Experts: Israel ahead of curve on coronavirus

Put together by a team of 30 experts, the report demonstrated that strict regulations were bringing about a positive trend, but also warned that isolation measures should remain in place.

By MAYA MARGIT/THE MEDIA LINE
As of Sunday, 63 ventilators had been manufactured locally and delivered to the Health Ministry as part of DOPP's efforts (photo credit: DEFENSE MINISTRY)
As of Sunday, 63 ventilators had been manufactured locally and delivered to the Health Ministry as part of DOPP's efforts
(photo credit: DEFENSE MINISTRY)
Israel’s battle to stop the spread of coronavirus appears to be bearing fruit and is leading many experts to express cautious optimism about these efforts.
There are more than 9,000 confirmed cases in the country, and as of Tuesday evening local time, 61 people were dead. However, the rate of new cases seems to have slowed following weeks of social distancing and stringent directives limiting movement.
Last week, Israel’s National Security Council released a report analyzing the outbreak. It found that the rate of new infections had fallen from 1.25 to 1.15 new cases a day for each previously diagnosed patient, according to The Marker, an Israeli news site.
Put together by a team of 30 experts, the report demonstrated that strict regulations were bringing about a positive trend, but also warned that isolation measures should remain in place, at least for now.
“So far, the fight against the virus in Israel is [relatively] quite effective,” Dr. Shmuel Even, a senior research fellow at the Tel Aviv-based Institute for National Security Studies, told The Media Line. “The ratio of the number of dead to the number of known patients in Israel is only 0.36% [as of the end of March], which is very low relative to the rest of the world.”
Even stressed that early on, the Health Ministry recognized the threat that COVID-19 posed and proceeded to stop international flights. At the start of February, Prime Minister Binyamin Netanyahu limited – and soon after banned – flights from East Asia, a decision that was met with harsh criticism at the time.
“There are claims that Israel should have done more laboratory tests in the early stages,” Evan adds.
Israel’s first coronavirus case was confirmed on February 21 after a woman returning from quarantine aboard the Diamond Princess cruise ship, which had been docked in Japan, tested positive.
On February 26, Israelis were warned against traveling to Italy – where several people had already died – and were even urged to cancel all international travel plans. In early March, the Health Ministry announced that every traveler arriving from abroad would be required to self-isolate for a period of 14 days.
It was not until March 11, when 120,000 people worldwide had already tested positive, that the World Health Organization (WHO) declared a pandemic.

