Analysis

The One Critical Measure Missing From Israel's New COVID-19 Strategy

Expert says plan unveiled by new coronavirus czar Ronni Gamzu's fails to address the eroding state of medical services ■ With new authority to sever infection chains, defense establishment may recommend another short lockdown

Amos Harel
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Staff in the coronavirus ward at Sheba Medical Center, Tel Hashomer, July 20, 2020.
Staff in the coronavirus ward at Sheba Medical Center, Tel Hashomer, July 20, 2020.Credit: Emil Salman
Amos Harel

This week it was possible to assert clearly that the morbidity rate of the coronavirus in Israel has stabilized in relative terms. For the past two weeks the daily infection rate has ranged between 1,600 and 2,100 people on weekdays (the weekend – Friday-Saturday – numbers are lower); the rate of those testing positive is between 7 percent and 9 percent; and the number of seriously ill is between 250 and 330. Nearly 100 coronavirus patients are on ventilators.

At the same time, the number of those hospitalized because of COVID-19 is rising, slowly but persistently, and is approaching 800. The number of deaths from the disease has also risen and  now stands at about 10 per day. (Still, the number of those who have died is far from the forecasts the government heard, which spoke of 800 dead in Israel by the end of July; to date, there have been 500 deaths.)

Israel's Locked-down, Let-down Youth Rattles Netanyahu's Cage. LISTEN

The picture differs from one locale to the next. In Bnei Brak, the overwhelmingly ultra-Orthodox city which is a center of morbidity in the second wave, too, more than 1,000 people were found to be newly infected in the past week, with 20 percent testing positive. Tel Aviv recorded 1,400 new cases, but a far lower proportion – 6 percent – tested positive. The national data remain excessively high, but are not yet critical. At the moment, we are far from the health system’s capacity, which according to some estimates is about 800 seriously ill coronavirus patients. One of the reasons for the relative stability in the number of serious cases is apparently an improvement in medical care. The condition of many of those who diagnosed as seriously ill has been improving in a comparatively short time.

The line being advocated by the new national project coordinator for the battle against the virus, Prof. Ronni Gamzu, is that another total lockdown should be avoided, and used only as a last resort. His approach is victorious, for now. The hope is that continued social distancing practices (keeping away from others, wearing a mask, avoidance of crowding) will prevent loss of control of the coronavirus and hold off the point of collapse. At the moment, Prime Minister Benjamin Netanyahu and the so-called coronavirus cabinet are going along with Gamzu. Possibly they have understood that at last there is someone in charge and that it’s best to let him work. Or possibly the powers that be grasped that, given the current state of public bitterness and mistrust of the government, it’s best not to risk measures like another lockdown, which is liable to encounter broad civil disobedience.

Another move made by Gamzu, one that should have been authorized long ago, involves placing the testing and epidemiological investigations in the hands of the IDF. Senior defense officials who recently joined the effort against the pandemic lately, were taken aback by the gloomy situation they found in the functioning of the Health Ministry. Five months after the virus reached Israel, the country is still nowhere the near the desirable state of affairs in regard to testing for the disease and conducting epidemiological investigations.

People wearing masks walk in Jerusalem on July 29, 2020.
People wearing masks walk in Jerusalem on July 29, 2020. Credit: Emil Salman

Recently, various estimates have been published about the time it takes to test the sick and then locate and isolate the people they were in contact with. In many cases, this process takes between one and two weeks – far from the target of 36 or 48 hours the government is talking about. With 2,000 new cases a day, each of whom was in contact with an average of 20 to 50 other people in the preceding two weeks, the investigation mechanism is under unreasonable strain. At the moment, Israel is totally unable to break the chain of infection in time. Mainly as a result of Shin Bet security service tracking, hundreds of thousands of Israelis are spending long days in enforced isolation, often due to mistaken information. This is totally at odds with an orderly epidemiological investigation, to say nothing of the severe infringement of personal privacy.

