Two competing forces will determine which way the coronovirus pandemic is headed in Israel over the next few weeks: the ongoing vaccination drive and the spread of the mutated versions of the virus. The victory photos from the amazing vaccination drive, which attracted worldwide attention, gave cause for hope, but at this stage the vaccinations still have not made inroads against the pandemic.
Now that the problem of vaccination supply has apparently been resolved, the high daily infection rates are overshadowing optimistic scenarios of the end of the pandemic. This has been accompanied by a recording-setting number of severely ill people and an unprecedented burden on the health care system, which is stretched to the limit. Contrary to the previous outbreaks, the system must now deal with a huge mass of sick people as well as 250,000 people in isolation, and at the same time conduct a national vaccination drive requiring complex logistics and enormous human resources.
If that were not enough, mutations of the virus – the British and the South African – are shown every day to be a significant factor in the infection rate, and at this stage it is not yet clear whether the vaccine is effective against them.
The challenge of mutations
Testing and contact tracing have shown that the British variant is already pushing up the infection rate in Israel and it’s not a matter of breaking a few chains of infection. “It [the variant] has taken over the British infections and ours too,” Dr. Ofra Havkin, the Health Ministry’s central district chief physician, said this week in a meeting of the Knesset Constitution, Law and Justice Committee.
Recent contact tracing done at Sheba Medical Center, Tel Hashomer, shows that the British mutation can spread even in very brief encounters. “We are dealing with something that is much more infectious than the known virus,” Prof. Gili Regev-Yochay, director of Tel Hashomer’s infectious diseases and epidemiology unit, says. “The British variant attaches itself much better to the receptors [on the cells] and is pushed much more into the cell, and therefore only a very small quantity of the virus is needed for infection to occur,” she said.
As a result, the hospital has decided to tighten its isolation protocol of medical teams, who are sent into isolation after only a five-minute exposure to an infected patient, as opposed to a 15-minute exposure as before. “The message is that there is something here that is very infectious and even five minutes is too long to be together. That means that we don’t eat together or do anything together without a mask,” Regev-Yochay said.
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The South African mutation, whose spread Israel is trying to control, has also raised concerns. So far eight Israelis have tested positive for it. “We don’t know for sure how the vaccine affects [this variant] it, and that will also be checked here,” Dr. Havkin said at the Knesset. According to Havkin, this variant itself has a number of mutations and Pfizer Pharmaceuticals is checking the vaccine against only one of them. “The goal is to isolate people returning from South Africa and prevent the spread as much as possible to gain time,” she said.
But the chances of chasing down the mutation and successfully stopping its spread are not particularly high considering the extent of infection and the contact tracing and testing systems. With more than 9,000 confirmed new infections a day, large numbers of Israelis going in and out of isolation, and institutions requiring tests – Israel is conducting 120,000 tests a day. A new policy requiring a referral before a test is intended to provide some relief, but the burden on laboratories is enormous and the chances of breaking the chain of infection is small because waiting time for an answer is growing. While the Health Ministry says it delivers an answer in 32 hours on average, many people say they have had to wait two or three days.
Contact tracing, which relies on 3,000 investigators, is not built to deal with such high numbers of infections and can only reach 6,000 newly confirmed carriers a day. This leaves more than 3,000 infected people who are not questioned and thus their chain of infection hasn’t been broken.
Moreover, in a situation in which some newly infected people go into isolation of their own accord, it is impossible to trace their chain of infection. Add to that the high level of infection from the mutations and it becomes clear that any delay in breaking the chain of infection constitutes huge potential for spread of the disease, even during lockdown.
“The variants spread faster, but apparently do not cause more severe illness,” the Health Ministry said on Wednesday. The heads of the health care system and decision makers will soon have to factor in the impact of the mutation on infections in Israel.
Vaccines – the life raft
Israel’s life raft seems to be the vaccine. Like previous lockdowns, this one can have an impact by preventing gatherings. But when Israelis emerge from this latest lockdown they will do so with an advantage that did not characterize previous lockdowns: Many, particularly groups at risk, will have been vaccinated. Nearly two million have already been vaccinated, with many receiving their second shots. According to Health Ministry figures, about 55,000 people are being vaccinated every day. This is a significantly lower figure than at the height of the first round of vaccinations, during which 150,000 people a day were getting a shot. This is explained by the fact that the second round is a mirror image of the first round some three and a half weeks ago, which began with the inoculation of medical staff at a small number of vaccination centers and low numbers of people. The number of people getting their first shot is now smaller. But it is expected to rise again soon, with the addition of teachers and people age 50 and up set to be vaccinated.
Infections after vaccination
The Clalit Health Maintenance Organization’s research institute has followed up some 200,000 of its members age 60 and up for at least 11 days after vaccination. It found a significant decline in infections from the 14th day after the first shot. These are preliminary findings only, but they’re encouraging,” Prof. Ran Balicer, Clalit’s director of health planning policy, said.
According to new figures published Tuesday by the Health Ministry, as of January 10 (when 1.77 million people had been vaccinated), 375 Israelis were infected and hospitalized after receiving their first shot, most of them with pre-existing medical conditions. Of these, 244 were infected within seven days after the shot.
The ministry said that 1,127 people who were vaccinated (0.06 percent) reported side effects, mostly slight, including general weakness, headache dizziness, fever or muscle aches.
The vaccination drive, on the one hand, and the new mutations, on the other, place Israel on the threshold of a new chapter in the fight against the pandemic. Over the next few weeks, these two competing forces – the infection rate and the vaccination rate – will determine which way Israel is headed in the struggle.