Analysis |

Israel's Government Can't See Beyond Constant Lockdowns. But There's Another Way

'If there were 100,000 tests a day, we would never need a lockdown,' says one public health expert who argues that the economy should stay open during the coronavirus outbreak

Meirav Arlosoroff
Meirav Arlosoroff
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A closed store on Sokolov Street, Holon, November 2, 2020.
A closed store on Sokolov Street, Holon, November 2, 2020.Credit: Tomer Appelbaum
Meirav Arlosoroff
Meirav Arlosoroff

There’s an old joke about how economists don’t like to talk about the future and, if they need to make predictions, it will only be about the past. The coronavirus has affected even this old joke, so that today economists think that predicting the past is also laden with risk.

For instance: What happened in the months of June through September? Did Israel dangerously lose control of the pandemic, forcing us into a second lockdown? Among experts, analyzing the growth in the number of daily new cases to 9,000, the 15 percent positive rate for testing and 800 serious COVID-19 cases are still subject to considerable debate.

Haaretz podcast: Will Trump's purged Pentagon let Israel attack Iran?Credit: Haaretz

If, for instance, you ask Prof. Udi Qimron of Tel Aviv University’s Sackler School of Medicine, who is a proponent of encouraging herd immunity, he will tell you that what happened during those months was wonderful. The rise in new cases will save us from a third and more virulent coronavirus wave this winter. As he sees it, Israel allowed the virus to infect a large part of the population, notably young Haredim, and is now more resilient to the coronavirus.

Until recently, Qimron’s views were regarded as heresy; today they are seen differently because of the surprising trajectory of COVID-19 infections in the Haredi world. Almost a month after they declared a revolt against the lockdown, stopped being tested and reopened large numbers of their schools, their rate of contagion has remained low. Their rate of positive coronavirus test results has fallen from 25 percent, just before the second lockdown began September 18, to just 3 percent today, proof that their low rates of contagion aren’t because they refuse to be tested.

On the surface at least, the data strengthen the view that the contagion among the Haredim is slowing due to the high rates of infection during the summer. By some estimates, 30 percent of the ultra-Orthodox were infected during those months.

Not just Qimron, many of the big hospital chiefs are now saying that with the benefit of hindsight, their concerns about the surge in serious cases during the summer were uncalled for.

“I supported the second lockdown because I thought the figure of 800 seriously ill would bring about the collapse of the [health care] system,” one administrator told TheMarker. “In retrospect, I realize I made a mistake. The hospitals didn’t collapse – they weren’t even close to collapsing. Even at the height of the lockdown, we had available beds and the quality of care wasn’t affected. I think we could have handled 1,500 or 2,000 seriously ill patients.”

His explanation: Israeli hospitals learned a lot from the first lockdown. They were better prepared, ensured they had more beds available, trained teams and their internal medicine departments (which currently serve as backups to intensive care units) now specialize in treating coronavirus sufferers.

It is true that the patient load between hospitals wasn’t distributed evenly, but that’s an administrative problem that can easily be solved by the winter, the administrator said.

“I told the coronavirus chief, Nachman Ash, that with the capacity that the hospitals have today, there’s no need to call a third lockdown, even in the winter,” the administrator said “The government needs to learn to manage the rapid rise in infections and prevent it from reaching a level of thousands of sick all at once. But that can be done gently, with local lockdowns and through social distancing.” A key statistic that informed the debate over the need for a second lockdown, and which remains the main one in regard to a possible third, is the rate of infection. The R number, which signals whether the coronavirus is spreading, has risen to above 1 for the first time since the second lockdown began, and with it the number of daily new cases has again risen to 900. That has set off alarm bells in the Health Ministry, which is today opposed to any further easing of the lockdown rules that remain in force.

A coronavirus ward in Shaare Zedek Medical Center, Jerusalem, 16 November, 2020.Credit: Ohad Zwigenberg

In consultation with the Health Ministry, the National Security Council is moving ahead with a plan for continuous lockdowns – once every few weeks, the economy would take a break to contain the pandemic. The background to the proposal is the assumption that Israel is again risking a hasty exit from a lockdown doomed for failure. The only solution is lockdown or nothing.

But note one surprising thing: The rapid rise of the R number began at a very early stage, with the initial opening of the closure, when the 1,000-meter limit on people leaving their homes was canceled, gatherings of up to 10 people were again permitted and nursery schools and businesses that weren’t open to the public were allowed to open. This small increase in social contact, even before the schools were reopened, was enough to raise the R number.

Why? Health experts don’t know. They can only guess. One explanation, which both supporters of herd immunity and of lockdown agree, is that there is no way of stopping the pandemic except by confining people to their homes. Any increase in human contact, even the slightest, increases the R number.

On that basis, lockdown advocates say everything must be done to stop the spread, no matter what the cost. Qimron and his supporters reach the exact opposite conclusion: Since we can’t stop an infection that spreads by air, there’s no reason to even try. Let the virus spread while ensuring that the most vulnerable parts of the population are protected.

Some public health experts contend that the increase in the number of new confirmed cases in recent weeks is good news – it shows that there are more asymptomatic carriers and that our ability to break the contagion chain is improving.

They argue that there are only two ways to fight the coronavirus – either to reduce the infection rate to zero by lockdowns, or to leave the economy open on condition that widespread testing is conducted to identify asymptomatic carriers and break the chain of contagion in real time.

“If there were 100,000 tests a day, we would never need a lockdown,” says one of the advocates of this approach.

In Israel’s case, identifying the infected is critical because our population is relatively young. That is both an advantage and a disadvantage.

The advantage is that we are suffering fewer deaths because the vulnerable elderly population is relatively small. The disadvantage is that we lack an efficient way of reining in the pandemic because we have such a large number of asymptomatic young people who are out in public a lot and spread the virus. The Haredi and Arab populations have the added problem of living in crowded conditions. The result is that COVID-19 spreads faster here than in many other countries.

The reopening of shops in Kiryat Ekron following the lifting of coronavirus restrictions, November 17, 2020.Credit: Moti Milrod

What is the answer? It depends on whom you ask. At the Health Ministry, the Pavlovian response has been to prevent a complete reopening of the economy and to plan for another lockdown.

With the departure of coronavirus chief Prof. Ronni Gamzu and the imminent departure of Prof. Itamar Grotto as Health Ministry deputy director general, there are no voices left opposing further lockdowns. The mood at the ministry is conservative and risk-averse. In any case, lockdown advocates seem to include Prime Minister Benjamin Netanyahu. That means that the risk of further lockdown has risen considerably.

Against that, other leading health experts are saying that now is the time to make hard, complicated decisions. Israel by its nature is going to have high R numbers and it seems that every time we reopen the economy it rises again. Assuming we don’t want to remain prisoners in our own homes until a vaccine arrives – in the spring at the earliest, it appears – we need to manage the contagion, to reopen the economy gradually and conduct as many tests as possible. And, more than anything else, not get overly exercised over a rise in the R number. It’s not the end of the world.

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