Prof. Retsef Levi of the MIT Sloan School of Management laughs when asked how he manages in the U.S. with his unusual first name. “Americans don’t care,” he says. “Israelis are the ones who are surprised by the name.” He says that his name is easier to deal with than those of his more famous brothers – Reshef, a comedian, and Yannets, an author.
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Levi seems to have inherited their parents’ penchant for challenging their surroundings. He is busy challenging the Israeli government, Health Ministry, advisers and decision-makers on their handling of the coronavirus pandemic.
“You have to raise red flags about the decision-making process in Israel,” he says. “Before MIT, I served in senior roles in intelligence 12 years, and I see submission to a concept like with the Yom Kippur War. The government isn’t internalizing the lesson we learned in the army then – to challenge the decision-making process with a frank debate and as many opinions as possible.”
Levi knows what he’s talking about. His academic specialty is risk management, especially in the health care system. He advises U.S. hospitals and the U.S. Food and Drug Administration. In Israel, Education Minister Yoav Gallant asked him to join a team of experts to advise on the safe reopening of schools during the pandemic. Levi is convinced the ministry’s plan – division into so-called capsules, ventilation of classroom, frequent testing and sampling of the sewage system for the virus – is safe and should have allowed schools to remain open during the current lockdown.
Levi argues that the decision to close nearly all schools in the country when, in his opinion, it was possible to keep them open safely, typifies the decision-making process he saw over the six-week period that he took part in cabinet discussions of the school operation plan. In short, he says, the process is unprofessional, not transparent, based on the belief that the only effective response to the pandemic is a strict lockdown, with no effort made to pinpoint high-infection areas and crack down only in those places.
“I don’t understand the strategy,” Levi says. “If Israel would adopt a policy like in Australia – a four-month lockdown to get to zero infections – I would disagree but at least I’d understand the organizing principle. But Israel imposes each time a three-week lockdown, which doesn’t accomplish anything, and it doesn’t have any policy for afterward except to planning for the next lockdown.”
No transparency, no data
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The “accordion policy” championed by Prime Minister Benjamin Netanyahu, of opening and closing the economy in response to infection rates, was bound to fail because it doesn’t act against the drivers of infection, Levi says. “After nearly a year, we know that large indoor gatherings without masks are the source of infection. It’s clear that the largest infection sources are big weddings and Haredi schools, which operate without social distancing, mainly the yeshivas. [The authorities] needed to take action against these sources, but they did the opposite. They closed small businesses and the school system, which are not proven infection sources, and didn’t enforce regulations against yeshivas and weddings. They closed what was easy, leaving the infection sources open.”
What enabled this backwards decision-making process is, of course, a lack of transparency and data. Levi blames the Heath Ministry, which didn’t collect data and didn’t collaborate with the Education Ministry in an attempt to determine whether the source of the widespread infections in the school system was the schools or the families.
Levi cites the only study on the subject, which examined the reopening of schools in May and found that it didn’t increase infections. In contrast, there is a counterclaim that it was the Education Ministry that didn’t collaborate with the Health Ministry in conducting such research. Either way, it’s clear that thorough research on the school system was not conducted. Levi also blames the professors who are the supposed heroes of the pandemic, whose forecast models are not transparent enough and sow fear unnecessarily.
Levi argues that the conclusion that hospital death rates rose due to overcrowding, initial evidence of the health system’s possible collapse, reflects a misunderstanding of how hospitals operate. “When there are many patients, the hospitalization threshold rises. They only admit the most severely ill, and then death rates necessarily rise,” he says. “It’s not because the care is worse.”
This is also the weak spot in Levi’s arguments, what he says should be done to cope with hospital overcrowding and the rise in the proportion of patients who are severely ill. His proposals, such as bringing in retired doctors, is less convincing. And health care workers are unlikely to welcome his suggestion to reduce their personal protective equipment. “Leading U.S. hospitals cut back on protective gear, the main defense is the N95 mask and a face shield,” he says. He also advocates reducing the quarantine period for people who may have been exposed to the virus to five days plus one negative test (the recommendation of the U.S. Centers for Disease Control and Prevention). “There’s no medical need for a 14-day isolation, and it causes the people who need to quarantine to be uncooperative,” he adds.
Silencing and a lack of professionalism
Levi’s proposals aren’t necessarily right, but he isn’t alone in his criticism. Prof. Udi Qimron of the Tel Aviv University medical school gained notoriety this month when a film about the pandemic by journalists Orly Vilnai and Guy Meroz (“And What if the Whole World is Wrong?”), featuring his remarks on herd immunity, was broadcast on Israeli TV. Qimron’s views, which are shared by dozens of scientists touting what they call a “common sense” approach, aren’t new. But most Israelis only heard about them recently, after the Health Ministry rejected them for months.
Levi, it must be emphasized, didn’t join Qimron’s recommendation on herd immunity. “I don’t volunteer to be infected by this pandemic,” he says. “I always wear a mask, especially in closed spaces, where it’s proven that masks protect against infection.” He does join Qimron’s criticism regarding the silencing of dissent, labeling anyone who thinks otherwise at the Health Ministry a “coronavirus denier,” the cabinet only inviting experts who advocate lockdowns and of course the lack of professional work of collecting data and analysis to identify infection loci and to take action against them.
Levi is mostly mad over what he sees as the unnecessary closure of the education system, “which much research abroad teaches that it can be managed safely, and that no one considers the terrible social, economic and health costs of closure.” He says the costs include depression, opioid addiction, family violence and the worsening of chronic illnesses because of delayed treatment.
While Qimron and Levi are noted scientists, they may still be wrong. It’s just that their criticism resonates because their claims aren’t considered at length, and because it’s clear that what is being done has failed, and Israel is one of the only countries that experienced three strict lockdowns, one of the only countries that didn’t fight to keep its education system open and despite the advantages of being a warm country with a relatively young population, a mortality rate that is higher than the global average. Israel has the second highest death rate in the Middle East.
We are no success story in managing the pandemic. It explains the late blooming of lockdown opponents, known colloquially as “coronavirus deniers.”