When, after a long period of quiet, Israel’s national center for information on the fight against the coronavirus issued two research papers over the weekend, the timing was no coincidence. It was meant to support the plans of the Health Ministry and Coronavirus Czar Ronni Gamzu to impose a full lockdown during the High Holy Days.
In the first paper, the center, which is staffed by the Military Intelligence reservists reporting to the Health Ministry, examined the high risk of contagion in closed spaces, especially where people engage in activities that cause them to breathe heavily. These include singing, prayer, dancing, aerobic exercise and a lot of talking. The paper was based on findings of superspreader events around the world that took place in churches, fitness centers and call centers. With or without masks, people in these enclosed spaces transmit the virus because of the kind of activities they do.
The paper isn’t coy about the conclusions it derives from the facts: “On the eve of the High Holy Days, it is important to emphasize that the risk entailed with the crowding and praying taking place over an extended period of time in enclosed rooms in synagogues, in particular those in ‘red’ cities, can be expected to lead to expanding infection and in turn a further increase in morbidity and deaths.”
In short, Military Intelligence was enlisted to help Gamzu in the face of ultra-Orthodox resistance to any restrictions on any synagogue gatherings during the High Holy Days.
The second paper addresses the importance of imposing a nationwide lockdown to stop the spread of COVID-19, but its conclusions are far more nuanced. A general lockdown was successful in controlling the pandemic in certain places around the world and failed completely in others. Where it failed – for example in Peru, Argentina and South Africa – authorities had trouble getting the public to cooperate. In some cases, cooperation was impossible, for instance in Peru, where 40% of the populace doesn’t have a refrigerator, meaning they have to take daily food shopping trips.
The conclusions reached in the second paper don’t offer unqualified support for Gamzu’s and the Health Ministry’s lockdown policies because they acknowledge the need for widespread public cooperation. The one critical thing the paper does note in their support is that if mass events, such as Rosh Hashanah services, are on the calendar, a general lockdown can act to prevent them and head off mass contagion.
Litzman was right
That is apparently the reason why Gamzu chose the fall holiday period to impose the lockdown the cabinet approved on Sunday. Construction and Housing Minister Yaakov Litzman’s resignation on the grounds that “the decision to impose a complete lockdown during the holidays was planned in advance in the absence of any preparation for the holiday period” was justified. As the Haredi minister sees it, Gamzu doesn’t care about the holidays in their own right; he sees them as a nothing more than a potential vector for COVID-19 that must be stopped.
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To be honest, the holidays argument is the only good reason to order a lockdown. All the other justifications don’t hold water. The claim that lockdowns are the only way to contain the pandemic are wrong. Other countries have reduced the rate of contagion by successfully enforcing social distancing. When lockdowns have failed, it’s because the government wasn’t able to win the public’s cooperation.
The justification for a lockdown on the grounds that the hospitals are close to capacity with COVID-19 patients and that the virus must be stopped before we reach the red line of 800 serious cases is simply not true. Two senior hospital managers told TheMarker that there is no red line. They say the system can expand capacity by accelerated training of critical care staff, mainly nurses. (This is where there’s a risk of a shortfall, not with doctors.)
“It’s sad that a superb health care system like Israel’s is bringing the country to a halt because of 500 seriously ill people,” said a manager at one of the country’s biggest hospitals. “In the first wave, the health care system sought a lockdown because it needed time to get ready. In the second wave, the situation should be reversed – we have to be prepared in order to give the economy breathing space without a lockdown. We have to expand the number of beds, and we can do it.”
Israeli hospitals today count about 16,000 beds. The managers say it’s fully within the capabilities of the hospital system to meet the goal of expanding the number of beds for critical care from 800 to 1,200 in the face of a major health crisis, especially since only a fraction of the critical care cases require ventilators and the specialized skills involved.
Hospitals can open new internal medicine wards and reassign nurses, putting newly trained ones in those wards and while having experienced nurses in critical care units. “It’s like the Yom Kippur War,” said one. “We created a brigade while ascending the Golan Heights and after a week of fighting, they became a battle-hardened unit. Every experienced nurse, after a week in a coronavirus ward, is good enough.”
Proof that Israel’s hospitals can handle an increased number of COVID-19 patients comes from the Health Ministry itself. While raising the red warning flag, it has let hospitals keep to their ordinary work routine. It believes the hospitals can handle both coronavirus and other patients. That’s in contrast to the first wave, when the ministry ordered the hospitals to focus on the coronavirus and avoid any non-essential medical procedures.
The argument that Israel has failed in all the other measures it’s taken to fight the coronavirus is not convincing. Israel did fail, but it was because it never really tried. The government issued orders about public gatherings but never enforced them. If the police had been serious about enforcement – for instance, closing synagogues that violated the rules for six months – the message would have gotten through.
As the experience of other countries has taught us, it’s not enough to just order a lockdown. Officials have to ensure that it is kept. Israel’s Achilles heel in recent months wasn’t the lack of appropriate and relevant directives, it was that the directives were dead on arrival.
If the problem isn’t policy but enforcement, then it follows that even more draconian policies won’t be effective by themselves. Gamzu was convinced that his traffic light policy would be enough to stop the pandemic, but that would be true only if the policy was enforced. Because it wasn’t, the virus continued to spread.
Wouldn’t it have made more sense to enforce the traffic light policy before risking total lockdown measures that threaten to paralyze the economy?