The experts who advised the National Security Council during the coronavirus crisis have no doubt: If the right decisions hadn’t been made at the right time – as early as possible – Israel’s fate would have resembled that of badly stricken Western countries.
They say it’s very simple: There are no shortcuts. Countries that swiftly closed their gates, isolated people who returned from abroad and imposed a lockdown early on saved the lives of thousands, if not tens of thousands. Those that tarried, tried to dodge the truth or made foolish decisions got hurt.
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In recent weeks, amid Israel’s dramatically lower infection rate and death rate, critics are increasingly bashing the government’s policy during the crisis, saying the pandemic’s severity in Israel was overrated, or that the lockdown was too broad and long, unnecessarily damaging the economy.
The experts who advised the NSC apparently had the greatest influence on the decision-making, which was concentrated in the hands of Prime Minister Benjamin Netanyahu. Prof. Eli Waxman , a physicist from the Weizmann Institute of Science, headed the team of 10 members, though in the panel’s first incarnation, few were pandemic experts and few were women; these aspects got criticized. Waxman, Israel Bar-Joseph, also a physics professor at Weizmann, and Yarom Ariav, a former director general of the Finance Ministry, talked to Haaretz about their work.
The 10 experts entered the picture in mid-March. According to Waxman, “At that time things were murky. There were a lot of contradictory situation assessments by experts who provided different predictions – from the claim that it was like the flu to tens of thousands of deaths expected in Israel.
“Within three days we wrote our first report. It included a quantitative analysis of the data in Israel and many other countries, a reliable assessment of the situation and data-based predictions on what would happen.
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“Since the pandemic’s course was similar in many countries, and since Israel was several steps behind many countries, it was possible to do a cogent assessment of its development and the effect of the various measures. We very quickly realized that we shouldn’t use theoretical models.
“The models are very simplistic and the problem is far more complex. There’s a huge number of parameters, and any change in defining them will dictate a prediction with a different result.
“There’s no difference between models used by physicists, mathematicians and epidemiologists. They’re all variations of the same basic model. Some are more unfounded and some less, so none are reliable and they shouldn’t be used for making decisions.
“Our predictions turned out accurate – those from March 25 on the time during which we’d suppress the rate of spread and the final numbers of infected and seriously ill. This is what got the NSC and the government to adopt our situation assessments and recommendations.
“Recently, we’ve again been hearing the charge that the models didn’t predict the swift drop in the rate of new infections. But the swift drop isn’t unique to Israel. It has been observed in many countries that imposed a swift and effective lockdown like Austria, Australia and New Zealand. There aren’t any miracles in Israel.”
According to the team, there was no alternative to the drastic step of a lockdown. Toward the end of March, the experts concluded that the lockdown had averted an Italian scenario: an inundation at the hospitals and their temporary collapse, as happened in Lombardy.
“In a conversation, the top Health Ministry people estimated that tens of thousands of infected people had already fallen ill but hadn’t yet been diagnosed,” Bar-Joseph says.
“We said: There are now 5,000. It isn’t going to happen. The overestimations at this stage led to wild, pointless procurement. We said the event would end with under 1,000 dead. At first it was hard for Bibi to believe us after he had been pumped with other predictions,” Bar-Joseph adds, referring to Netanyahu.
“Today there are coronavirus-deniers. People are giving all kinds of explanations on why Israel has been less affected by the pandemic: the heat, unique genetics.”
He says that “in an island country – and Israel is one because it has only one entry gate, Ben-Gurion International Airport – it’s simple: You close down. There wasn’t any great genius here. Neighboring Lebanon and Jordan also had low infection rates, but there they imposed even stricter and more effective lockdowns than we did.”
The next wave
In recent months, security officials have been operating a central control center that has coordinated all the information on the coronavirus. On Tuesday a ceremony transferred responsibility to the Health Ministry; it was reported that 90 people from Military Intelligence will be reassigned to work at the center for the next year and a half.
The experts believe this isn’t enough. The databases are still decentralized among a number of different agencies, it’s not clear if the data is reliable, and there are strict limitations on access to information, so it doesn’t always get sent to the right places. Without closing these gaps, the contact-tracing body won’t be able to do its work properly, the experts say.
Moreover, they say the Health Ministry must appoint a deputy director general to head the unit for emergency situations. The Health Ministry is a regulatory body, not an operative one, so it was stymied by certain aspects of the crisis. An emergency unit will be able to coordinate the day-to-day efforts, make recommendations to the director general and confirm implementation of the decisions.
Waxman says he’s troubled by the reopening of the economy because the steps for dealing with a second wave of the pandemic, if there is one, haven’t been taken. “When there’s a problem with the preparations, the tool that remains is the lockdown,” he says. “If we impose it again, that means we failed in the preparation.”
Bar-Joseph agrees. “I can’t understand the apathy that’s enveloping the system amid the unbearable price of a lockdown if it’s imposed again. Public officials have been telling us that they’ve closed the gaps,” he says.
“But what investigative work has been done since? How did we function during the crisis? Thanks to the measures the state employed, we’ve gained time. We have to take advantage of this. We can’t lose a billion shekels [$285 million] a day again for every day of a lockdown.”
