January ended with a lot of unprecedented numbers, most notably that 1.5 million Israelis were diagnosed with the coronavirus over the month. That’s more than double the number diagnosed from the outbreak of the pandemic in 2020 until the beginning of 2022. The number of tests performed and rate of positive results also soared, but January 2022 was about more than statistics.
It demonstrated the evolution of the pandemic and provides a lesson in risk management at a time of uncertainty. The omicron variant scrambled the deck for the decision-makers and the public, but it also showed the fragility of old paradigms and created new ones.
In the omicron wave, unlike its predecessors, relating to a particular statistic and trying to extrapolate the bigger picture from it is like a group of blind people, each of whom is feeling a different part of an elephant. What would 70,000 new cases of infection per day mean? In January 2021, it would have spelled thousands of deaths and serious cases.
In the current wave, however, things are different – due to the characteristics of the virus, how it is diagnosed, ongoing monitoring, the level of immunity (due to vaccines and those who have recovered from COVID) and available drug treatment. The country’s leadership has also changed. This has altered how decisions are made and the balance of power between the professionals and the politicians making the decisions. The public has also changed after two difficult years of a pandemic in addition to new developments on the political and security fronts.
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The changes made room for a real debate about the price of living with the coronavirus, particularly the emotional harm it has inflicted on children and what it has done to economic activity. But the policy of living with the virus that the government declared would have probably looked entirely different if the rate of serious cases and deaths among those diagnosed with COVID had been the same, or close to, what was experienced with the delta variant.
Hovering over the situation is the uncertainty regarding possible long-term health effects, a sudden spike in serious cases or deaths and delays in decision-making on the pandemic. Risk management in situations of uncertainty is sometimes based on inferior or very preliminary assumptions coming from abroad, and always involves an element of risk. In such circumstances, any current decision can become a future double-edged sword.
The present situation is a lot more complex and segmented than what the country faced in previous waves. One need only take a look at the Health Ministry’s dashboard – the detailed statistical presentation about the pandemic on the ministry website – to understand this. In addition to the general picture, more and more metrics have been added, including the ministry’s internal reporting on nine separate groups with regard to their vaccination history alone – from not vaccinated to recovered and vaccinated to those having received a second booster shot.
So how are decision-makers to fashion policy that will provide reasonable protection to each group while curbing the pandemic and maintaining routine? And at what price? This is just one example of the dilemmas presented by the current fifth wave.
In January the number of cases shot up in an unprecedented fashion. On January 23 alone, there were 85,146 new cases diagnosed in Israel – more than seven times the daily record before the current wave. And it is thought that the actual number – including unreported cases – is at least double.
The sharp increase in cases is discouraging, but its effects and how it is being addressed are different from earlier waves. In most cases those infected with the omicron variant have mild symptoms or none at all, so current policy has focused on isolating patients and not those around them. But in a situation in which half a million Israelis a week are being infected and placed in isolation, the effects are being felt in the economy, the country’s schools and the health care system.
The data on seriously ill patients are among the most sensitive and controversial gauges of the current wave. In previous waves, it was what dictated government policy, due to concern that the health care system would be overwhelmed. In the current wave, it presents a new and deceptive reality.
As a proportion of all the diagnosed cases, serious cases are much smaller than in prior waves, because the omicron variant generally causes less severe symptoms and because of the public's level of immunity, including at-risk groups. Hospitals are also reporting that even among those seriously ill, the disease is generally presenting itself in a less severe form. But even those infected with omicron can find themselves in critical condition, and the number of deaths from the variant is on the rise.
Another prominent phenomenon in the current wave is the shortage of medical staff due to COVID infections and staff burnout after two years of dealing with the pandemic. The shortage of personnel naturally impacts the system's capacity to deal with the increase in serious cases at a time when it is expected that the country’s hospitals will be seeing increased numbers of patients.
The increased use of rapid antigen testing has also altered testing policies. Until now, Israel had been relying on its widespread PCR testing network which involves swabs administered by professionals, transportation of the samples, laboratory testing, recording, documentation and the transmittal of the test results. PCR test results are more sensitive than antigen tests and provide a real-time tool from which a picture of the situation can be gleaned. But with the pace at which the virus is spreading in the current wave, reliance on PCR testing alone becomes difficult or impossible. January, then, saw a shift toward at-home testing.
Nevertheless, on certain days, more than 400,000 PCR and antigen tests were administered by medical service providers and the positive rate approached 30 percent – a figure that would previously have been unimaginable. And the data don’t include the large number of home tests that have become part of the routine around the country.
In the fourth delta-dominated wave a clear difference between patients who had been vaccinated and those who had not could be seen in hospitals. In the current wave the distinction is not as clear-cut, but the rate of unvaccinated patients among those in the hospital remains very high.
The vaccine is effective in preventing serious illness in the omicron wave, but its effectiveness is less than it was in the prior delta wave. Even those who have been vaccinated are at greater risk of becoming seriously ill, and the more time that has elapsed since the patient’s last dose the more the risk increases.
Those 60 and over who have been vaccinated constitute about a quarter of the infected, with the most important reason being that the vaccine provides limited protection against infection. But the infection stage represents only one level of protection that the vaccine affords.
The omicron variant has proved better at evading that protection. It is therefore not surprising that there are large numbers of vaccinated patients infected by the new variant – as well as patients who have recovered from other variants. But the vaccine provides a second layer of protection that those who have not been vaccinated lack by enabling the immune system to work more effectively in fighting the virus and its effects on the body, so that generally vaccinated patients do not get as sick.