Israel Takes First Steps Toward post-COVID Normal, but It Faces a Winding Road

The data is encouraging, but how long it will take for Israel to return to the normality of pre-COVID days depends on questions with no clear answers

Ido Efrati
Ido Efrati
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Pedestrians walk in Jerusalem, this week.
Pedestrians walk in Jerusalem, this week.Credit: Emil Salman
Ido Efrati
Ido Efrati

After a prolonged period, beset by feelings of chaos and loss of direction, the last few days have given Israelis justified reasons for heaving a much-needed sigh of relief. Already during the current lockdown, it turned out that Israel faces a situation that differs from the one that characterized most of the last year. This was a two-sided reality in which two new players were setting the tone: the vaccine and the mutated strains.

After many weeks in which the mutations had the upper hand, the data collected in the last few days shows a clear trend of improvement, with the high effectiveness of the vaccine allowing one to dare and imagine a normal routine again. It’s easy and desirable to cling to any solid positive evidence which provides hope for the future, but Israel has not yet made the transition into a post-coronavirus phase.

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With one hand it holds the powerful tool of the vaccine, while with the other it juggles between the gaps and soft spots on the winding road that leads to an exit from the lockdown and a return to normal life. The situation is positive but fragile. The coming weeks will see an exit from the lockdown, accompanied by key questions that as yet have no clear answer.

What impact will the high rate of vaccination among people over 60 have?

The coronavirus cabinet was presented earlier this week with a number that is nothing less than stunning. Out of 4,746 confirmed daily cases (based on a weekly average), only 319 were 60 or older. That’s less than 10 percent. The rate of vaccination in this age group (including people recovering from COVID-19) is 90 percent. This means that Israel has managed to create an almost complete protective envelope around the largest of its vulnerable populations. It’s not a hermetic protection, but this was the group with the highest mortality rate and that imposed the heaviest burden on hospitals.

The neutralization of the vulnerability of people aged 60 and over could have a huge impact on managing the crisis and exiting the lockdown, conceptually and practically. It will enable greater flexibility, providing a safety net allowing the taking of risks that Israel has avoided so far. However, it’s difficult to assess the extent of this advantage when exiting the lockdown increases the exposure to a more contagious variants of the virus, which could erase some of the achievements of the vaccination campaign.

How will exiting the lockdown impact the severely ill?

Hospitals are not yet celebrating the news about a drop in the number of new cases. Coronavirus wards now have 990 seriously ill patients, 346 of whom are in critical condition. Even though this is a decrease from the 1,200 seriously ill patients at the peak of the epidemic, the overloaded medical teams and the harm to routine hospital work have not seen dramatic changes. There is not one hospital without an overloaded intensive care unit, and coronavirus-combating systems in hospitals have hardly shrunk since the downward trend began.

According to the figures, 40 percent of seriously ill patients are now under 60 years of age. This fact does not ease the stress in the coronavirus wards. Moreover, according to hospital doctors, the severity of illness they are now encountering is greater than before, requiring more resources compared to earlier peak outbursts. Some doctors attribute this to the prevalence of mutations, which apparently impacts the speed of deterioration and the worsening of symptoms. The present wave has seen a peak in the use of heart-lung (ECMO) machines, which are used in the most severe cases. This has led to a triage and rejection of some patients, due to the insufficient extra manpower that’s required in such cases.

The health system can handle high numbers of confirmed cases, mainly when they involve young, healthy people, who are at lower risk of deterioration. Thus, as the vaccination drive continues, the number of confirmed cases will be of less importance when considering the lifting of restrictions.

How will reopening schools affect the situation?

Children are the only group not being vaccinated, for now. With most of the population vaccinated, they will be the most vulnerable group. Given this, and the fact that the highly contagious British variant is present in Israel, the opening of schools will proceed under many restrictions.

There is great uncertainty regarding the opening of schools. This will happen gradually, with children in highly-infected “red” cities remaining home. Continued improvement in the number of infections may see all schools reopening, possibly with learning capsules still in effect, in most communities.

This move is accompanied by great concerns, given that during the lockdown there was a spike in the number of children contracting the virus. In a letter to hospitals from Dr. Sigal Liverant-Taub, head of the medical department at the Health Ministry, she asks them to prepare for such a development.

How long will it take for Israel to achieve widespread immunity?

The vaccine is undoubtedly the most important tool, apparently the only one that will end the crisis. Given the spread of the British variant, the rate of vaccination is particularly critical. Since it takes a month to achieve full immunity, a fact that is unchangeable, the Health Ministry is attempting to speed up the vaccination drive, with 140,000 people currently being vaccinated daily.

Four million Israelis have already been vaccinated, 2.2 million of whom already have their vaccination certificates. The Health Ministry is currently investing 30 million shekels ($9.25 million) in campaigns aimed at specific groups, including young people, and at combating fake news. In the second stage of the exit from the lockdown, planned for February 23, the government plans to use incentives and sanctions, as well as to promote tourism abroad, which is available only to people who have recovered or received the vaccine. The government is planning legislation that would allow workplaces with high exposure, such as schools, medical institutions and public transportation, to demand that employees get vaccinated. This could lead to five million people getting the second dose by mid-April.

Is the second phase within reach?

If this phase begins as planned, it will restore big chunks of almost-forgotten normalcy. It is designed to bolster the vaccination campaign by providing irresistible incentives for the vaccinated. The second phase will include the opening of malls, commercial centers, markets, gyms and studios, cultural and sports events, museums, hotels (minus dining rooms), swimming pools and exhibitions. Street stalls and places of worship will also resume activity, with gatherings of 10 people in closed spaces and 20 in open spaces allowed.

This precious package is almost immediately obtainable, at least according to plans. It depends on attaining several goals: reaching three million people who have received the second dose, a contagion factor of less than 1, over 90 percent vaccination rates for people in their fifties, and fewer than 900 seriously ill patients.

Experience shows that the connection between plans and their implementation can be coincidental, and efforts have already been made to bring forward the second phase. This pressure to speed up the exit or make criteria more flexible – coming from politicians – will apparently continue in the coming days. This pattern has been with us since the crisis began. Only this time, it’s hard to gauge the price this political pressure might exact.

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