The obvious solution that Gamzu has devised involves transferring responsibility to the IDF and establishing – at a very late stage – a new investigation constellation. This body finally has a budget and is now in the process of being set up. The army will allocate a directorate to the project, probably under a brigadier general who will have hundreds of officers and soldiers at his command. The estimate is that an effective system can be established within a few weeks, but by then the daily number of new cases might be too high.
Consequently, the defense establishment may recommend another lockdown for a few weeks, with the aim of reducing the morbidity rate and allowing the new body to start working fulltime with the state in relative control of the situation. Any such recommendation will likely encounter fierce resistance from the Finance Ministry, the business sector and quite a few ministers. The fact is that, following the government’s failed performance to date, it will be very difficult to impose a second lockdown on the Israeli public.

Critical element

The point of collapse of the health system depends primarily on the functioning of medical staff. That, and not the ventilators (which are now being used sparingly) is the critical element in coping with the virus. For now, the hospitals are coping with the load because the internal wards are less full in the summer, meaning some can be converted to coronavirus units, where complex treatment is required and where staff need to wear awkward protective gear.

In the winter, the coronavirus will intertwine with the flu. The Health Ministry is not yet able to assess the severity of the overload. There are also mitigating circumstances. The fact that there are few flights to Israel means that fewer people will bring with the seasonal flu from the Southern Hemisphere (where it’s now winter), and in any case they will be required to self-isolate for two weeks. In addition, social distancing and the face masks that are mandatory because of the coronavirus, can also help reduce flu infections.

Dr. Yoav Yehezkelli tells Haaretz that an essential component is missing from the Gamzu plan as published so far: the strengthening of the health system and dealing with the medical teams' burnout. Yehezkelli, an expert in internal medicine and a lecturer at Tel Aviv University, was one of those who set up the team to deal with epidemics in Israel. 

“A commander-in-chief prepares his soldiers for the next battle,” he says. “In Israel, nothing was done between the first wave of the coronavirus and the second wave. As one who also works in the field, I can say that the burnout is shocking. It is especially flagrant among physicians in the community, the staff of the health maintenance organization’s clinics, who are working under an immense load of requests for treatment. Another reason for concern lies in the shortage of protective equipment. It will not be long before the managers of the health system will look around and discover that they have no soldiers for the campaign.” An extensive survey conducted by the Health Ministry in 2017 found that the burnout among medical teams “requires urgent intervention.” Of course, nothing has been done since then, Yehezkelli says.

Another key question concerns the opening of the new school year on September 1. In the United States and Western Europe, where schools have been shut since last winter because of the pandemic, the question of how to reopen is generating serious disagreements. The Americans have never curtailed the virus, other than in the Northeast, such as in New York and New Jersey, which were the hardest hit states in the first wave.

Some European countries are now seeing the onset of a second wave, despite the late and cautious restarting of their economies. All these countries, unfortunately, are treating Israel as a story with a moral to it: what can happen to a country with resourcefulness and advanced technology, which restarts its economy and reopens its schools without control or forethought, and entangles itself in a second wave of the disease that breaks all records.

Mean streets

The fear of a new security flareup, like the prolonged health crisis, is a weight issue. But the most immediate danger now confronting Israel lies in the combination of worsening economic distress due to the pandemic, and the political and judicial confrontation which is spilling into the streets. Last May, there was media criticism of a report by a team of experts that was advising the National Security Council warning about the possibility of a future wave of potentially violent demonstrations, against the backdrop of further deterioration in the economy.

That forecast is already being realized, in part. So far, not many Likud voters have joined the protests against Netanyahu. Perhaps economic concerns haven’t yet prompted them to cross the lines, after years of venerating the prime minister. Still, the number of demonstrators against Netanyahu is swelling by the day, because of his unbridled behavior, the sometimes hard hand wielded by the police and the violent attacks by right-wing thugs. On Thursday, members of La Familia, the extremist organization of fans of the Beitar Jerusalem soccer team, called for the nightly demonstrations near the prime minister’s residence in Jerusalem to be broken up by force.

On Saturday night, thousands are expected to take part in the Black Flag anti-corruption movement’s protest on bridges and at interchanges around the country. There is an unmistakable explosive smell in the air, which recalls the street battles during the rough days of the Lebanon War of 1982 and the terrorist attacks that followed the Oslo accord. Benjamin Netanyahu and his circle, some by deed and some by failure, are contributing to this. It could end very badly – and this time around the public is unlikely to buy the traditional pieties and evasions that will follow the bloodshed.

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