Analysis

Israel's Biggest Challenge in Preparing for a Second Wave of Coronavirus

The assessment that Israel defeated COVID-19 may lead to dangerous complacency ■ Securing a vaccine means fighting out other countries, and taking a gamble

Amos Harel
Amos Harel
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The Tel Aviv Port, May 2020.
The Tel Aviv Port, May 2020.Credit: Meged Gozani
Amos Harel
Amos Harel

Twice a day – at about 11 A.M. and shortly after the 8 P.M. television newscasts – Israel’s Health Ministry publishes the latest local data on the coronavirus pandemic. The actual people who have died from the virus are barely noticed by the public these days; their death is usually met with a collective shrug of the shoulders – like the death of elderly people from other illnesses. When was the last time we saw an obituary for an individual who died from COVID-19?

It seems that people’s interest lies elsewhere: In the number of newly infected people since the previous update. Those numbers have been low for some time. The lifting of the lockdown restrictions here began on April 19. Independence Day (April 29) was more than two weeks ago. Experts say that the effect of each phase in the battle against the virus is seen only after two weeks after it commences, due to the time that passes between when a person is infected and he or she begins feeling symptoms, is hospitalized (in some of the cases) and their condition worsens (in fewer cases).

But in the meantime, since May 2, the number of newly infected has stood at fewer than 100 a day, and this week that number dropped to fewer than 30 a day. It’s like a question in a math exam: The water in the pool is emptying out by means of a pipe whose circumference is larger than that of the pipe that’s filling the pool. The number of so-called actively ill COVID-19 patients has fallen below 4,000 (from a high of nearly 10,000), owing to the number of those who have recovered.

These data are bolstering the assessment that Israel has successfully navigated the health crisis, at least until the possible arrival of another wave of coronavirus, presumably around the start of winter. Hence the accelerated loosening of restrictions and the growing demand to lift those that are still in place.

At present, the economic debacle in the country has only just begun. Unemployment has surged to 25 percent, the highest in Israel’s history. The Finance Ministry is forecasting severe negative growth this year, along with the wholesale closure of thousands of small- and medium-size businesses. The local economy, as is the case with the rest of the world too, will be feeling the impact of the pandemic for years. In the meantime, as the government’s efforts to micromanage people’s lives escalate (this week the Health Ministry called on people not to use their cellphones while traveling on public transportation), the chaos grows in vital realms, among them the education system.

A new health minister, Yuli Edelstein (Likud), was appointed Thursday, as the ministry’s director general, Moshe Bar Siman Tov, announced his resignation. The fact that former Health Minister Yaakov Litzman fled from taking responsibility for managing the crisis established Bar Siman Tov’s status at the height of it as the strongman of the health system. The outgoing director general calls the results of the battle against the virus in Israel to date a success. The number of Israelis who have died thus far, 264, does not skew the annual mortality data.

On the contrary: Because fewer people were infected during this past winter with other respiratory ailments (probably due to the lockdown), and fewer died from the usual problems of contamination in hospitals and in road accidents – in fact, during the past few months, the country’s mortality rate has actually dipped a bit from the average. Still, in the long term (and as a result of cases of excessive weight gain, depression and suicides to be attributed to the prolonged lockdown) these numbers could change.

קניון מלחה בירושלים, בשבוע שעבר
Malha Mall, Jerusalem. May 2020Credit: Emil Salman

Bar Siman Tov’s final meetings with the ministry’s senior officials are focusing on preparations for next winter. The working assumption is that cases of COVID-19 will intermingle with those of people suffering from the seasonal flu outbreak. The concern, to invoke a historical analogy, is that after the success of the Six-Day War, complacency will set in, leading ultimately to a medical disaster comparable to the Yom Kippur War in 1973. The great challenge is to keep the governmental establishment vigilant in advance of yet another wave, along with ensuring the cooperation of the citizenry. The message being sent by some cabinet ministers, to the effect that Israel has expelled the coronavirus for good, is does not help.

The current transition period is meant to be used for repairing points of weakness. According to the Health Ministry, the process of testing for the virus and getting the results has been significantly streamlined, now that most of the tests are being done by the health maintenance organizations and various bureaucratic obstacles have been removed. The average time that elapses from the time a test is requested and when its result is received has dropped to just 12 hours. At the same time, the number of tests has fallen to about 5,000 a day, in the absence of requests.

