Israel’s entry strategy for the coronavirus crisis was more reasoned and coherent than its exit strategy. Rapid measures taken at the beginning of March – notably, deciding to quarantine most Israelis returning from abroad and the introduction of a policy of social distancing – saved lives and averted an impossible overload in hospital intensive care units, as occurred in Italy’s Lombardy region and in New York City.
The lost time in countries such as the United States and Italy cannot be regained. According to an April 14 opinion piece by two epidemiologists in The New York Times, if the United States had adopted social distancing and other measures early last month, it might have been possible to reduce the number of cumulative deaths from the coronavirus in the country by about 90 percent. U.S. President Donald Trump (who, in contrast to his friend Benjamin Netanyahu, at least allows journalists to ask questions after he addresses the nation) was asked this week what actions he had taken against the pandemic throughout the entire month of February. He had no answer to give and lost his temper.
In Israel, as in some European countries that have been hit far harder, a containment trend is now visible. The number of patients on ventilators has almost stabilized; the number of deaths has not increased dramatically; the number of newly infected is not really known, because not enough testing is being done yet. But contrary to some expectations, there is no symmetry between the increases and decreases in the rates of infection and of death. The virus erupted with tremendous force, the containment will be lengthy – and may include new outbreaks.
In the past few days, leading experts on the pandemic in the United States have put forward quite pessimistic forecasts. In the April 14 edition of Science magazine, a research team of immunologists and epidemiologists from Harvard wrote that a one-time lockdown will not suffice and that social distancing measures will be needed off and on until 2022.
For his part, Dr. Scott Gottlieb, former commissioner of the U.S. Food and Drug Administration, told Vox, “I don’t think there’s going to be a binary point in time when we just return to what we were doing. I think world history is permanently altered by this episode. As long as this pathogen is circulating in the background and we don’t have a vaccine and very effective therapeutics, this is going to alter the way we live and do business.”
In Israel, Prof. Ran Balicer, director of health policy planning at the Clalit HMO and an adviser to the Health Ministry on the pandemic, wrote in Haaretz this week, “Some Israelis are clinging to the hope that after Passover we’ll get back to normal life… This is not the case, and this must be made very plain.”
Balicer is in favor of easing the lockdown, but makes it clear that this constitutes a calculated risk. The restart of the economy needs to be undertaken with one eye on the situation in the hospitals along with maintenance of a safety margin that will prevent an extreme overload of patients on ventilators.
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Israel’s tough closure measures have generated an aggressive freeze of economic activity, which, compared to much of Europe, has not been countered so far by generous aid packages for hard-hit businesses. The indifference the government is displaying in its slow handling of the difficulties confronting the newly unemployed and the self-employed dovetails with the appalling passivity the leadership has demonstrated in two critical issues on the medical front: testing for the coronavirus and dealing with the situation in old-age facilities.
This week, Brig Gen. (res.) Uri Zeipert, former commander of Israel Air Force’s Tel Nof base, was appointed to head a unit tasked with improving the testing procedures. Only now, a month late, is the daily number of tests approaching 10,000 – even as the Health Ministry continues to heap bureaucratic difficulties on the process at every step of the way.
According to the ministry, the goal at present is to ensure an average waiting time of 48 hours to get the results of the tests. But last week, according to a report from by the Gertner Institute, which specializes in epidemiological studies, and based on ministry data, the time lag was eight days.
Serological tests, intended to identify antibodies to the virus present in the blood, have been mentioned since the start of the crisis as a vital means for monitoring the spread of the coronavirus and to return the economy to a regular footing. It was reported Thursday that the Health Ministry will be purchasing serological testing equipment from the Abbott health care company.
Facilities for the elderly continue to be the virus’ killing field, even though Israel had received warnings about this problem from Europe and the United States by early March. A long-term rupture has been created in the relations between the state and the residents of these facilities and their families. But go explain that to Israeli politicians who are totally preoccupied with forming an emergency government with 34 ministers, all of whom are undoubtedly essential.
The government’s discussions on easing the lockdown will address three principal questions: getting people back to their jobs (the Finance Ministry wants a 50 percent return of workers in the next week or two, the Health Ministry will try to keep it down to 30 percent); a partial opening of commercial enterprises; and – the toughest question of all – reopening the schools.
