Analysis |

Doctors Did Their Best, but Politicians Led Israel Straight Into a Lose-lose COVID Crisis

Israeli leadership mismanaged the COVID pandemic, while the health care system and demographics saved the population

Meirav Arlosoroff
Meirav Arlosoroff
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Doctor Guy Choshen, director of the COVID-19 ward in Ichilov Hospital.
Doctor Guy Choshen, director of the COVID-19 ward in Ichilov Hospital.Credit: RONEN ZVULUN/ REUTERS
Meirav Arlosoroff
Meirav Arlosoroff

The news last week that the United States had suffered 500,000 coronavirus deaths was accompanied by commentary noting that the toll was higher than the combined American death toll from World War II, the Korean War and the Vietnam War. That was a dramatic comparison but an unfounded one: Every year more people die of natural causes than in war. It would be fairer to compare the COVID toll to deaths from natural causes.

There’s no comparison between the 5,700 Israelis who have died from the coronavirus thus far and the 2,700 soldiers killed in the Yom Kippur War. The Yom Kippur dead were mostly young people, making their mortality rate many times higher than for their age group than in normal times.

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By comparison, the 5,700 who have died as a result of COVID-19 should be measured against Israel’s ordinary annual mortality rate. That figure for 2020 was 48,688, as compared to 45,980 for 2019. That amounts to a 5.9-percent increase.

An assessment of the mortality rate should be compared to the most dire forecasts when the pandemic first broke out that the coronavirus death may reach as high as 100,000. In addition, you have to remember that mortality rates from other medical causes, such as flu and respiratory disease fell in 2020, apparently due to the lockdowns, masking and social distancing.

Except that this is a rough calculation. Every year, the Israeli population grows by 1.9 percent, which partly offsets the mortality rate, as does the improvement in health overall of the general population. As a result, Israel’s mortality rate has been declining by 2.3 to 3.5 percent annually. In the first three months of 2020, before the spread of COVID, Israel’s mortality rate had been the lowest ever.

Prof. Alex Weinreb, research director at the Taub Center for Social Policy Studies says that when you take into account all of these factors, the excess mortality rate was 10 to 11 percent. In terms of life expectancy, this translates into a two-month drop for life expectancy. In the U.S., life expectancy fell by 1.3 years.

In fact, the peak of the COVID pandemic occurred in Israel not in 2020 but in January and February 2021. In January alone, 5,378 people died in Israel of all causes, a 17-percent increase over a year earlier. There are no data yet for February, but Weinreb estimates that for the 12 months between March 2020 and February 2021, excess mortality reached 16 percent and life expectancy fell by 3.8 months.

Even that is a moderate toll, relatively speaking. The fact that Israel has weathered the coronavirus (so far at least) so well is due to several reasons.

One is the mysterious drop in infant mortality: Last year 420 infants died, down from 540 a year earlier, an almost 25-percent decrease. How did this happen? One theory is that there was a decline in respiratory disease. Another is that since babies were at home with their parents, they were less at risk of fatal accidents.

In any case, the demographer Ari Paltiel calculated that the additional 120 babies who survived 2020 is equivalent to saving 10,000 years of human life or, put another way, equal to the deaths of 585 people aged 70 or over.

The dramatic decline in infant mortality, and for that matter in all childhood deaths (occupancy rates at children’s wards in Israeli hospitals in January were the lowest in three years and child mortality dropped 23 percent in 2020), helped offset the impact of coronavirus deaths.

However, the main factor behind Israel’s COVID success was its age structure. Israel is a young country, and the coronavirus is a disease that mainly affected the elderly. Weinreb investigated this demographic shield by examining the rates of morbidity and mortality by age in Israel and internationally. He found that if those two rates had been evenly distributed by age, Israel’s mortality rate would have been 32 percent higher. Disaster was averted because Israel was so successful in protecting its vulnerable elders.

Netanyahu at a press conference at Tel Hashomer hospital last month. Credit: Amos Ben Gershom/GPO

By other measurea, however, Israel scored a massive failure. If Israel’s age structure had been similar to that of other countries belonging to the Organization for Economic Cooperation and Development our mortality rate would have been double what it was. Instead of 3,362 deaths by the end of December 2020, the number would have been 6,766. Without the natural defense of having a young population, that would have been COVID’s toll for the year.

The actual number put Israel in 25th place in per capita COVID deaths, similar to Sweden’s. Prime Minister Benjamin Netanyahu’s boast that Israel has been a global success story in handling the pandemic is unfounded. Quite to the contrary, we are No. 9 in per capita cases.

The reason is that the government failed to prevent the spread of the virus. The fact that we didn’t reach No. 9 in per capita deaths is due to our success in protecting the elderly from the spread of the virus and the health care system’s success in withstanding the burden of high numbers of handling the highcase load. These numbers show that we have one of the most efficient health care systems in the world.

Weinreb compared mortality rates of coronavirus patients and found that Israel’s was one of the world’s lowest. Only South Korea can boast the same rate of success in preventing COVID deaths. If the Israeli rate were the same as the world average, life expectancy would have fallen five months, instead of 2.2 months. Again, the credit goes to the health care system, which fought to save every single life.

That the coronavirus was a difficult event, but not a catastrophic one, is due to Israel’s excellent health care system and its young population. On the other hand, Israel’s politicians caused us considerable damage. Management of the crisis was a complete failure and the proof of that is the high rate of spread of the disease.

The debate over whether we should have gone through three lockdowns for the sake of saving 10,000 lives turned out to be meaningless. The government imposed three lockdowns, more than almost any other country, but failed to use these restrictions to effective use by reining in contagion rates. In the end, it was a lose-lose for Israel: We paid the price in lost economic output and increased social distress and got back nothing in return.

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