Analysis |

Israel's Lockdown Calculus: Saving as Few as 500 Lives Will Cost $8 Billion

That’s the price the coronavirus cabinet agreed to pay by imposing a third lockdown

Meirav Arlosoroff
Meirav Arlosoroff
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The Jaffa flea market during the second coronavirus lockdown.
The Jaffa flea market during the second coronavirus lockdown, Oct. 5, 2020.Credit: Ofer Vaknin
Meirav Arlosoroff
Meirav Arlosoroff

Here’s a question no one is asking: Why is Israel going into a third lockdown?

At the start of the pandemic, the Health Ministry claimed that a lockdown was needed to flatten the curve, prevent a flood of coronavirus patients into the hospitals and to stop the health-care system from collapsing. This time, no one is saying that this is the goal.

Israel has imposed two lockdowns without the hospitals coming anywhere close to collapse. This time, too, the number of serious COVID-19 cases is about 500, compared with a nationwide capacity to treat about 2,000. Israeli hospitals have managed with the curve; there’s no reason to put the entire country into a lockdown to flatten it.

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Instead, the undeclared goal of the third lockdown is to prevent excess mortality. The Health Ministry fears that this figure could run into the thousands if the new surge in infections isn’t stopped.

But it’s problematic to switch goals without launching a public debate and weighing the alternatives. What price is the public willing to pay to reduce death rates?

Israel does this all the time: Every year, the government committee deciding which medicines and services will go into the so-called health basket conducts the same kind of examination, asking how much the state will spend on products that will save the lives of certain people. The coronavirus deserves no less a transparent discussion.

At least until recently, there wasn’t much controversy. The prevailing view before the second lockdown was that a much higher mortality rate would seriously damage the economy by creating panic. Preventing the rate from rising had both health and economic benefits.

But that’s no longer true. Today, it’s clear that the Israeli economy is no longer at risk of collapse, because of the rapid rollout of the coronavirus vaccine. Soon, a decent chunk of the population will be inoculated and contagion rates will be limited.

That should be a consideration imposing a third lockdown, shouldn’t it?

The coronavirus cabinet knows this because this case was presented to it. Prof. Eran Segal of the Weizmann Institute provided the ministers with estimates on the number of confirmed carriers, seriously ill patients and deaths with or without a lockdown if the number of vaccinations reached 100,000 a day (a rate Israel is expected to achieve shortly).

Five scenarios

Progress with the vaccines is vital because of their double impact. First, when the most vulnerable groups are vaccinated, rates of severe illness and mortality are halted even if the infection in the general population continues. Second, it’s assumed that the inoculations will make the vaccinated less contagious, thus slowing the infection rate (the R number, the number of people each patient infects) for everyone else.

That assumption, by the way, is highly plausible but only partly based on studies. (Moderna did one but Pfizer didn’t, according to Segal.)

In the meantime, Segal has provided five coronavirus scenarios – one in a general lockdown and four without, with different progressions of the R number. And the result shows not a great difference between the scenarios (not counting the most extreme and least likely one in which contagion rates continue unchanged).

In a general lockdown, Israel would reach 6,000 confirmed daily cases by the middle of January, with a peak of 900 serious cases and about 1,100 deaths by the end of March. However, if there is no lockdown but Israel got the contagion rate under control, the R number wouldn’t exceed 1.2 to 1.3, compared with 1.15 to 1.25 right now. The coronavirus numbers wouldn’t be very different from a lockdown level.

Segal found that in a more probable scenario with an R number of 1.2, the number of confirmed cases would reach 8,000 a day, the seriously ill would peak at 900 and deaths would reach 1,600, some 500 more than under a lockdown.

All these estimates assume that the coronavirus would continue to spread because there would be no lockdown. But, with the most at-risk groups being vaccinated, the numbers for severe cases and deaths would be greatly curbed.

In a scenario in which the R number reached 1.3, confirmed daily cases would soar to 17,000 but the number of severe cases wouldn’t exceed 1,700 (within the maximum that Israeli hospitals can handle). Meanwhile, the number of deaths would reach as high as 2,500 by the end of March, or 1,400 more than in a lockdown.

In the most extreme scenario, which assumes that even the vaccinated are contagious, the numbers get a lot worse – 22,000 cases a day, 2,400 serious cases (exceeding the hospitals’ capacity) and 2,700 deaths. But that’s the only one of the four non-lockdown scenarios that ends so badly.

A question of values

What all this means is that at the cost of at least 10 billion shekels ($8.1 billion) for a three-week lockdown, Israel will be saving 500 lives in the most probable scenario and 1,400 in the most extreme one. Is it worth the price?

That’s a lot more of a question of values than of economics, but it has to be asked. We can’t ignore the claim that human life can’t be measured in money terms, but the fact is, that’s what the health basket committee does. If someone proposed to the committee to spend 10 billion shekels to save the lives of 1,400 people, the committee wouldn’t hesitate for a moment in rejecting the idea.

The opening meeting of the health basket committee, which decided which new medications and technologies would be covered by the public health system in 2020, Sept. 1, 2019.Credit: Emil Salman

To this, we have to consider that unlike the dilemma facing the health basket committee, with coronavirus deaths we’re talking about very old people with very few years left under any circumstances. That also has to be considered in the debate.

The fact is, every decision to improve a dangerous intersection on the roads, aid welfare organizations or provide nursing care for the elderly (an area where Israel has lagged) means the saving of lives. But Israel has always been stingy about this.

The figures on lives lost were presented to the coronavirus cabinet, but they didn’t influence the final decision to impose another lockdown. Like robots, the ministers went for the closure even though conditions are different from the previous two times.

Why? One reason is that the government can’t undertake more limited policies to control the contagion; it’s left with the binary choice of all or nothing. It’s the accordion policy that Prime Minister Benjamin Netanyahu has spoken about.

The other reason is political. Forgoing a lockdown may not lead to many more seriously ill and dead patients, but it will increase infection rates. Netanyahu doesn’t want elevated rates when Election Day arrives in March. In other words, a lockdown isn’t better for the economy or our health, but it’s good for the prime minister.

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