The objective now is to improve efforts to locate the people who were in contact with an infected individual and to complete the whole process within 48 hours, or 60 hours in periods of overload. The team dealing with this, headed by Israel Defense Forces Brig. Gen. (res.) Uri Zeifert, has a staff of 24.

By the end of May, serological tests will be available that will be able discover antibodies in the blood. The project of administering them is slated to encompass 100,000 people, beginning in the predominantly ultra-Orthodox city of Bnei Brak. Similar efforts in Spain and France have led to assessments that 4 to 5 percent of the overall population contracted COVID-19 and that the great majority did not display symptoms. Estimates of the true incidence of disease in Israel is about 1 percent, though this will only be confirmed after the testing takes place. In any event, the “herd immunity” model, in which at least two-thirds of the population must be infected, is a far cry from what has been seen on the ground here.

Can Israel aspire to reduce the rate of illness to nearly zero before the winter? The report drawn up by a team of experts, headed by Prof. Eli Waxman, who advised the National Security Council, maintains that the current rate can be reduced further. According to the paper, which was released this week, “Such a situation will permit regular and ongoing activity of the economy and of society, a safe environment for the entire population, including the extensive segments defined as being at high risk, and will provide a safety net for overcoming possible outbreaks without the need to adopt additional national lockdowns… A number of countries in Southeast Asia are adopting this approach and are successfully sustaining full economic activity.”

A game of roulette

In any event, the emerging view is that the coronavirus, as a global health challenge, will be with us for another year, or more. The optimists foresee the availability of a vaccine only in the spring of 2021. Israel will have to make a serious effort to reach a high spot on the list of countries seeking to purchase it when it exists. There have been talks recently between Israel and three different pharma firms working to develop the sought-after vaccine. This situation is really a game of roulette, as it’s not clear which vaccine will actually work, and the price tag for signing a contract up front for the purchase of a million doses is estimated to be about 100 million shekels (about $28.5 million).

Before a vaccine is ready, the hope is to make progress developing medicinal treatment for COVID-19 patients and to come up with simpler and more efficient testing. But as things stand now, face masks and social distancing will continue to be with us during the coming year.

The Tikva Market in Tel Aviv, May 2020.
The Tikva Market in Tel Aviv, May 2020.Credit: Tomer Appelbaum

Edelstein and his new director general will have to fight to increase the Health Ministry’s budget, but also to ensure that any additional funding that is injected into the ministry will be earmarked for the HMOs, which are responsible for community health, and not only for hospitals, touted in the media and elsewhere as the heroes of the crisis. Also in the background lies one particular failure, costly in terms of human life, that the state must avoid repeating: the debacle of the spread of disease in facilities for the elderly, where about a third of the coronavirus fatalities occurred.

This seems to be a time for summing up. The coronavirus committee of the Knesset, headed by MK Ofer Shelah (Yesh Atid), is completing its work this week. Since the election, in early March, this was the only body that actually scrutinized the functioning of the government during the crisis.

In its concluding report, already issued Thursday, the panel notes that only recently did it come across two documents dealing with proposed deployment for emergency scenarios: a 2007 plan for preparing the health system for an influenza pandemic, and a national scheme drafted by the defense establishment in 2018 to cope with an epidemic.

“These are detailed, highly professional plans, of which broad sections are relevant for dealing with the coronavirus pandemic,” the committee wrote. “However, in practice the plans were not implemented. Organizations such as the National Emergency Authority, which were supposed to lead the confrontation with such a scenario, were left to stagnate, were weakened and were not involved at all in coping with the coronavirus.”

The Shelah committee report describes how the IDF and the Mossad found themselves at the heart of the crisis, with no prior planning. The story of the national control center established by those two bodies for fighting the coronavirus is characteristic of how Israel dealt with the crisis. After two months in which no operative body was established for dealing with the crisis, the security organizations identified the need, particularly in terms of procurement, and volunteered to contribute their experience and operational capability. The center gradually expanded and assumed additional operational tasks, mobilizing their immense capabilities for dealing with an emergency.

“The center’s activity was welcome,” the panel wrote, “but even those who headed it will admit that in order to properly confront a crisis that has social and economic implications, a different body is needed, for which this is its appointed task, and not [one that relies on] a spirit of volunteering and operational capability of bodies engaged in other efforts.”

The first two months of the outbreak (mid-January to mid-March), according to Shelah, were not exploited in Israel to prepare for what was to come during the crisis: neither for procurement of equipment, for staff work and or to compile an intelligence-based picture that decision makers must have. That began to happen only when the Mossad and the IDF came into the picture.