This past week, Illinois’ largest university, the University of Illinois at Urbana-Champaign, reported 780 new COVID-19 cases on its downstate campus following the start of classes on August 24th.
The bad news followed the recommendation of two University of Illinois physicists who advocated for opening the university. They had stated their models demonstrated that active cases at any one time would remain below 100, a figure they described as the "worst-case scenario."
So how could it be that in less than a week, the cases were seven times what the physicists predicted? For one, epidemiological models are tough, and the continual emergence of new information makes accurate prediction even tougher.
But allow me to provide another explanation: Two men who had no public health or epidemiologic expertise decided they were adequately suited to dictate the public health response to COVID-19 and shape university and state policy accordingly.
Similarly, this week – as Israel hits a daily record of new infections – dozens of Israeli physicians and scientists signed an open letter calling on Prime Minister Benjamin Netanyahu’s coalition cabinet to not impose a new countrywide lockdown and to remove social distancing measures (Israeli Physicians, Scientists Warn Against Lockdown, Call to Adopt Swedish Model).
There were few epidemiologists and other public health researchers on the letter. Of those that were, their names were smudged between those of agriculture specialists and ophthalmologists. I have no doubt that the authors of this letter are brilliant in their fields and have contributed immensely to the academy. But the sheer number of glaring errors in this letter is as shocking as it is misleading.
Because public health research has long been considered inferior within the biomedical community, it is not terribly surprising that some physicians and scientists feel poised to comment on public health policy without any training in the area. But letters like this make clear why they should resist their temptation. Much of the letter runs counter to the overwhelming consensus of public health scientists, including leading experts at the World Health Organization and Israel’s own government officials.
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The authors somehow manage to argue that the very measures shown to be most effective for public health do not prevent mortality and, on the contrary, prolong the length of time that at-risk populations are exposed to the virus.
A study in Nature found that across 11 countries, over three million deaths have been averted due to lockdowns, school closures, and social distancing measures since the start of the pandemic. Furthermore, existing evidence finds that loosening restrictions too quickly can increase mortality for at-risk populations as well as spawn a new wave of infections. In fact, part of the reason Israel went from an exemplar in its response to the pandemic to a visible failure has to do with the fact that restrictions were lifted too quickly.
Contrary to what the authors argue, the health risks of COVID-19 are not minimal. While it is true that people with fewer comorbidities have a lower risk of death, healthy people are dying, and others are getting sick and experiencing long term health issues, some of which the scientific community is only starting to identify.
The authors make the claim that because four cases of infection from an unknown source were discovered in New Zealand, that New Zealand’s vigorous COVID-19 response is ineffective. The authors clearly want the reader to assume that intense public health measures won’t work since there were these four cases. Let me remind the authors that this week Israel is seeing almost 3,400 cases a day – and rising.
The authors then go on to their larger political push: They want Israel to take up the Swedish model, stating that they want a policy that leads to the removal of social distance limits, allowing for continued exposure of non-at-risk populations, which they claim will lead to herd immunity.
This is a mischaracterization of what the Swedish model entails, as Sweden still maintains several social distancing measures, some even more stringent than Israel’s. Even so, Sweden has much higher COVID-19 mortality rates than neighboring countries, and it has not reached herd immunity. Nor has any country in the world.
Similar to the strategy put forth in the Israeli scientists’ letter, the United Kingdom initially sought to allow a large percentage of the healthy population to get COVID-19 in an attempt to build herd immunity. They changed course after an Imperial College report predicted dire consequences of tens of thousands of deaths and an overwhelmed health system, if the country’s strategy did not change immediately. Israel’s government hasn’t even consciously chosen to follow the herd immunity strategy, yet the health system in parts of the country is set on a disastrous path.
The authors then casually intimate that Israelis would see even better results than the Swedes if they took up the Swedish model, and suggested this is in part because Israelis may have higher cellular immunity.
Of course, this begs the question: What research do they have to make such a baseless claim that the Israeli genetic makeup is potentially superior in combatting this virus to that of the Swedes? Again, they don’t cite any evidence, but we should be extremely cautious – as history has shown us – of any claims about the genetics of a Jewish-majority country.
The key indicators we actually can compare across Israel and Sweden are household size, trust in government, and social behavior, and all of these are markedly different between the two countries. Trying to apply Swedish’s model to Israel requires considerable guesswork.
Thankfully, a new petition attacks many of the unsubstantiated claims made in the letter and denounces initiatives for Israel to take up the Swedish model. The petition also makes clear that public health and economic prosperity go together. They note that calls to open the economy while infection rates continue to rise are misleading, since countries that tried to open up the economy before managing the virus ultimately harmed both the economy and health of the country.
The original letter recklessly presents itself as authoritative but is riddled with errors throughout, conflating conjecture and opinion for scientific evidence. Even more concerning, this letter will surely be co-opted and used against any future public health intervention that the Ministry of Health issues.
Ultimately, the authors of the letter present a false dichotomy: let everyone get infected, or have an indefinite national lockdown. Neither is necessary.
Instead, Israel should commit itself to strong public health interventions with mandated social distancing policies and safeguards for the elderly and other high-risk populations. It should target areas where cases have skyrocketed and secure that adequate public health infrastructure and testing is in place within these areas. Wishing this pandemic away is not going to work. Neither will presenting deceptive or fallacious information.
Israel has the highest rate in the world of new coronavirus infections per capita. It's time to get serious.
Joseph Bruch is a Ph.D. candidate in Population Health Sciences at Harvard University. He studies social epidemiology and his research focuses on the effects of financial systems and policies on population health. Twitter: @Joe_Bruch