It took barely a month since the national project coordinator for the coronavirus took over for him to find himself on thin ice, alone. The immediate reason for this supposedly lies in a dispute over the annual Rosh Hashanah pilgrimage to Uman, Ukraine, of tens of thousands of Hasidim to visit the grave of Rabbi Nachman of Bratslav. But Prof. Ronni Gamzu undoubtedly understands that the matter does not end there.
Prime Minister Benjamin Netanyahu is carefully maintaining a safe distance from Gamzu, while occasionally dispatching his attack units to savage him. And because we are living in unusual times, when the prime minister is insistent on waging a rear-guard battle against a triple indictment, the implied threats aimed at the coordinator sound as if they were taken from the lexicon of criminal gangs.
The concerns about Uman have assailed Gamzu almost from the day he assumed the post. In a regular year, more than 100,000 Israelis visit Uman during the Jewish holidays in the early fall, including several tens of thousands of Bratslav Hasidim. To Gamzu and other medical experts, the crowding and the somewhat unruly atmosphere in the region of Rabbi Nachman’s grave looked like a sure recipe for increasing the morbidity rate in Israel, particularly in light of the fact that it will be difficult to supervise the return of the participants and to ensure their isolation in line with the current rules.
Unable to get a response to his concerns in Israel, Gamzu, in an unusual move, took his case abroad. Last week he sent a letter to the president of Ukraine, Volodymyr Zelensky, requesting a ban on flights from Israel during the period of the Jewish holidays. Deliberately, the request was made without involving the prime minister.
The media reports about Gamzu’s initiative outraged the Haredi parties. Netanyahu, whose chief concern is his political survival for the benefit of his trial, lost no time in distancing himself from the coordinator and in announcing that he had nothing to do with the letter. On Wednesday, the attackers were unleashed for the hunt. Coalition whip MK Miki Zohar, for whom no assignment seems too petty, lashed out at Gamzu in an interview with Kan Radio, the state broadcaster. He accused the coordinator of not having dealt with the health danger posed by the demonstrations outside the prime minister’s residence in Jerusalem because he was afraid of the media. Now Gamzu must accept that the flights to Uman will take place come what may, he said, and Gamzu would do well to start preparing for this, instead of sending missives to Ukraine contrary to Netanyahu’s position.
The prime minister waited a few hours before issuing a quite anemic statement of support for the coordinator. Gamzu is not a big soccer fan, but there were enough fans who offered him the appropriate analogy. The announcement from Netanyahu’s bureau is comparable to an expression of confidence in a coach by the club’s management following a string of losses. Everyone understands that the next time we hear from the management it will be in the form of an announcement that the coach has been fired.
Gamzu has experience in managing a large hospital and even the Ministry of Health. He is far from being a naïve fellow who doesn’t grasp the rules of the political game. Nevertheless, he appears to have been taken by surprise by the responses his approach generated. Which doesn’t mean he is about to backtrack. In the meantime, Zelensky announced his intention to stop the flights. The airlines had arranged this year to make 82 direct flights to Uman, each with an average of around 250 passengers. According to the Ukrainians, that number will be reduced considerably.
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In contacts with the Kiev government, the possibility was also discussed of supervising the arrival of Hasidim from Israel in roundabout routes, via flights from third countries. Gamzu is continuing to insist that the stoppage of the flights this year is an absolute prerequisite, despite the criticism leveled by Zohar and the Haredi parties. Barely between the lines, he intimated that he would resign if he doesn’t get his way. Health Minister Yuli Edelstein this time chose to depart from his party’s line and back the coordinator.
The manner in which Gamzu assumed his post was out of the ordinary. Netanyahu had conducted protracted negotiations with Prof. Gabi Barbash but without reaching agreement on the powers the latter would have. At the end of July, when Barbash withdrew his candidacy, Gamzu plunged into the task without bothering to define his own powers. The thinking was that given his potent motivation and public status, the system would flow with his decisions. In fact, he still does not have an orderly, official letter of appointment.
