Analysis |

Israel Should Fight the Coronavirus With a Scalpel, Not a Sledgehammer

An experiment with continual monitoring at Israel Aerospace shows the way. But Health Ministry isn’t interested

Meirav Arlosoroff
Meirav Arlosoroff
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A sign reads "Don't panic" above the Carmel Market shops closed during Israel's coronavirus lockdown in Tel Aviv, March 25, 2020.
A sign reads "Don't panic" above the Carmel Market shops closed during Israel's coronavirus lockdown in Tel Aviv, March 25, 2020.Credit: Meged Gozani
Meirav Arlosoroff
Meirav Arlosoroff

Several of the most critical units of Israel Aerospace Industries have been working at nearly full capacity even as the coronavirus rages across Israel. IAI has been designated an essential industry but that doesn’t gives its workers any added protection against contagion and the need for many of them to go into quarantine. To address the quandary, management worked with a lab at Hadassah Medical Center to develop what they call a “green island.”

The idea is to continually identify coronavirus carriers among the workforce. The test is done every three days – the minimum time it takes for a newly infected person to show symptoms – on each worker. Those who are found to be carriers are immediately sent into quarantine; those who are clean continue working full time.

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The system isn’t foolproof. It’s clear that some carriers test negative or only test positive after they have infected others. But the intensive testing enables IAI to constantly isolate carriers and let a critical mass of others stay at their jobs.

Hadassah was the first in Israel to use the model, employing it for its own medical staff. The decision by the hospital’s CEO, Zeev Rotstein, to introduce the system went against the Health Ministry’s opinion, but it appears it’s been the way Hadassah has been able to operate at a much higher level than other Israeli medical centers.

Health officials are now trying to deploy Green Island nationwide. “At Israel Electric Corporation [the government-owned power utility], there are already 250 employees in quarantine and we can’t be in a situation where IEC is paralyzed because so many employees are sick. We need to start monitoring and testing them,” said one official, who asked not to be identified.

Some want to start introducing the system in all critical sectors of the economy, such as infrastructure and the military industries, and then gradually expand it to the general population. The idea is to ease the lockdown and enable the Israeli economy to return to some semblance of normalcy. It could end up being Israel’s exit strategy for ending the lockdown even as the epidemic continues.

But for now, it’s not happening. The Energy Ministry’s request to monitor workers employed at major infrastructure sites has not been approved by the Health Ministry. IAI remains the only place where Green Island is being used.

Green Island is among the most prominent of several strategies that offer an alternative to the near-complete lockdown of the economy that Prime Minister Benjamin Netanyahu proposed Monday night. As time goes on, however, voices opposed to a “big and dumb” lockdown are rising; more and more are calling for a “smart, selective” lockdown.

Closed shops in a street in Ashkelon during spread of coronavirus disease, Israel March 20, 2020. Credit: AMIR COHEN/ REUTERS

A smart lockdown operates according to five main principles.

The first is to rein in the epidemic by reaching the point of “herd immunity,” at which so many people have been infected and become immune that the virus has nowhere to spread. The experience of China and Italy have shown that this point doesn’t require the entire population to be infected; it’s enough that local epicenters reach it to contain the contagion.

The second is that you cannot achieve herd immunity without imposing controls, as Britain is trying to do. It will bring too big a rise in sufferers and cause the healthcare system to collapse. The authorities must manage the process, which leads to the third principle: To isolate the most vulnerable segments of the population – the elderly and those with chronic illnesses.

The fourth is that the authorities must engage in constant testing of the general population to identify carriers and put them into quarantine before they infect too many others, which is what Italy did in the town of Vo.

When the first carrier in Vo was identified, the town’s entire population of 3,300 was tested. Some 3% were found to be carriers and quarantined. Three quarters showed no signs. The town itself was quarantined for two weeks, at the end of which the rate of carriers had dropped to 0.25%. The policy of general testing stopped the epidemic in its tracks. By comparison, on the cruise ship Diamond Princess, no testing was done and the rate of infection rose to 25% in the same two-week period.

A security guard stands at the entrance to Yokohama port as the quarantined Diamond Princess cruise ship is seen in the background Wednesday, February 19, 2020Credit: Jae C. Hong,AP

The fifth principle concerns price. A complete lockdown imposes a heavy cost on the economy and eventually on human life. In Israel, it would cost between 140 billion and 250 billion shekels ($38 billion-$70 billion), a burden Israel would struggle to recover from. A smart lockdown would enable economic activity to resume by letting more people return to their jobs.

Admittedly, it will be very difficult to manage the risk because the level of uncertainty remains high. Experts still don’t know enough about the future progress of the contagion. They don’t know how many carriers there are in the population because no country has conducted enough tests – South Korea has done the most testing, but that’s not nearly enough to reach a firm conclusion from country to country – nor do they known the actual mortality rate.

Right now, the mortality rate among known coronavirus sufferers ranges between 0.5% in South Korea and Germany, to 10% in Italy. Why? No one knows. In any case, because most carriers are presumably not identified, the actual rate is probably very different from the official numbers. Estimates are that they are between half and one-hundredth the official number. But it’s only an educated guess.

In lieu of solid data, a decision to impose a full lockdown has no firmer justification than does a selective one. Dr. Michael Assaf of Hebrew University’s physics department, who has provided the Health Ministry with different scenarios of the epidemic’s future course, estimates that the current partial lockdown will result in 20,000-25,000 deaths in Israel, while a selective one targeting the vulnerable would result in just 10,000. In other words, even some in the Health Ministry think a selective action would be better than a general one.

“Everyone is singing our praises from their balconies right now,” said one healthcare official, cynically. “When will people stop singing and jump off their balconies because of economic distress?”

That’s harsh criticism of the ministry’s policies, which refuses to dramatically increase the scope of testing, doesn’t allow systematic monitoring to enable as many people as possible to return to work, offers no exit strategy and is pushing only for a complete lockdown without considering any alternatives.

Even so, the expert quoted above doesn’t claim he knows more than any of the other Health Ministry authorities. In the next few days, we will get a preliminary look at how the lockdown that was imposed more than a week ago has impacted on the number of cases and deaths. We will then have a better idea if Israel is following the path of Italy or that of Taiwan, Italy, Germany or South Korea.

Israel would be advised to wait for that data before making a fateful decision on a complete lockdown or on something else.

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