Israel Predicts Up to 40,000 Coronavirus Patients May Die. What if There’s a Way to Avoid This?

This forecast is predicated on the current situation, after the country has been put in a partial shutdown for a week

The coronavirus unit at the Sheba Medical Center in Tel HaShomer, Israel.
Eyal Toueg

In a scenario that the Health Ministry presented to Prime Minister Benjamin Netanyahu earlier this week, 25,000 people may die in Israel due to the current coronavirus outbreak. The scenario’s optimistic prediction is for 10,000 people to die. Thus, the decision was made to further clamp down on Israeli society.

This scenario was drafted by Dr. Michael Assaf and Prof. Yinon Ashkenazy of the Hebrew University’s Racah Institute of Physics. Assaf specializes in statistical physics and particle interactions. This is what brought him to study the lifetime of illnesses – and from there, to draft coronavirus progressions for the Health Ministry.

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Assaf’s forecast is of course frightening. He predicts that the current situation, with the current limitations on movement and commerce, will result in a peak of more than 10,000 seriously ill coronavirus patients who need respirators on a given day. Since Israel doesn’t have enough respirators, many of these people will die, and the outbreak will claim more than 20,000 victims. Under this scenario, the outbreak will peak in two months.

This forecast is predicated on the current situation, after the country has been put in a partial shutdown for a week. The partial shutdown slowed the pace of infection from 1.27 (meaning the number of confirmed cases increases by 27% every day) to 1.18, the pace Italy achieved after imposing a nearly complete shutdown. Assaf forecasts that Israel will achieve a rate of 1.15 to 1.18, a relatively slow rate of increase, due to the restrictions on the population. Even at this rate, Israel is likely to see 20,000 dead, he forecasts.

But Assaf’s predictions raise no small number of questions, some of which he himself acknowledges. He talks about at least half the population becoming infected, with a death rate of 0.7% to 1% (in other words, 0.4% of residents will die, or up to 40,000 people), and at least half of the patients in serious condition dying. This leads to the forecast of 30,000-40,000 deaths should Israel not do anything, and 10,000 deaths should Israel be particularly effective.

Flattening the curve.

How do these figures line up with the 3,300 people who died in Wuhan, China, the city of 15 million people where the outbreak began and initially spread unheeded? How do they square with the chaotic situation in Italy, where some 6,600 people have died to date? Under Assaf’s forecasts, the virus is likely to kill 2 million people in Italy, and 11 million people in the United States.

It may be that the outbreak is only starting, and we’re heading toward millions of deaths around the world. But it could also be that we still don’t understand the numbers behind the disease – we don’t really know how many people have been infected, because apparently most of them won’t ever show signs of illness. The true number of infected is thought to be four times the number of confirmed cases, or possibly even 10 times the figure.

This could explain the gap. If the number of infected is actually four times the reported cases, then the death rate isn’t actually 1%, but rather 0.25%. Under this scenario, Israel’s maximum casualty count wouldn’t be 40,000, but 10,000, and proper action could reduce that figure to 5,000. If the actual number of cases is 10 times the confirmed cases, then the casualty figure falls even further, to a maximum of 4,000 people, or 2,000 with proper action.

So how many deaths will Israel have – 2,000, 10,000, 25,000 or 40,000? The lack of widespread testing means that no one really knows. And yet Netanyahu was told that 10,000-25,000 people will die.

The massive uncertainty regarding the deadliness of the outbreak is subjecting the Health Ministry to criticism, for two reasons. The ministry has consistently worked off the worst-case scenario, and it hasn’t done anything to find out what the actual figures are. It hasn’t investigated the infection rate among the population at large.

Assaf also shares this criticism, in his scientific way. While he built the forecasts on behalf of the Health Ministry, he takes issue with the ministry’s policy of imposing increasingly severe closures as the only means of halting the outbreak.

There’s also another strategy for tackling the coronavirus pandemic, one much more successful than keeping the entire population at home. This is a two-part strategy: 1) conducting a very large number of tests, some 10,000 a day or more, to identify who’s infected, and 2) isolating them. This strategy also focuses on isolating the at-risk population: people over age 60, and people with pre-existing medical conditions.

Assaf’s analysis focuses on the impact of isolation on the at-risk population – limiting social interaction for the elderly to one-quarter or one-eighth of the usual. The most vulnerable would be put into hermetic quarantine, and wouldn’t go to supermarkets, synagogues or ritual baths. They’d enter their homes and wouldn’t leave for three straight months. Under this scenario, the number of people requiring ventilators would be half or even a quarter of those forecast under other scenarios, enabling the sick to receive the best possible treatment.

This would also cut the number of deaths by half or even more. Putting the vulnerable population into a complete quarantine is significantly more efficient than putting the entire population into a partial quarantine. Even under Assaf’s frightening numbers, this would mean cutting future casualties from his current forecast of 25,000 people, to 10,000 with proper action. Some 60% of lives would be saved via the right strategy.

This strategy has several facets. Israelis would be required to maintain social isolation, meaning the current situation of a population-wide partial shutdown would persist, because otherwise it would be very difficult to keep the elderly and vulnerable from becoming infected, as they still need caretakers, food, etc. We also need to increase the pace of testing, because the more we test, the better we’ll be able to identify infections and changes in the infection rate.

This could enable us to ease the closure on the population at large, and let us know how close we are to achieving herd (collective) immunity.

Instead of ramping up the shutdown, Assaf recommends we concentrate on widespread testing and protecting the vulnerable. These two steps can dramatically change the slope of the graph, he says – in other words, pushing the forecast casualty figure below even 10,000. To make this happen, the Health Ministry and the prime minister need to make the right decisions.