Uman is the first test of his standing; if needed, it will also give him a point of exit. If Netanyahu and the Haredi parties are bent on tripping him up even in the case of such clear-cut health damage, what’s the point of continuing?
Putting the genie back in the bottle
The argument over Uman started in the shadow of somewhat dramatic headlines about a renewed spike in COVID-19 cases in Israel. The headlines, though, are a bit misleading. It’s true that the number of confirmed carriers per day is again surging toward the 2,000 mark (up from 1,600 a day in the past few weeks), but that is due in part to an increase in the number of tests, which now exceed 30,000 per day. No substantial change has occurred in the percentage of positive tests. And, as usual, it has to be recalled that most of the newly ill are young and asymptomatic, or have a very mild form of the disease.
The main relevant number, as in the past, concerns the number of seriously ill and in particular the number of seriously ill who are added each day. This week, the first figure ranged between 400 and 430, which is still about half the estimated maximum capacity of the hospitals. Even with a high incidence of the disease, Israel is not yet close to the horror scenarios that played out in Britain, Spain, Italy or New York during the first wave, when the health systems there could not cope with the overload.
A rise in the number of the newly seriously ill was recorded this week, which for a moment confounded the experts. Generally, the seriously ill constitute between 2 percent and 2.5 percent of the total number of those who have contracted the disease. This week, the numbers jumped. All manner of possible explanations were put forward. According to one of them, there are young people who have contracted the coronavirus but are only mildly ill and do not report the fact (in order to keep themselves and their acquaintances out of isolation), thus resulting in “transparent incidence,” which is revealed late, in the number of the seriously ill. According to a different explanation, more elderly people are now becoming infected and their condition tends to become more aggravated than that of young people. On Thursday, the suspicion arose that the phenomenon stemmed from a change in the criteria or from a new hitch in counting by the Health Ministry.
The headlines about the rise in morbidity were enough to ratchet up media pressure on the government to impose more restrictions on the public now. There is no doubt that the government and the coronavirus cabinet – which has hardly left an imprint – have conducted a confused, wobbly policy in the past few months. As has been the case from the start, there is palpable influence from pressure groups, an infusion of ulterior motives and apprehension by politicians about making decisions that don’t sit well with the public.
Still, the presentation of the dilemma as a binary alternative – severe restrictions now or a total lockdown during the period of the Jewish High Holy Days – misses the complexity of the problem. It is precisely the national coordinator who is not eager to impose a lockdown and still does not see that step as inevitable. Gamzu is also attentive to the economic constraints and is trying to be considerate of the woes of the various sectors of the economy. The “barometer” team that is advising him – its task being to apprise the coordinator about the situation in the hospitals – reported this week that, despite the increasing load, the system is far from the point of collapse.
The bottom line is that Israel is not succeeding in pushing the genie back into the bottle: The spread of the second wave of the virus, which broke out at the end of May, was contained but has not been reduced to more reasonable dimensions. The facilities for the elderly, notwithstanding a certain improvement in handling them thanks to the establishment of a national hotline, continue to be a primary venue of mortality. According to official data, as of August 24, the number of coronavirus deaths in old-age homes stood at 238 – more than a quarter of the total number who have died from the disease in Israel.
In addition, a serious problem is developing among the country’s Arab population. While the incidence of COVID-19 has declined a little in the past two weeks among the Haredi population, and is now close to that of the general public (the R rate, signifying the number of people who become infected by a virus carrier, fell to slightly below 1), the R rate in the Arab communities stands at approximately 1.15. The morbidity there is affecting both the Jewish population and the West Bank Palestinians, with whom Israel’s Arabs maintain extensive family and business relationships. The problem in Arab society stems basically from broad disregard of the directives. Heavily attended events, including weddings, have taken place in the past few weeks in which no attempt was made to maintain social distancing.
