When Israel's coronavirus czar and Health Ministry experts tried this week to advance a differential policy as part of the lockdown's exit strategy – a gentle hint that the state must impose greater restrictions on ultra-Orthodox towns where the virus is raging unimpeded – Prime Minister Benjamin Netanyahu cut them off. “Differential policy won’t work in Israel,” he barked, again placing his own political interests above national interests.
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As usual, Netanyahu is wrong, and it’s Israel’s Arab citizens who are proving it. There, beyond the spotlights, Israel conducted a differential containment policy that reduced infection rates sharply in Arab-majority towns. As of Tuesday, only 7.3 percent of the coronavirus tests of residents of these communities came back positive. This is significantly less than the 11.3 percent positive rate in Israeli Jewish society as a whole, and far from the 25-30 percent in communities with a Haredi majority.
The Arab communities’ success in reducing infection rates has important lessons for Israel as a whole. First, the coronavirus crisis can be managed, and proper management makes all the difference. Second, you can get the population to obey, but without trust between the population and the leadership you can’t beat the virus. Third, coronavirus czar Prof. Ronni Gamzu’s so-called traffic light model has great merit, and the plan showing “red” levels of infections in Arab municipalities got local leaders and residents engaged in curtailing the virus. Fourth, the general lockdown imposed on all of Israel, without regard for infection rates and compliance with regulations, only reduces the motivation to curb infections.
All of this is evinced by Kafr Qasem. As of late August this Arab city in the center of the country, bordering the Green Line, was “red” on Gamzu’s traffic-light scheme. More than 400 of the town’s 25,000 residents were sick, and nearly 50% of tests came back positive. As of early October only 55 people have COVID-19, and the positivity rate is a mere 5%. If the traffic light system were still in use, Kafr Qasem would be well into the green now, after just six weeks of effort. The lockdown replaced the color-based scheme, angering some residents. They say they feel as if the lockdown rendered their success meaningless and is preventing them from enjoying the fruits of their efforts.
Kafr Qasem’s successful coronavirus response was led by Mayor Adel Badir and municipal director general Eyal Kuntz. They were guided by Gamzu as well as the IDF’s Home Front Command, which kept breathing down the necks of town officials and pushed them to keep the situation under control, dictating daily tasks and clear goals. In retrospect, Kuntz admits that the Home Front Command’s unrelenting pressure to map out each task and conduct status checks three times a day brought results.
Management, management, management – that’s what they did in Kafr Qasem, with state help, and thus they proved what should have been clear already: The virus is not a dictate from on high, and with proper management it can be controlled.
“The secret was a set work method,” says Kuntz. “At first we’d have days with 50-60 new patients a day. Each one would receive a phone call from city hall in the morning, offering assistance and confirming that he or she was in isolation, and calls would go out to their close associates as well – family and neighbors. Our familiarity with residents enables us to identify the nuclear family and the extended family and get a broader picture of infection chains. Closer contacts were sent to be tested and were isolated. Within a day, patients and people in isolation received a phone call from the municipal welfare service and the psychological service, to see if they needed help and to encourage those isolating to be tested. We had unfettered drive-in testing, and some days we’d have a 50% positive rate.”
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The town has three prominent weak points: The first, large weddings, is the main driver of infections. The immediate answer to this was to set a personal example: The mayor and the entire municipal leadership stopped attending all weddings.
The second issue was compliance with quarantine orders. “The Shin Bet security service sent text messages to anyone who had been in contact with a coronavirus patient, telling them to self-isolate, so people began leaving their cellphones at home,” says Kuntz. “It was totally ignored. The only people who isolated were the ones who tested positive, and many of them also didn’t maintain isolation within their homes, and thus infected family members.” The municipality realized that the only way to convince people to self-isolate was to greatly ramp up testing, and focused the full municipal effort on that.
The third weakness was a lack of information. The Health Ministry has not been issuing lists of residents required to isolate broken down by cities, but rather only a list of people who tested positive. This creates a major challenge in breaking infection chains, as every confirmed infection is likely accompanied by at least five more people who need to be in isolation without the municipality’s knowledge. Kafr Qasem got past this by building its own database of patients and people required to isolate.
Thus, for lack of choice, Kafr Qasem built its own contact tracing department, which contacted every patient and then anyone needing to isolate within a day, told them to isolate and encouraged them to be tested.
Clear goals were set for all tasks: “We set a goal of 120 calls a day to people two or three degrees away from patients, which means at least 240 attempted calls a day,” says Kuntz. Progress toward goals was measured three times a day, and there were eight teams working in contract tracing and support for residents. For the first time ever, they set up an enforcement team to make sure restrictions were being maintained, a rare occurrence for an Arab town in Israel.
Another major reason the response worked was the traffic light program, and the incentive it provided for easing restrictions. Thus Kafr Qasem, in complete opposition to the rebellion that broke out in ultra-Orthodox towns, beat the national government to the punch and shut down its own schools before being told to do so.
“The most important part was the feeling that this was in our hands, and that if we became green, the restrictions would be lifted,” stated Kuntz. Residents wanted to rehabilitate local commerce, he explains. “The national lockdown ruined things, because now it doesn’t matter, so why try to improve?”
If Israel had continued with the traffic light plan, including lockdowns on red cities, a full lockdown could have been prevented, Kuntz says. In Arab communities, at least, it worked. “If there hadn’t been Haredi refusal, the traffic light would have worked,” says Kuntz. Netanyahu, take note.