For the first time in weeks, in recent days the number of daily new cases has increased, though it’s still modest. Waxman remains cautiously optimistic.
“Israel is emerging from the crisis as one of the world’s leading countries in dealing with the pandemic, with a big gap between it and most OECD countries. The severe and rapid lockdown made it possible both to stop the spread and return to the routine relatively early. For this, the Health Ministry and the government deserve credit,” he says.
“But it’s not clear to me how the decision-makers haven’t understood that next time a lockdown is only the last resort. I’d be glad to tell you I’m calm, but that’s not the case. In the meantime, we’ve been ringing all the alarm bells.”
The gate that wasn’t closed
Israel was only partially cut off from the rest of the world, because for a long time many flights continued to arrive from the United States. The media provided two explanations for this: the desire to avoid angering the Trump administration and pressure from ultra-Orthodox politicians that allowed in hundreds of ill yeshiva students without sufficient supervision.
A study at Tel Aviv University found that about 70 percent of the infection chains from abroad at the start of the pandemic originated in flights from the United States. Bar-Joseph says the lack of supervision of the American flights was “a disgrace.”
According to Waxman, “We didn’t see any country behaving differently from us and managing to crush the curve. Ninety-five percent of countries behaved the way we did. So should we gamble? There’s no logic to this.
“The pandemic has behaved a similar way in many countries. The rate of the pandemic’s spread when no social-distancing measures were taken was similar: a doubling of the number of sick people every three days .... With significant social-distancing measures, a considerable reduction is achieved in the pandemic’s growth rate. Suppressing the spread – that is, the start of a decline in the number of new people who become sick any given day – is achieved 20 to 30 days after the imposition of a lockdown.”
Waxman adds: “The number of inhabitants in Lombardy is similar to the number in Israel. At first, there and here, the number of sick and the growth rate in the number of sick were similar. Lombardy was late in imposing a lockdown by about 15 days and paid with 13,000 dead, 45 times more than we have.
“In Lombardy the health system collapsed. The sick filled all the intensive care beds, the gravely ill kept coming in, didn’t get the proper treatment and died. New York City, with a number of inhabitants similar to Israel, imposed only a partial lockdown and has paid with 20,000 dead. The lockdown was absolutely necessary. Without it, we would have ended up in a situation like New York, Italy, France and Britain.”
According to Waxman, ”The achievement isn’t only one of health. The early and strong lockdown enabled us to suppress the pandemic and get the economy and society back into activity more quickly than countries that were late in imposing a lockdown or imposed a partial lockdown.
“An excellent example of this is Sweden. There they have a partial lockdown that’s reducing activity by about 40 percent, compared with 70 percent in Israel. They’ve been in this condition for a long time, the per capita death rate is close to Italy’s and they won’t be able to go back to full activity for a long time because the pandemic hasn’t been suppressed. The economic, health and social damage there will continue to grow.”
The team completely rejected the idea of herd immunity; the Swedes took a partial stab at that method. “One argument by supporters of herd immunity is that the number of asymptomatic carriers who aren’t identified is very large,” Waxman says.
“This argument is mistaken and contradicts the empirical data around the world. A herd-immunity policy would have brought disaster upon us. There’s still concern that these ideas will take root in Israel if there’s another outbreak.”
According to Ariav, “There’s a mistaken impression of a trade-off between public health and the economy. Actually, there’s a total convergence of interests here. The lockdown was a last resort. We have to do everything possible so we won’t need it again if there’s a second wave of the disease in the fall.”
He believes that the decline in the infection rate to a few dozen new cases a day – for a while it was even less – lets Israel return to socioeconomic life with few restrictions while focusing on the hot spots as they’re identified.
But for this situation to be maintained, Israel must maintain the machine that stopped the coronavirus the first time. The team is recommending three main new entities: a contact-tracing body for rapid questioning of patients “from the suspected to the quarantined,” a national information center on the coronavirus crisis, and a Health Ministry unit to tackle emergency situations. Without these, the country isn’t ready to deal with a repeat outbreak.
The ministry has indeed announced its intention to establish a body for rapid contact tracing but doesn’t yet have the staffing or budgeting, so it’s work hasn’t yet begun. The experts say it’s essential that the authorities can ensure the isolating of an infected person within 48 hours and identify more than 85 percent of the people with whom he or she has been in contact.
According to Waxman, the Health Ministry’s belief that these things are being accomplished within 36 hours, as reflected by the small numbers of sick, “isn’t at all connected to reality. The Health Ministry’s opposition is continuing. All along the way, people have tried to thwart the initiative.”
As Bar-Joseph puts it, “East Asian countries managed to suppress the coronavirus without a lockdown thanks to an effective mechanism for identifying and severing the chains of infection. They got burned by the SARS epidemic and they came prepared. Israel, like a lot of countries, heard about the pandemic in China and – pardon my language – didn’t move its ass on time.”
Ariav says identifying infected people on time is like locating a lone-wolf terrorist. “Time is the critical element. Identifying the chain of infection must be carried out quickly,” he says. “Without authority for an investigative body, that isn’t going to happen.”