In one week, on September 10, the coronavirus cabinet is expected to decide on new fall holidays restrictions to vary among localities based on infection rates, as well as a nationwide lockdown during the Rosh Hashanah weekend.
Public health professionals predict that Israel’s infection curve is unlikely to begin dropping over the next week. More likely, some say, is that the start of the school year Tuesday will lead to more cases of COVID-19 in the next couple of weeks.
Coronavirus czar Prof. Ronni Gamzu is expected to submit to the cabinet Thursday a list of new, more detailed restrictions regarding so-called “red cities,” where infection rates are highest, beyond the restrictions on gatherings that have already been presented. Gamzu has been drawing up the guidelines with senior Health Ministry officials and other professionals, and they include additional funds for testing, contract tracing and the country’s health care providers.
Gamzu's traffic light plan is scheduled to officially go into effect September 6, and the results will be carefully monitored.
Meanwhile, with the rise in coronavirus cases in Israel, it seems Gamzu's efforts have not borne fruit. In Israel, every day there are more than 2,000 new patients and deaths in the double-digits. There are more than 400 seriously ill patients and more than 960 deaths since the pandemic began.
On Wednesday, Israel recorded 2,926 new cases.
A recent report by the National Center for Information and Knowledge in the Battle Against the Coronavirus, entitled “Meeting the prime minister’s goals,” says that at the current rate of infection it would take more than 90 days to reach the goal of “only” 400 new confirmed cases a day. On a good day, nearly 30,000 virus tests are conducted, although the daily target is 60,000 tests. Meanwhile, medical laboratory employees have been on strike since the beginning of the week.
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On the bright side, the infection coefficient – the R number, or how many people each infected person infects on average – has reached the goal that Gamzu set when he assumed his post – under 1 – and now stands at 0.9. Constant efforts are being made to improve testing and contact-tracing. “The system to cut the chains of infection has progressed considerably but it hasn’t reached its full potential. That will apparently happen only after the holidays,” one of the experts accompanying Gamzu told Haaretz.
The source said that this progress is reflected by the number and speed of epidemiological investigations, the training of additional personnel and an increase in computer resources.
Hospitals, particularly those in areas with high infection rates, are under pressure with more seriously ill patients, but a recently deployed assignment system has been moving some patients to hospitals in other parts of the country, and hospital sources say the situation is improving. Nevertheless, the number of seriously ill coronavirus patients in hospitals continues to climb, albeit moderately.
But all these are just parts of the complex puzzle involved in managing the coronavirus crisis. It seems as though the more in-depth and professional processes become, management of the crisis becomes more complicated. Not just from a medical-epidemiological perspective, but from social, economic and political perspectives too.
The tools available to Israel in managing rising infection rates have been blunt and inadequate. These include the lockdown switch, which seems to have just two operating modes – on or off – and attempt to persuade the public to comply with mask-wearing and social-distancing regulations. Any real solution aimed at maintaining something resembling a routine and keeping the economy going, required and still requires great resources and effort. Gamzu learned very quickly that every effort to define, isolate or rank the rate of risk, or to focus efforts, had an immediate political and social consequence. This was certainly the case when discussing the focal outbreaks in the Arab and ultra-Orthodox communities, or the controversy over flights to Uman.
Support for the coronavirus czar
A public letter of support for Gamzu, distributed Wednesday and addressed to the prime minister, the alternate prime minister and the health minister, was written by representatives of various medical associations. “Recently we have witnessed attempts to thwart [Gamzu’s] plan by the political system which called him to work,” the doctors wrote. “We expect the political leadership to rise above sectorial considerations and let Prof. Gamzu and his staff work.
“Prof. Gamzu represents the science and medicine in Israel and it’s important to listen to him. Without control over the pandemic we cannot expect recovery in other areas of life, particularly the economy. We want to express our full professional support for Prof. Gamzu and his staff, and hope that the state and Health Ministry leadership will join us.”
The ‘red cities’ trap
The traffic light plan imposes restrictions on localities classified according to their respective infection and morbidity rates, and aims to enlist leaders and residents to earn a better color. The plan's plan relies on extensive support from local authorities, along with an entire array of other agencies, including the Home Front Command, Magen David Adom, health maintenance organizations, Health Ministry representatives and more.
Public-health officials and others believe that it’s a good plan. But glitches are already popping up that could become more significant as the fall holidays approach. In an announcement Wednesday at the end of a visit to Betar Ilit, an ultra-Orthodox city with a high infection rate, Gamzu said, “Without a marked change in the morbidity rate in the red cities, we will not be able to avoid a full closure. We now stand at 14 percent positive tests in the city and the responsibility for the situation is from now in your hands.”
He added, “Unfortunately, we are witnessing a systematic violation of the guidelines. Every night there are events in the city that violate all the regulations and yesterday, against our instructions, schools in the city were opened. I understand the complexity of the situation, but I must say, unequivocally, that without an increase in enforcement and encouragement of testing, we will have to make complex decisions that could result in a full closure.”
According to Gamzu, 28 percent of Israel’s coronavirus cases are among the country’s Israeli Arab minority, which accounts for around 20 percent of the population. Haredi Jews account for an additional 22 percent. “A significant rise in the incidence of illness will force us to take grave steps on a national level. Without a significant change in the trend by the target date, September 10, we will be forced to formulate new and broader instructions that will seriously undermine routines outside the red cities as well,” Gamzu said.
Red cities and traffic lights
According to Health Ministry sources, the situation in Betar Ilit doesn’t reflect the situation in all of the so-called red cities.
“In other cities there is cooperation and requests for help. There are also mayors who have themselves asked Gamzu to impose a lockdown to gain control over morbidity,” said a source who is familiar with the details and spoke on the condition of anonymity.
The group of experts advising Gamzu do not share a uniform perspective. Some supported very stringent moves at the beginning of the school year and a total closure during the holidays. Others believe in a more measured approach, in line with the traffic light plan.
“The traffic light plan is correct, but now opinions are divided over what to do in the red cities,” said Prof. Zev Rothstein, director of Hadassah Medical Center in Jerusalem and a member of the panel of experts.
“I think the emphasis should be on providing assistance to those cities; whether it’s more teachers to shrink the capsules, more testing and working closely with local government. Once you impose a closure and stop studies you are encouraging a revolt,” he said. He added that the more negative consequences there are for red cities, the greater the risk that residents will avoid being tested.
Prof. Nadav Davidovich, another member of the team of experts, said: “The traffic light plan comes to bring more attention and resources to those cities, not to set them apart. If you take a red area and just impose a closure, you’ve done nothing. You have to invest in tests, public relations, welfare services and deal with marginalized populations and the elderly. It requires a focus on details because not all places are the same.”
Lockdowns, as Israelis have learned, have a heavy economic and social cost, and it is not clear how such a decision will be received by the public this time around. During the first lockdown, the closure was presented as a means of buying time for preparation. Now, eight months into the crisis, a lockdown would likely be perceived as failure to assert control over the pandemic.
“I believe there is a choice,” Rothstein said. “Things need to be done in a smart and focused way, even if it’s more personal and difficult. Lockdown is too easy a solution with a lot of social and economic damage and will lead to another wave of justified protests.” He added that he hoped Gamzu would succeed in his task, “because his thinking is solely medical, clear of politics.”