Health Ministry officials and external experts are debating whether the coronavirus pandemic should be treated as just one more disease that does not impact daily life, after most of the population has been vaccinated and deaths from the virus have decreased over the past months.
Last month’s surging numbers COVID-19 cases emerged in an Israel that was different from the one that existed during the first three waves of the pandemic. By December, a majority of the most vulnerable population vaccinated.
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However, Israel has recently seen a renewed spread of infections and a gradual reinstatement of restrictions as the delta variant proliferates across the country.
Preventive measures against the virus are determined based on the number of serious cases and the burden it places on hospitals, as well as on mortality rates.
Today's COVID-19 is no less serious or less common than the disease that hit Israel and the world in the first months of 2020, disrupting economic activity around the globe. But when Pfizer, the developer of the vaccine most commonly used in Israel, declares that it is 93 percent effective in preventing serious illness, even against the more infectious delta variant which has become the dominant one in Israel, increasingly there are voices calling for an end to the ever-changing policy of restrictions.
Prof. Eran Segal of the Weizmann Institute, a member of panels advising the Health Ministry, says that “Israel is facing a decision of whether to continue addressing the disease based on older indices, mainly the contagion factor.” Segal, whose models for predicting the course of the pandemic succeeded in approximately predicting the second wave and the success of the vaccination drive, says that “it’s time to recalculate our course with regard to COVID-19. The present approach has economic costs, creating uncertainty. We have to ask ourselves: how long will this last, will our lives will remain this way indefinitely, and what must happen so that this reality changes.”
The delta variant of the virus, which originated in India, is more than twice as contagious as the initial strain that was first identified in Wuhan, and one and a half times more contagious than the alpha strain that emerged in the United Kingdom. Nevertheless, there are no indications that it leads to a more serious or fatal disease. Figures collected over the last few weeks in the U.K., which preceded Israel by a month in the renewed wave of infections, show that the high incidence of vaccination greatly reduces the numbers of seriously ill patients, thus preventing a collapse of the medical system.
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The impact of the new wave is still being examined. Out of the country's 3,800 active COVID-19 cases, the number of seriously ill people is 40, a number that doubled last week. The rate of positive tests is 0.7 percent, after weeks in which it was virtually zero. The coming weeks will provide a more reliable picture, answering whether the U.K., which still has more stringent restrictions than Israel does, and with the dominant vaccine not coming from Pfizer, has managed to bring about a long-term halt of the disease.
The Health Ministry estimates that the proportion of Israelis with immunity is 65 percent immunity in Israel, with some 55 percent being vaccinated and 10 percent having recovered. Among vulnerable populations, there is an estimated 90-percent rate of immunity. The vast majority of unvaccinated people are children and adults younger than 50. Before the spread of the delta variant, medical personnel in Israel estimated that the country had reached an effective immunity threshold akin to herd immunity, although this term is not being used officially. So far, 6,430 people in Israel have died of COVID-19, out of 840,000 people infected and thousands of seriously ill patients who required ventilators.
Closures and social distancing had economic repercussions last year, as well as social and mental ones. Assuming that the coming weeks do not bring a spike in serious illness, senior health officials will have to determine whether Israel is still in an emergency health crisis, or whether the information and experience that have accumulated will allow us to abandon masks and mass quarantine, which until March 2020 were never instated in Israel.
Dr. Lion Poles, a member of the department responsible for dealing with epidemics at the Health Ministry, says that the disparity appearing in the U.K. and Israel between the larger numbers of people infected and the small numbers of seriously ill patients support a future change of policy regarding the virus. He does have reservations, however, regarding comparisons with other viral diseases: “There are differences in comparison to flu, which is a seasonal disease, that is usually light even among non-immunized people,” explains Poles. “The coronavirus is, so far, unrelated to seasons of the year. There is uncertainty regarding the varying virulence of the virus, as well as the duration for which the vaccine is effective and when a booster may be required. We must try to get to that point, but until we’re more certain and better immunized, we cannot move to ‘living with the virus.’”
Prof. Hagai Levine, until recently the chairman of the Israel Association of Public Health Physicians, also rejects the use of the flu as a basis for determining the treatment of the pandemic. “Corona is corona and flu is flu,” he says. “There are similarities, but also many differences. We’re still in the midst of a pandemic. It should be the opposite, with flu treated more seriously. It’s not a light disease and its seasonal outbreak kills many people, here and overseas. There is always a risk that it, too, will become a pandemic.”
Prof. Ran Balicer, the head of research and innovation at the Clalit health maintenance organization and the head of an advisory panel to the Health Ministry, defines the relegation of the coronavirus to the same status as flu a “long-term prospect.” “The question is when we’ll have enough information to take such a decision without dire consequences," he says. "We wanted to avoid a situation in which restrictions are imposed after taking a hit, with the public refusing to comply.”
Balicer notes the British government’s decision to reduce restrictions to a minimum next week, subject to a final decision. This includes ending social distancing requirements, orders to work from home, and the mandate to wear masks everywhere. Balicer hopes that “in a few weeks we’ll be able to make informed, data-based decisions, with small margins of error. Right now, changing approaches would be a wild gamble, more than in Britain, which has an extra month of experience and data.”
Prof. Gili Regev, the director of the Infection Prevention and Control Unit at the Sheba Medical Center, believes that changes can already be discussed using the available data. “I’m certain we’ll start treating corona in terms that are closer to the flu, but I’m not convinced that now is the time," she says.
Regev opposes a policy of isolation for people exposed to infected people, a policy that is currently an important element in severing chains of infection, along with other measures such as monitoring sewage. There are currently 50,000 people in isolation, compared to 250,000 at the peak of the pandemic. “It’s time for rapid tests to be available in pharmacies,” she adds.
Prof. Dror Mevorach, who headed the coronavirus ward at Hadassah University Hospital in Ein Karem, calls for limiting quarantine and reducing the mandatory length of quarantine, as well as improving testing at Ben-Gurion International Airport. “It’s hard to completely dispense with isolation, since the contagion potential of the delta variant is very high,” he says.
The health system isn’t rushing to openly declare a change in approach, but there is a change in the mindset of some experts. New Health Minister Nitzan Horowitz supports an easier approach meant to avoid strict preventive measures, as does Prime Minister Naftali Bennett. During former Prime Minister Benjamin Netanyahu's term, Bennett called for avoiding closures, suggesting using other tactics in combating the virus. So far, the coronavirus cabinet has avoided imposing new restrictions, only restricting entry and exit requirements at the airport.
Other senior officials warn that treating COVID-19 like the flu by ignoring the number of cases and considering only seriously ill patients could ultimately lead to a lockdown. Dr. Sharon Alroy-Preis, head of public health services at the Health Ministry, said on Channel 11 last week that in a situation with thousands of daily infections and many people in serious condition, other measures at the ministry’s disposal would be irrelevant.
Whereas the number of seriously ill patients is considered crucial in terms of tracking the virus, there are other indices worthy of attention, say experts. One is the number of children with COVID-19. Only those aged 12 and up can be vaccinated at this point, with vaccinations for younger ages still unapproved. Most children have lighter symptoms than adults, with longer-term effects still unknown.
Recovering patients, even those who had light symptoms, report prolonged effects on their respiratory systems and on daily functioning, with reports of chronic fatigue, headaches, concentration and memory difficulties, as well as mental trauma. One expert says that science and medicine can only provide partial answers. The rest is a question of values, with advantages and disadvantage remaining unknown factors. “This is a much scarier and more dangerous disease than flu," he says. "Allowing the disease to spread is a horrible idea.”