On one hand, if the education system does not resume its activities, a large number of the younger members of the labor force will be confined to their homes. On the other hand, however, schools and preschools are liable to become infection incubators, with the virus spread all over by children, most of whom are asymptomatic.
The pressure cooker created by the lockdown has to undergo a release, but for a long time the solution will entail life in the shadow of the coronavirus, not a return to the old routine.
Bibi and Barsi
The responsibility for making decisions of an unprecedented gravity under conditions of extreme uncertainty is effectively in the hands of two people: Prime Minister Netanyahu and the director general of the Health Ministry, Moshe Bar Siman Tov. The “Bibi-Barsi” partnership was quickly forged at the beginning of the crisis, even though the junior member of the pair is aware of the sensitivity of his status and of the risk that he could emerge from this whole episode as a scapegoat – much like many others who’ve worked with the prime minister in the past.
The allegation that is still being voiced by dozens of those who are involved in combating the virus is that sloppiness still reigns supreme. As Meirav Arlosoroff reported Thursday in TheMarker (Hebrew edition), a vast number of teams and “war rooms” have been created to deal with different aspects of the crisis and are issuing dozens of competing reports, but their activities are far from being synchronized. There is a motley of competing powers, all encroaching on one another. The Health Ministry is having a hard time undergoing a shift, amid the epidemic, from a mainly regulatory body to a managerial one, of the sort needed to operate such a broad force.
The proposal to transfer management of the crisis to the Israel Defense Forces is problematic and is not being enthusiastically welcomed by the General Staff. But continued management in the present format is a recipe for hitches – certainly in the coming months, when delicate navigation will be required between rehabilitating the economy and preventing a future, uncontrollable outbreak of the coronavirus.
The battle against the virus requires the involvement of dozens of bodies, engaged in a complex process that involves analysis of extensive data and meticulous methodology. The solution that would appear to be called for is to hand over management of the crisis to a single individual who would head a strong task force, who would have the Health Ministry’s director general by his side, and who would also be accountable directly to the prime minister.
There are at least two experienced people who could undertake a challenge of this magnitude: former IDF Chief of Staff Gadi Eisenkot and former IAF commander Amir Eshel. Most likely, the ever-suspicious Netanyahu would veto both. But Maj. Gen. (res.) Yohanan Locker, who was Netanyahu’s military secretary and is on good terms with him, might also be a suitable candidate for the role of “coronavirus czar.”
The prime minister will ultimately have to appoint such a czar, even if at the moment he thinks he is reaping political gain from the relatively low percentage of deaths from the virus. Behind the scenes, the picture appears far gloomier. A veteran physician who holds a senior post told me this week that for him, the crisis is evoking melancholy memories from the 1973 Yom Kippur War, in which he participated as a young officer, in terms of the lack of preparation for such enormous and fateful events.
On the margins, there is another matter that deserves attention. The systematic violation of the instructions by leaders of the country on seder night (both Netanyahu and President Reuven Rivlin hosted members of their family at their tables, in disregard of the directives for isolation) justifiably sparked broad anger from ordinary citizens who obeyed the directives, only to discover that there is one law for them and another for the self-styled aristocracy. But, aside from the justified concern that large social and other gatherings are causing, a secondary industry of people informing on each other is developing in the country. This phenomenon seems to complement the invasive monitoring measures being operated by the Shin Bet security service, measures that the state now wants to expand.
Thus, with the accretion of small steps, undetected in real time, Israeli society is acquiring a police-state mentality. If Israelis don’t want to find themselves – under the persuasive excuse of a war against the virus – in a local version of the German film “Other People’s Lives” (which dealt with the East German system of citizen surveillance), we had better start paying attention to the ring of informing and surveillance that is tightening around us.
These developments were well articulated Thursday by Prof. Hagai Levine, who chairs the Israel Association of Public Health Physicians. “It is difficult to understand why the state is refraining from using accepted epidemiological tools for monitoring sickness,” Levine says. “It is difficult to understand the eagerness to use clandestine tools whose usefulness is completely unproven. The absence of transparency and the absence of professionalism are undermining the public’s trust and public health. It is essential to ascertain potential conflicts of interest among all the ‘advisers’ who are meddling in issues of public health and are working vigorously to promote security and technological methods that are causing great damage to public trust, which is so vital to continue coping with the virus."