September of our fears
Israel, as Netanyahu repeatedly points out, is not the only country experiencing a second wave of the virus. In the past month, about two months after it happened here, a rise in morbidity is flagrantly evident mainly in the Western European countries that were severely affected by the virus in the winter and spring. There, too, the rise reflects a renewed spread as a result of the lifting of the lockdown restrictions and some social distancing measures. In a number of countries, it stems also from an increase in the number of tests. The rise is particularly discernible in France and Spain, and to a lesser degree in Britain, Germany and Italy.
The incidence of the disease is not of the same intensity as in the first wave, and what is of course more important, the mortality rate this time is far lower. If in the first wave the death rate approached 10 percent of the confirmed cases, this time it’s about 1 percent, a bit more than in Israel (where the mortality has been relatively low since the first wave).
For the time being, the Western European countries are not experiencing any overload or collapse in the hospitals – phenomena that heightened the mortality rate in the first wave. Moreover, in the densely populated urban centers that suffered severely in the first wave, such as London, Stockholm and northern Italy, the morbidity and mortality rates have remained lower relative to other regions in the country and the continent.
Scientists and physicians who are airing doubts about the severity of the virus, and in particular those who believe that lockdowns cause severe harm, view these data as proof that their approach is the right one. Some of them are drawing on the data to promote a theory, which has yet to be proven in research studies, that in addition to herd immunity, which apparently exists in a section of the population in the wake of exposure to previous corona viruses, a 20 percent rate of incidence of the disease in a specific urban center is sufficient to prevent an additional outburst. This is being described as a “saturation point” of the virus, which, once reached, creates partial immunity in the population and reduces the danger of the virus’ renewed spread.
That is less relevant for Israel at the moment, because the disease did not spread here on a similar scale in the winter and spring. On the other hand, with the number of the newly infected per day so high, the government’s declared goal – improving the ability to break the chain of infection – doesn’t look to be achievable. On September 1, after much preparation, the army is to assume responsibility for the epidemiological deployment, whose task is to locate the chains of infection. The hope is that the Israel Defense Forces will be able to complete about 400 investigations a day, finalize an investigation within 24 hours and in most cases reach those in line to be infected in time, in order to isolate them and prevent further infection.
That’s an ambitious goal, but even this is very far from addressing the daily addition of newly sick – it only scratches the surface. There’s also another important event on September 1, of course: the start of a new school year. Following the relative failure of the return to school at the end of the first wave, in May, the new year is generating various apprehensions. It’s likely that the schools, where learning takes place in closed classrooms and other interior spaces, will raise the risk of infection, at least to a degree.
With the situation in Israel a depressing subject, it’s always possible to look at the United States and know that things are a lot gloomier there. This week the Trump administration decided to change the rules for coronavirus tests in a way that will prevent testing for anyone who has come in contact with a confirmed case, if he has no symptoms. That looks like a total abandonment of the effort to break the chains of infection.
Concurrently, President Donald Trump is cultivating expectations of a breakthrough in medical treatments and in the creation of a vaccine for the virus. Trump is counting on an “October surprise” – a dramatic announcement that a vaccine exists – shortly before the November 3 election, which would tip the scales in his favor. However, many scientists fear that the political pressure will hasten the use of a vaccine that has not yet undergone all the necessary preliminary tests.
As matters now appear, Israel is not facing the danger of a broad wave of mortality induced by COVID-19, such as has been recorded in the United States, Brazil and a few European countries. In fact, there’s a dispute about whether there was excess mortality in Israel in the first half-year of the epidemic. But the vacillating policy of the government in its struggle against the coronavirus, the tempestuous political wrangling and the contradictory pressures are nevertheless bringing into being a new reality, one that bears some similarities to the situation in the United States. It will consist of a hesitant, prolonged dithering in the shadow of the coronavirus, while waiting with frayed nerves for the arrival of a vaccine that is meant to put an end to the epidemic.