There are three main elements to a successful strategy to exit the lockdown forced on us by the coronavirus. First is ongoing, systematic monitoring in a variety of ways, including testing for antibodies (serology). This should be the basis for decision making, and once decisions are made, their impact on infection rates and public behavior must be assessed.
Second, the public health strategy must be adjusted based on risk levels in different areas, while also taking high-risk groups into account. And of course, success also requires adjusting expectations and keeping the public informed of the plans, to preserve its trust.
Achieving this requires correct use of the public health system, which is the expert in monitoring, evaluation and implementing public health policies based on scientific evidence and data.
A strategy is also needed for exiting the economic crisis, which is no less critical than the health crisis, since it also has a dramatic impact on public heath, illness and death rates. Here too the expertise of public health workers is required, as well as that of professionals from other fields, to ensure proper solutions for those in need.
Finally, a question no less important than how to exit is, where to? The answer to “which road should I take from here?” depends largely on where you want to go.
Accumulated experience with previous pandemics and economic crises shows that the health impact is tangible long after the crisis is supposedly over. There’s a rise in complications from chronic illnesses and diseases of “despair,” a rise in the number of deaths due to use of alcohol, drugs and tobacco, and a rise in suicides and mental illness.
But a crisis is also an opportunity. This crisis is an opportunity to strengthen the public health system, in Israel and worldwide. And it must not be wasted.
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Much has and will be written about the neglect of hospitals in Israel and its effect on health both in normal times and in emergencies. But too little has been written and said about a no less serious problem – the neglect of Israel’s disease-prevention system. This ongoing neglect, even now, during the coronavirus pandemic, stems from outrageous stupidity.
The public health system – including headquarters staff, local offices, laboratories, the Israel Center for Disease Control and schools of public health – is responsible for promoting health and preventing illness, during normal days and emergencies alike. Public health workers stand alongside hospitals on the front lines of coping with pandemics.
A recent state comptroller’s report said that when it comes to preparedness for epidemics, every dollar invested in prevention saves $16 later. Nevertheless, the public health system and preventive medicine are at the bottom of Israel’s list of priorities, even today. This situation must change.
In Canada, in contrast, lessons were learned from the SARS outbreak in 2003, and the country undertook fundamental reforms to bolster the public health system. When the coronavirus pandemic ends, and even while it’s still raging, Israel, too, must learn the right lessons.
Israel’s public health system has no standards at all, and all the data shows that the manpower shortage in public health services is costing us, both in money and health. The current pandemic proves that the public health system is no less vital a part of our national infrastructure than the security establishment’s elite units.
So perhaps now we can hope that the government will decide to plan for how we exit from here toward a healthier Israel. We can hope that when it rebuilds Israel’s society and economy, it will be wise enough to seize the opportunity to give public health the place it deserves, in normal times and emergencies alike. We can hope that public health and sustainability will be taken into account in every decision that’s made, and that there will be a long-term plan – or in other words, proper preparation both for the climate crisis and narrowing the gaps in health services.
Hagai Levine is chairman of the Israeli Association of Public Health Physicians and a professor of epidemiology at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine.