These are Israel’s options for avoiding another major COVID surge

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Coronavirus infection rates in the country continue to soar. As of Wednesday evening, 236 people were hospitalized with severe cases of COVID-19, with 58 of them in critical condition and 49 on respirators. On Tuesday 3,280 people tested positive for the coronavirus, with 3.34 percent testing positive.

In light of these worrisome numbers and despite Israel’s high vaccination rate and a new campaign to give booster shots to immunized people over 60, drastic measures, including another lockdown, are back on the table.

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Public health experts are in broad agreement that vaccinations alone cannot stop the spread of the pandemic. “No matter what we do, within a few weeks we’ll have 1,000 severely ill patients,” said Prof. Eli Waxman of the Weizmann Institute of Science, a participant in the discussions of the coronavirus cabinet.

According to one scenario presented to the forum Tuesday by Weizmann’s Prof. Eran Segal, if measures to slow the infection rate are not taken, by the end of the month there will be a daily average of about 170 severely ill patients in Israel’s hospitals – similar to the numbers seen in Israel’s third wave of infections.

Several new measures have been introduced or are in the works. In addition to the launch of the booster vaccine campaign this week, limitations on incoming and outgoing passenger traffic through Ben-Gurion International Airport and Green Pass restrictions have been tightened.

Concert goes in Tel AvivTomer Appelbaum

The approaches supported by experts fall into three general categories, ranging from “wait and see” all the way to a full lockdown as soon as possible.

Mass infection

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The most lenient approach holds that there’s no reason to rush into harsh restrictions because Israel’s hospitals can handle the relatively low number of severely ill COVID-19 patients, and booster shots are likely to help keep that number in check. Supporters of this approach point to the decline in COVID-19 cases in Britain after the removal of restrictions, possibly due to a combination of a high vaccination rate and the herd immunity caused by mass infections.

“The de facto implication of the coronavirus cabinet resolutions is that Israel is choosing mass infection,” Segal said. “Will it work? We don’t know. There is no certainty that we will have a decline like that of Britain. We can’t rely on that.”

Projections Segal showed the coronavirus cabinet on Tuesday predicted that by the end of the month, Israel’s hospitals will be near the breaking point and that the booster shot will only reduce the number of severely ill COVID-19 patients rather than the total number of people sick with the disease.

Medical staffer monitors COVID ward in JerusalemOhad Zwigenberg

“We don’t know what giving a third shot to over-60s will do,” he said, adding that it might cut the number of severely ill patients in half and slightly reduce the total number of patients who end up being hospitalized with the virus. He said that tightening restrictions on public gatherings will slow the spread of infection slightly, at best.

Waxman said Israel cannot rely on the British experience to decide policy: “We’re in an uncertain situation in which all kinds of things could occur. When you talk about risk management, you need to ask yourself if you’ve planned for scenarios that cannot be ruled out with high probability. A lot of people don’t understand this, including those in the government. People say, ‘Let’s see what happens in Britain.’ But no one really understands what’s happening in Britain and whether it is relevant to what’s happening in Israel. If we wait for things to develop in a negative direction, we’ll crash.”

Containment measures

Another approach talks about fast and effective measures to contain the rising morbidity rate, or at least to delay the time when Israel has to go into lockdown. That strategy has been heard more often in recent weeks, with the rising number of cases. Advocates say the government has done too little, too late.

As policies go, it would be a tough one to carry out, requiring hard work of government ministries, health care officials, local authorities, police and others. It includes restrictions that would hurt the economy, such as limiting activities to Green Pass holders and returning to Purple Badge standards (in other words, limits on big gatherings), backed up by strict enforcement and an intense program of public education.

However, as hard as it would be to implement, many experts hold that it can be done without disrupting everyday life and believe it could save the government from imposing a lockdown.

“Every day that passes is making it harder to avoid a lockdown, but I think it’s still possible,” said Prof. Ran Balicer, the head of research at the Clalit health maintenance organization who heads a committee of experts advising the Health Ministry on the coronavirus pandemic.

“The number of seriously ill on September 1 will be determined by what we see in the second week of August. In other words, every decision taken and announced will have to go into effect based on the situation in the second week of August,” he said, adding that it can be done without harming economic activity.

“The challenge decision-makers face now is whether to experiment with measures that will partially hurt the economy in the hope that in the medium term they will save us from the bigger harm of a lockdown. Every day or a week or two can be quite significant from every perspective,” Balicer said.

Travellers exit Israel’s Ben Gurion International Airport, amid a spread of the Delta variantAmir Cohen

Waxman said the decision to restate the Green Pass this week should have been done a few weeks ago, when the resurgence of COVID-19 started. “We certainly could have stopped the outbreak with the Green Pass if it had been imposed immediately. But the view was then that we don’t need to do anything and that Israel is like Britain,” Waxman said. “But today the Green Pass is no longer relevant. The longer we wait, the worse things will become. No matter what we do now, we’ll reach 1,000 seriously ill, and we know that with 600-700 seriously ill, the quality of care declines.”

Numbers point to a lockdown

A lockdown is something that Israel and its new government want to avoid. But like its predecessor, it appears that the current government will find it hard to manage the situation as it is now, which requires coordinated, demanding, systemic work and the imposition of restrictions. Israel is on its way to adopting the accordion method of opening and closing the economy.

Some of the experts who attended the cabinet meeting this week say a lockdown is inevitable. The only question is the timing and duration. Opinions are split over whether to call one now or in another two weeks, with the understanding that the longer the government waits, the longer the lockdown will have to be.

Roni Numa, the retired major general heading COVID-19 prevention operations at Ben-Gurion Airport, told the cabinet meeting that an immediate lockdown was the only thing Israel could do to contain the coronavirus. Segal said that at this juncture, the government seems to be following Britain’s lead in the hope that Israel will also see a decline in contagion. But if it fails, the only option left will be a lockdown because the number of confirmed cases is so high, he said.

A lockdown is the most extreme step the government can take, and will hurt the public and the economy. Given the high numbers, it is expected to be lengthy and its effectiveness is by no means assured. During Israel’s third lockdown, and with the emergence of the British variant in the country, Israel posted record numbers of confirmed cases, severe morbidity and mortality. “Since the source of most of the infections is in homes, it takes a few weeks until you start to see a decrease from a lockdown,” Balicer warned.

And in the long term? “Vaccinations don’t solve the problem because no small part of the population still hasn’t been inoculated. The long-term goal is to vaccinate all children and make it part of the standard course of vaccination,” said Waxman. “When we get there, the situation will look completely different. This is our vision. Until then, we will have to use additional means.”