A well-known saying goes that once is chance, twice is coincidence, but a third time is enemy action. Now, almost a year since the coronavirus hit Israel, the country is in a third outbreak and entering its third tight lockdown.
This time, the vaccination campaign at least offers hope for the future. But it’s hard to avoid wondering whether a third lockdown could have been avoided, and if so, how.
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Was there a way to manage the pandemic better, at less cost to our health, economy and social life? Could different decisions have improved Israel’s situation? And to what extent has the public contributed to the problem?
In hindsight, there were many management failures. Yet it’s also impossible to ignore the role of human nature.
Both decision makers and the public oscillated between fear for people’s health and fear for their social and economic well-being. Both also tended to focus on the immediate picture, which changes rapidly in a pandemic, rather than the long term.
Restrictions and preventive measures were therefore seen as unjustified when infections were first starting to rise, which meant that despite improved testing, contact tracing and knowledge of the virus, Israel’s capacity to control it remained limited. It had little ability to take any steps between full opening and full closure.
Nevertheless, it’s easy to see where decision makers kept repeating the same mistakes. This contributed to the pandemic’s spread and undermined public trust.
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Exiting the second lockdown
In October, the Health Ministry presented a nine-stage, four-month plan for exiting the second lockdown, with at least two weeks between each stage. It began October 18, when Israel had around 1,700 new cases a day, and was supposed to end in February with less than 250 per day.
But three days later, on October 21, Prime Minister Benjamin Netanyahu sought to compress the plan into five stages. Dr. Sharon Alroy-Preis, the Health Ministry’s director of public health services, said she didn’t see how this was possible, but if it had to be done, she recommended leaving the first four stages intact.
Yet her advice was ignored. The second stage began on November 1, the third (opening stand-alone stores) a week later, the fourth (opening strip malls) on November 17. By November 27, Israel was even opening malls.
A few days later, Israel had over 1,000 new cases daily, up from 672 on November 1. Ten days after that, the number had hit 2,000.
For reasons it never explained, and against the Health Ministry’s advice, the government decided on a nighttime curfew during Hanukkah, then backtracked. On December 27, a loose lockdown began, with schools remaining open, but by the end of December, the number of new patients was more than 5,000 a day. A week later, it exceeded 8,000.
Throughout this period, the government ignored its own stated conditions (in terms of the daily number of new cases and the infection coefficient) for transitioning between stages. At some point, it set 2,500 new cases a day and an infection coefficient of 1.32 (meaning each patient infects 1.32 other people) as the threshold for starting a three-week lockdown, but never did so.
No differential treatment
Decision makers consistently refrained from differential treatment of places with high infection rates, responding only when incidence was high nationwide. The government’s “traffic light” plan had called for differential restrictions to extinguish localized outbreaks, but implementing it would have required a daily Sisyphean effort, involving close cooperation between the authorities and the public and substantial enforcement.
Schools closures in towns labeled “red” and “orange” were enforced very partially; in many such towns, studies continued as usual. Efforts to impose local lockdowns also failed, revealing how much Netanyahu and the entire political system feared confronting interest groups with political power. And the law enforcement system’s weakness became glaringly apparent.
Consequently, handling of the virus became dependent on individual mayors, resulting in wide gaps between different localities.
The coronavirus exposed the abyss dividing the Arab and ultra-Orthodox communities from the rest of Israel. Both communities contributed to Israel’s poor situation – not just in terms of virus incidence, but also in terms of public trust and morale, which was destroyed by the government’s inability to deal with these groups.
Today, the ultra-Orthodox comprise 12 percent of the population but 27 percent of coronavirus cases. At its peak in December, the community’s infection coefficient hit 1.74.
Yet school continued as usual between the second and third lockdowns, even in “red” cities, as did mass indoor events, with no penalties for violators. This shows how the government’s dependence on the ultra-Orthodox parties affected management of the crisis.
Schools proved to be an important source of infection during the second wave, prompting tighter restrictions when they reopened after the second lockdown. But when the third lockdown began on December 27, the Knesset Education Committee overruled the coronavirus cabinet’s decision to close schools.
Since then, Health Ministry data shows, the number of schoolchildren with the virus has soared. The number of verified cases rose from 4.5 per 10,000 to 10 per 10,000 among teens aged 15 to 17 and from 4.2 to 8.5 per 10,000 in the 12 to 14 age group.
Testing and contact tracing have been deemed essential to controlling the virus. Israel now performs over 100,000 tests a day, while hundreds of millions of shekels were spent to establish a contact tracing system with 3,000 human contact tracers and technological tracking.
But what was supposed to work in theory doesn’t entirely work in reality. Only in about half of cases do contact tracers manage to identify the source of infection. They also can’t keep up with more than 4,000 new patients a day.
Moreover, knowledge doesn’t always lead to action. Many people required to quarantine refuse to do so, including two-thirds of people returning from abroad, and enforcement is minimal.
The British mutation
To date, 150 cases of the British mutation of the virus, which spreads more quickly, have been identified in Israel. But the number may well be higher, since an ordinary coronavirus test can’t tell which strain of virus a person has. Consequently, it’s conceivable that this mutation contributed to the rise in infections.
December’s spike in cases shone a spotlight on Israel’s wide-open borders. Hundreds of coronavirus cases a month, or perhaps even more, come through Ben-Gurion Airport, and not always from “red” countries. That figure may be small compared to the thousands of local infections per day, but the Health Ministry says this hole must be plugged.
Nevertheless, efforts to do so haven’t worked, as an abortive experiment with quarantining returning travelers in hotels showed. Most such travelers also don’t quarantine at home, nor is there any legal way to force them to take coronavirus tests.
The vaccine hope
Over the past few months, management of the crisis has been marked by hesitancy, inconsistency, power struggles and political considerations. Decisions were made that defied public health considerations and professionals were excluded from the decision-making process.
Yet the public’s behavior also played a role. And in hindsight, it’s hard to see a viable option other than a tight third lockdown while awaiting our only hope – that the vaccines will defeat the virus.