Is it time to sound the alarm, or can Israel expect to see another decrease in the infection rate with minimal changes?
As the country leading the world in vaccination, herd immunity and research on the pandemic, Israel has almost no one to ask but itself.
The question came to the forefront this week after an official who attended the coronavirus cabinet meeting on Tuesday told a local TV station that if the public does not adhere to Prime Minister Naftali Bennett’s basic health directives – mask wearing, vaccinating, and staying away from large gatherings – a lockdown could be rolled out just in time for the Jewish New Year.
Rosh Hashanah starts only a few days after the school year in 2021 – on September 6.
The current data are in fact cause at least for a raised eyebrow.
At that same cabinet meeting, a report showed that 2% of those diagnosed with coronavirus are developing a serious case of COVID-19. Based on the current number of new cases per day – more than 700 – this means Israel could have 1,000 serious cases in the next six to seven weeks.
At the country’s COVID peak, there were around 1,200 severe cases.
A big concern is that the wedding season, which begins after the Tisha Be’av day of mourning on Sunday, could cause an eruption of new cases. Weddings among the haredi sector in the summer and the Arab sector in the early fall were a big cause of infection in previous waves.
Bennett visited a wedding hall in Tel Aviv on Thursday to discuss practical ways to keep the industry open while preventing weddings from becoming nests of infection.
“Now, the sense is that everything is OK,” Bennett said. “There are vaccines. People are not dying in the streets.”
But he warned that the Delta variant is highly contagious, and the Health Ministry fears super-spreading events, which were the plague of the second wave.
“We are concerned about super-spreader events, what there was at the start of the second wave when the halls were opened – and boom,” Bennett said. “The worst situation for infection is crowding, a closed place and the flow of oxygen, strong breathing without a mask; this combination is deadly.”
Later, he rolled out the “Happy Pass” that requires people attending wedding or other event halls for parties of more than 100 people to present either a vaccination certificate or a negative coronavirus test taken within the last 72 hours. It also requires that a worker be appointed to oversee COVID rules.
“If the situation continues as it is today, I recommend closing events,” said Prof. Gabi Barabash, who attended the coronavirus cabinet meeting, in an interview with N12.
Bennett and the coronavirus cabinet have thus far taken a position of minimal restrictions and maximum routine, hoping that the public will put faith in the new administration and follow its basic protocols.
When former prime minister Benjamin Netanyahu was in office, it was argued that one of the key factors in the public’s lack of adherence to directives was its ever-diminishing trust in the country’s leaders and their populist decision-making.
So far, Bennett has asked for five things: to wear a mask in closed public spaces, which is punishable by a NIS 500 fine; to vaccinate – there are still around 1.5 million eligible Israelis who have not been inoculated; to refrain from large social gatherings; to refrain from unnecessary travel; and to isolate when required.
“I SUPPORT the actions of the government to basically not place any severe restrictions at this moment,” said Prof. Eran Segal, a computational biologist with the Weizmann Institute of Science.
Why?
Prof. Arnon Afek, deputy director-general at Sheba Medical Center, helped answer the question: “The situation has dramatically changed and is totally different from what we saw in previous waves. We are practically all vaccinated, including more than 90% of the at-risk population.”
While nothing is foolproof, and when it comes to COVID-19 there is always a lot of uncertainty, Segal said he believes Israel can expect the virus to stabilize rather than spike in the coming weeks.
“I look at the United Kingdom, which has similar rates and even higher rates of vaccination than us, and the reproduction rate is at 1.15. Ours is not on its way down, too. Today, it was at 1.27,” Segal said.
The reproduction rate, also known as the R, signifies the number of people one sick person will infect.
“If the R remains at 1.3 or 1.4 for several weeks, we will have a problem,” he continued. “But I think what may happen – as we get more people vaccinated, like the 200,000 who got the vaccine in the last few weeks, and hopefully a few hundred thousand more in the coming weeks, together with the people who are actually recovering from the disease – we are going to rebuild the wall of immunity we had before the Delta variant. And as that wall increases, we will gradually see a decrease in the R.”
He told the Post that unlike the situation prior to vaccination when without any restrictions the virus would spread uncontrollably, “I don’t think that is going to happen.”
BUT SOME HEALTH OFFICIALS have said that Bennett is not doing enough, that the Happy Pass should have covered more locations - such as restaurants and bars - or that the general green pass should be reinstated.
One of those officials is Cyrille Cohen, head of the immunology lab at Bar-Ilan University. He expressed frustration at Bennett’s failure to roll out the green pass more quickly or any other practical decisions. He said that while listening to the prime minister deliver his COVID-19 address on Wednesday night, he was reminded of a speech made about a year ago by then-coronavirus commissioner Prof. Ronni Gamzu.
“He says, ‘we are going to make an alliance with the public,’ and ‘we are going to trust each other’ – we know how that ended,” Cohen said.
Gamzu made his speech when he took on the role of commissioner in July. A few months later, Israel was under lockdown.
“You can trust the public to a certain extent, and then you have to put in place and enforce some regulations,” he said. “We do see the positive side effects from the vaccines, that they are slowing the spread, but the virus is spreading, and we have to do something. It is better to do it today than to wait two or three weeks and then make decisions.”
According to Cohen, even if the virus spreads at its current pace, Israel will have a challenge sending children back to school on September 1.
“I am very worried for our kids,” he said. “They suffered enough.”
He recommended that the Education Ministry already hire extra teachers and aides to ensure that the country is ready for a capsule system from day one. He also said that while Bennett did a solid job expanding PCR testing at the airport, it is not enough.
“People have to take a test three or four days after they get back” in the country,” he said. “Even if you do not put them in quarantine after the first PCR test comes back negative, at least mandate the follow-up test. True, if you are positive, you might have contaminated people, but then you will know. It is better knowing than not knowing.
“This had to happen yesterday,” he continued. “The numbers are still manageable. But in November, we started to see a similar rise before the third wave. We knew it was coming, we knew we had to deal with the Alpha variant. But we waited, and we paid a heavy price in January.”
Afek also had a suggestion for how to ensure that Israel does not lock down on Rosh Hashanah: a booster shot of the Pfizer vaccine.
“We know now that, with time, there is a decline in the level of antibodies,” he said, noting that Sheba had done controlled studies of its healthcare workers, who were among the first to get the jab. This decline in antibodies is probably associated with the increased infection rate among people who are vaccinated.”
Afek admitted that there is not enough data, but he said when it comes to the coronavirus pandemic, sometimes you have to learn as you go.
He said the United States is behind Israel in vaccination and probably does not yet see the decline in antibodies that Israeli studies are starting to show. He said Israel should not be afraid to be first, and then the rest of the world can learn from the Jewish state.
“I do not believe there are still people objecting to getting immunized. It is not only ridiculous but also dangerous to themselves, their families and their entire communities,” Afek added. “Immunization is not a 0% risk, but it is much, much lower of a risk than COVID-19.”
SO, WHAT will Israel’s decision-makers do?
On the one hand, they could side with Segal, who said that “living alongside the virus does not mean placing new restrictions very frequently.”
Or, they could align with Cohen, who said, “The virus is just not over. We have to act now. If we do not set limits, we will pay a heavy price on the holidays.”
The challenge is that Israel is on the cutting edge, with few other countries to consult with or model after, and, as such, will have to make a choice without full evidence.
That choice will decide Israel’s fate not only on Rosh Hashanah but potentially also for all of next year.
As Afek said: “What Israel learns, the rest of the world will learn from Israel.”