All over the world Prime Minister Benjamin Netanyahu’s devotees marvel over how Israel is dealing with the coronavirus crisis. But the low death rate from COVID-19 here says nothing about the total anarchy over an exit strategy. This reached new heights last week in connection to the start of the reopening of the education system.
After many twists and turns, the picture became clearer Saturday evening. Schools will reopen for grades one to three and the last two years of high school – but not kindergartens, as had been planned. Haredi students, but only grades seven to 11, will return to school.
But the decision, it turns out, is just a recommendation. In some cities, classes will resume Sunday. Others, including Tel Aviv and Be’er Sheva, said they needed more time to prepare and will open the relevant schools later this week.
As throughout the crisis, the government has to make decisions under conditions of great uncertainty. Research from various countries, and a specific study by the Gertner Institute for Health Policy and Epidemiology Research of children in the largely ultra-Orthodox city of Bnei Brak, failed to clearly answer fundamental questions: To what extent are children at risk of infection? (It is known that children can be infected, albeit less than adults, but the rate is still not known.) To what extent can children, especially those without typical symptoms of COVID-19, infect adults?
At the same time, the coronavirus exposes all the major ills of the Israeli government – belated and improvised planning, preparations and decision-making alongside surrendering to pressure groups. The latter led to the decision Friday, proposed by Interior Minister and Shas Chairman Arye Dery, to reopen higher grades, but not the lowest ones, in Haredi schools.
The disagreement reflects a deep conflict between the health and education ministries. A National Security Council report said the former failed to give the latter clear directives the Education Ministry needed to prepare for the resumption of studies.
To complement this sorry picture, on Thursday’s broadcast of Channel 13’s investigative TV show “Hamakor,” Haim Rivlin followed Prof. Zeev Rotstein, CEO of Hadassah Medical Center. Rotstein runs the two Jerusalem hospitals under the organization like a private fiefdom that ignores the Health Ministry. In letting the reporter record conversations Rotstein held with Prime Minister Benjamin Netanyahu, Health Ministry officials and the head of a department in the Mossad – presumably without their knowledge, in most cases – gave viewers a rare peek behind the curtain of the unified front presented at media briefings. It was depressing: power struggles, knives drawn, mutual recriminations, confusion and no small amount of panic.
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None of that has disrupted the infection party that began with the gradual lifting of restrictions since the end of Passover in mid-April. The streets and even some beaches and parks are once again teeming with people. Social distancing is perceived as a recommendation. Masks? Sometimes.
The needless restriction of outdoor exercise to within 500 meters from home has been lifted. So has the pretense that the police are enforcing the regulation (still in place) to stay within 100 meters of home otherwise. The bottom line is that there are masses of people in the streets, some of them acting like the coronavirus is a distant nightmare that no longer endangers us.
The outcome will be known in the next two weeks. The health care system predicts a certain rise in infection, apparently at the moment fairly tame – fewer than 200 new confirmed cases a day; an average of about 1.7 percent of tests performed each day will come back positive. The coronavirus has so far struck Israel with less magnitude than other Western countries. If hot weather does indeed limit the danger of infection, perhaps the increase will be relatively restrained. If not, we might go back to the beginning and the Health Ministry will once again argue for strict quarantine. But it will have trouble ensuring the cooperation of the public in light of the erosion of people’s faith in policies.
If the upcoming period does not see a dramatic outbreak of the virus, the economy will continue to gradually return to normal, with surveillance of specific hotspots. The gap between such communities and neighborhoods, mainly ultra-Orthodox, and the rest of the country, is becoming clearer. The common assumption, which is only an informed theory, is that another outbreak is expected in the fall, perhaps combined with seasonal flu. Until then, the health care system has set a goal to have 7,000 ventilators in Israel. This is a huge number (at the moment fewer than 100 patients are on ventilators), but skilled personnel are also needed who know how to operate them.
In the ongoing coalition negotiations between Likud and Kahol Lavan the Health Ministry continues to be the child of whom neither parent wants custody. Yaakov Litzman resigned the post on orders of his rabbinic leader, after the pandemic revealed the magnitude of his failure in that role. Kahol Lavan co-leader Gabi Ashkenazi was in no hurry to volunteer. Now another name has come up, an expert, the CEO of Sheba Medical Center, Tel Hashomer, Prof. Yitshak Kreiss, whose candidacy representing Kahol Lavan was suggested in this column in late March.
The reason politicians are afraid of the health portfolio is clear. Under the circumstances it looks like a political deathtrap. The economic crisis, which is only expected to grow worse in the coming months, will bolster the status of the Finance Ministry in decision-making, certainly when a new minister comes in who will have to implement budget cuts in light of a growing deficit. The Health Ministry is very dependent on the treasury even in ordinary times. Every purchase of a new MRI machine requires the signature of the Finance Ministry’s budget department. The Finance Ministry’s hold will tighten in light of the crisis, making the Health Ministry a kind of subcontractor dependent on the good graces of the treasury.
In addition, negotiations are expected to begin on a new wage agreement for doctors. The agreement signed with the doctors a decade ago chalked up major achievements, that improved salaries, especially of senior members of their ranks. The lack of preparedness that was seen at the beginning of the coronavirus crisis will now focus attention on more hospital beds and more ICU beds and ventilators, although the limited spread of the virus so far has not dramatically tested the health care system nor brought it close to the feared collapse.
The coronavirus is an exceptional and very rare event, an extreme, first-time scenario. Soon an argument will develop: Do the gaps uncovered require upgrading preparedness in ordinary times, or should resources be channeled elsewhere, based on the system’s ability to improvise, as has been the case throughout the current crisis?
Despite the billions that have already been allocated to the Health Ministry over the past few months, the dilemmas will remain. We still don’t know the cost of the damage to the health of people who were not diagnosed or treated when the health care system was deep in the throes of the coronavirus crisis. Filling in the gaps that emerged will take time and cost a great deal of money. And funding for more hospital beds and doctors next year will also come at the expense of the medicines, treatments and technologies covered by the government. Budgetary distress is expected to continue, with the treasury having to take other needs into consideration, such as assisting the unemployed and small businesses. Potential ministers are aware of these problems, and that’s why the line of candidates is so short.