The rise in the rate of new coronavirus infections in Israel has not been particularly steep in recent days, but the rate of increase has been quite constant for a few weeks. The number has risen from 500 a day two weeks ago to 1,200. You can’t attribute this rise solely to more testing. The positive-test rate is steadily rising too. The virus has spread to most communities, and is no longer restricted to specific areas or populations.
The quickening pace worsens the dilemma facing the coronavirus cabinet and the government over the question of if and when to place more limits on residents and the economy. Like in the pandemic’s first wave in April, the debate concerns the need to prevent the health care system from being overwhelmed. Flooding the hospitals with seriously ill patients, particularly those needing ventilators, could cause their collapse. It’s the Italian scenario the Health Ministry warned us of early in the spring wave, but it didn’t transpire at that time.
The debate over how catastrophe was averted then continues. The government and its advisory teams credit the rapid lockdown; some critics claim it was the virus’ normal course in a relatively young country with properly functioning medical teams. The health system’s bottleneck mainly involves the number of teams trained to handle seriously ill patients, especially those needing ventilators. Even so, the number of patients in isolation reduces the number of available teams.
The drama this time is moving at a slightly slower pace. Due to a change in treatment procedures, the use of ventilators recently was reduced, and it is only done at a later stage of the sickness and only as a last resort. And with an increase in young patients in this second wave, the lower proportion of elderly patients in the at-risk groups this time slightly reduced the ratio of seriously ill patients.
Yet the death rate – compared to the number of infected patients three to four weeks ago – is liable to reach 1.7 percent of all patients, as happened in the first wave. That means that more than 10 people a day may be dying by month’s end, even before the health system reaches its limit.
A central question touches on the impact of the limitations already imposed on the public. The school year ended in late June for the lower grades. The government further curtailed the maximum size of crowds this month, mainly in event halls. The impact of these steps will only become clear by the weekend. If it turns out there wasn’t a significant drop in the rate of the spread of infection, it stands to reason that the debate on imposing harsher limits and even a return to lockdown will renew, despite the economic damage and broad public opposition expected for such a move.
In that event, the government will have little time to choose between options. The time it takes for the number of cases to double now stands at nine to 10 days. If the rate of seriously ill patients remains low but stable (about 2.5 percent of all identified cases), Israeli hospitals are liable to be burdened to the limit of their capacity within a month. As a consequence, treatment of some seriously ill patients will be compromised and the death rate will rise, as happened in northern Italy, London and New York this spring.
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Prof. Dov Schwartz of Ben-Gurion University, one of the interdisciplinary team leaders who studied the coronavirus crisis, and who has recently advised the health system and defense establishment, raises another idea that may be worth examining before returning to full closure. He says the state should consider calling on, or even ordering, people 65 or 67 and older to quarantine themselves at home for a month until the fury passes.
Thus, the most vulnerable population will be relatively protected from the virus for a short period, in which the state guarantees their income. A necessary condition would be the government using the time to require the health system to finally introduce the effective operation of an epidemiological network to break the chain of infection and meet the original goal of tracing contacts within 36 to 48 hours. This system will be relevant again if the daily infection rate can be slashed while the elderly are home. Schwartz, it should be noted, is also in the age group he recommends for quarantine.
Load gets heavier
The testing system was shaken up in recent weeks. Under Health Minister Yuli Edelstein’s orders, testing was expanded to include those without symptoms who were exposed to infected people. Thus, a great number of asymptomatic people contributed to the rise in positive tests for the infection. The change also lengthened testing lines, increased the workload on testing labs and increased the number of people being monitored by the Shin Bet security service, which sends people into quarantine because of close contact with a known COVID-19 carrier.
The health system took several steps in recent days to slightly lessen the burden. HMOs are again conditioning testing on the appearance of symptoms. At the same time, the Shin Bet cut the amount of time it tracks cellphones of people who were in contact with an ill person before being diagnosed (such that fewer people will be quarantined). However, the workload, the lines and the number of people in quarantine are onerous. It seems that with these numbers there is no real possibility of identification and cutting the chain of infection.
Strangely, the signature of Prof. Siegal Sadetzki is on the new directives, even though she announced her resignation last week. She published a long, piercing letter that indicated a lack of trust in the current Health Ministry leadership. However, it turns out she hasn’t yet left her job, and no appointment to replace her has been announced. Moreover, the efforts to find someone to head the control center for the fight against the virus have yet to succeed. Despite the ubiquitous talk of an emergency situation, it doesn’t look like anyone in the Health Ministry is in a particular rush to go anywhere.