Health Ministry statistics show that the number of people diagnosed did not necessarily rise as the number of tests conducted increased. For example, on March 28, 584 new cases were diagnosed in Israel. On that day, 5,040 people were tested, and the rate of those testing positive was 11.6 percent of all those tested. Similar numbers were found throughout the next few days, and on April 2 the largest number of cases were diagnosed since the beginning of the crisis: 764 people tested positive out of 7,294 people tested that day, or 10.5 percent.

The assumption had been in the Health Ministry that the more people tested, the more people they would discover were infected. But the data shows that starting as of the April 2 peak, while the number of tests rose by a few thousand a day and crossed the 10,000 mark, the number of new patients was on its way down – as was the percentage of those testing positive each day. On April 16, 11,908 coronavirus tests were carried out in Israel – the highest number so far. But only 257 people were found to be infected that same day. The next day 9,950 tests were conducted and only 224 people were diagnosed with COVID-19, a rate of 2.25 percent.

The large rise in the number of COVID-19 cases in Israel began in mid-March, and the peak of new diagnoses was at the end of the month through the beginning of April. Then what seems to be a falling trend in the spread of the disease, unrelated to the number of tests carried out.

These changes may have a number of causes, including the harsh restrictions on movement, the public following the health guidelines and the limitations imposed on specific towns with high infection rates. The decision to increase the number of tests per day and test thousands of people in nursing homes where a case of the disease had been confirmed, without any connection to whether the residents were showing symptoms, could have had an effect on the percentages of people testing positive.

An Israeli Arab shop owner wears a mask and gloves in the  village of Deir el-Assad, on April 16, 2020.
An Israeli Arab shop owner wears a mask and gloves in the village of Deir el-Assad, on April 16, 2020.Credit: Ahmad GHARABLI/AFP

The extreme scenario

One of the most important numbers facing the decision makers when they formulated their policy to fight the spread of the virus was the number of patients who required ventilation. The extreme case scenario the Health Ministry prepared for – and are still preparing for – is for thousands of people on ventilators, so much so that this would lead to a collapse of the entire health system. Because of the fear of reaching such extreme scenarios, Israel acted aggressively to buy ventilators and develop alternative devices produced locally, train medical staff and receive help from private hospitals. In practice, the number of people on ventilators has fallen in the past few days.    

“When I look at the situation here, also in light of the information that has accumulated in other countries who dealt with the coronavirus, it seems the peak is behind us,” said Dr. Dror Mevorach, the director of the internal medicine and coronavirus department at the Hadassah university Hospital in Ein Kerem in Jerusalem. The situation may still worsen as the closure is eased, but even then, it seems it will still be after the peak of the disease, he said. “There are those in the medical community who even think the disease is waning even without a closure. The closure in general was meant to maintain control over the health system, so it would not collapse,” said Mevorach.

The drop in the number of people on ventilators does express the overall drop in the spread of the disease, he said. The data from China shows that about 70 percent of those on ventilators died, but this is not necessarily what is happening in Israel because in China, Italy and Spain the health system was not functioning properly, said Mevorach. “In Israel the situation is under control, both in terms of the availability of ventilators and also in terms of the professional staff, so I believe the rate of mortality of ventilated patients is lower. In any case, it seems that at this stage working according to a scenario of thousands of people on ventilators is too cautious. Even if in another two weeks we see a sudden increase to 200 or even 250 on ventilators because of a local outbreak, we are still far from those scenarios,” he added.

Israel does have local outbreaks of COVID-19 – alongside the data on a national level. 46 percent of those currently ill with the disease in Israel come from ultra-Orthodox areas: in Bnei Brak there have been 1,940 patients as of Sunday morning, excluding the number of those who have recovered or died of the disease; Betar Ilit, 192; Modi’in Ilit, 246; and Elad, 264. In Jerusalem, 65 percent of those ill will COVID-19 – 1,500 out of 2,314; and 80 percent of those in Beit Shemesh, 220 out of 271, live in ultra-Orthodox neighborhoods.

Many of those ill in other cities, such as Ashdod, Petah Tikva, Netanya, Kfar Habad, Kiryat Ye’arim, Safed and others are from the ultra-Orthodox community too. All told, out of the 9,374 reported patients ill with disease today – not including those who have died or recovered from the disease – 4,362 live in ultra-Orthodox towns and neighborhoods.

The Arab town of Deir al-Assad in the Upper Galilee has been in the center of attention in recent days – and looks to be the site of the most serious outbreak of COVID-19 in Israel. Statistically, the number of cases diagnosed in the town climbed by 2,566 percent in a week: From three people a week ago to 80 as of Sunday. Deir al-Assad has the fourth highest rate of COVID-19 cases per capita, 62.5 patients per 10,000 residents. Only Bnei Brak, and two moshavim: Gilat and Zeitan, have higher rates – but the rate of infection in all of them looks to be falling in the past few days. The town of Bi’ina, close to Deir al-Assad, had a 1,300 percent jump in the number of cases last week, from only one to 13 as of Sunday.

The data show the “closure policy was effective and correct. It means that it is possible to loosen the reins a little,” said Prof. Avishai Ellis, the head of the internal medicine department at Beilinson Hospital in Petah Tikva. “The million-dollar question is at what pace.” The preparations according to the extreme scenarios of the Health Ministry was justified when the disease had just started spreading in Israel, he said.

The more time that passes, the more we will be sure that the extreme scenarios are not occurring and it is the time to take a step back, said Ellis. “We have to remember, this is a disease that no one knew about,” but doctors and medicine are characterized by the ability to learn while the situation is changing. But we should not become complacent, he says. “It seems the peak is behind us, but things will be put to the test again in the month of Ramadan and by Independence Day [next week]. If the success so far is continued – we are heading in a good direction,” said Ellis.

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