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The same day, Israel limited gatherings to 100 people. A few days later, the number was restricted to 10 people. At the same time, citizens were strongly advised to keep a two-yard distance from one another.
Last week, the Deep Knowledge Group (DKG), a Hong Kong-based venture capital firm, ranked Israel first among countries keeping people safe from the pandemic, followed by Singapore and New Zealand. The United States was ranked 27.
According to DKG, the survey relied on conventional parameters such as overall economic and technological development, in addition to data from the WHO, John Hopkins University and the Worldometer website.
“Two hundred data points were taken into account for each country, and in total, 10,000 data points were analyzed,” a spokesperson for DKG told The Media Line in an email. “The specific focus was on the capabilities of countries in applying advanced preventive progressive medicine, with the focus on AI [artificial intelligence] and digital medicine to extend healthy longevity.”
The firm said it looked at the reliability of diagnoses in each country, as well as the healthcare system, level of medical expertise, hospitals and medical equipment, military and other defense-mobilization capabilities, social discipline and several other factors.
“We have significant concerns about the accuracy of the data provided by some specific countries and their official statistics,” the spokesperson said. “In some countries, the number of identified cases and number of deaths from coronavirus may be intentionally distorted.”
While others agree that Israel has shown leadership in its quick response to the outbreak, they do not believe it is currently possible to rank countries, saying the situation is still evolving at a rapid pace.
Prof. Jacob Moran-Gilad, a medical specialist in clinical microbiology and public health at Ben-Gurion University of the Negev, told The Media Line that there was “a delay in the dissemination of coronavirus in Israel” due to travel restrictions and border closures.
“This bought Israel precious time in being able to prepare the health sector and the population for the later stages,” said Moran-Gilad, who is also a member of Israel's national epidemic management team.
“The majority of countries are struggling and putting [the bulk of] their efforts and capacities into that,” he noted. “Israel is in a unique position because we had some more time to organize ourselves.”
Still, he says, it is too early to rank national efforts.
“Even countries that appear to have succeeded in suppressing coronavirus infections in the very early stages may still experience a resurgence, so I would be very cautious,” he said.
Even if Israel is successful in containing the virus, Moran-Gilad says many will get sick, especially in those sectors that have exhibited opposition to embracing social distancing and heeding Health Ministry guidelines.
Israel’s laboratory-testing capacity has been another weak spot.
“I don’t think there was any harm done, but ideally it could have been faster,” Moran-Gilad stated. “Many professionals recommended performing wider surveys in the population to estimate the degree of dissemination of coronavirus. But to be honest, other countries have not succeeded in doing this either, barring a few.”
Prof. Cyrille Cohen, head of the immunotherapy laboratory and vice dean of the life sciences faculty at Bar-Ilan University, said he believes Israel’s COVID-19 testing capability is “quite good” compared to other locales.
“We’re doing a lot of tests, especially compared to other countries, like in Europe,” Cohen told to The Media Line. “We’ve reached 7,000 tests daily, which is a very good capability right now, and we’re trying to expand that. There are other countries that are not performing enough tests, so there are a lot of people who are not identified as carriers.”
Overall, Cohen believes the curve showing the coronavirus-infection trend in Israel is “not that bad” – though it could be better.
“In Italy, when they were at the same point as we are, more or less a month after the beginning of the infection, they already had 10 times more deaths than we do in Israel,” he said. “So we’re doing something right.”
Despite his cautious optimism, Cohen says there has been a “race against time” to prevent medical systems and hospitals from becoming overwhelmed with critically ill patients, and that it was too soon to tell how successful Israel would be in this regard.
Key Challenges
Among the major obstacles facing Israel, Cohen points to a shortage of medical equipment and a lack of responsiveness from ultra-Orthodox, or haredi, Jews, many of whom were slow to adopt health guidelines.
“People have to obey and follow the Ministry of Health’s measures, so I’m a bit worried about what’s going on in certain parts of Israel where people are paying less attention to those guidelines,” Cohen cautioned.
His concerns appear well founded.
So far, Jerusalem’s ultra-Orthodox neighborhoods and the haredi city of Bnei Brak, near Tel Aviv, have the highest concentrations of infection. People living in these areas traditionally shun the internet and mainstream media. Some refused to close synagogues and schools in March, when the directives first came into effect.
Nearly one-third of Israel’s coronavirus cases are in Jerusalem and Bnei Brak, the Health Ministry revealed on Tuesday. What’s more, a report compiled by the National Knowledge and Research Center for Emergency Readiness, published by the ministry, revealed that roughly 75% of Jerusalem’s cases have been concentrated in haredi neighborhoods. It recommended that these areas be isolated from the rest of the city.
Following mounting pressure on authorities, police set up checkpoints around Bnei Brak and drastically limited movement in and out of the city. Residents are now allowed to leave only for medical assistance or emergencies.
Other experts remain unconvinced that Israel’s national strategy is a success, as has been portrayed.
A team of scientists at the Hebrew University of Jerusalem’s Racah Institute analyzed current data and forecast that 1,000 Israelis will become critically ill from coronavirus by mid-April. As of Tuesday, more than 150 Israelis were listed in serious condition.
Prof. Nadav Katz, who conducted the study along with Prof. Yinon Ashkenazi, Prof. Doron Gazit and Dr. Michael Assaf, told The Media Line that the number of Israelis who will need ventilators is not much better than in other countries.
“[The upward trend] is not quite as fast as Italy, but it’s similar to Germany and other countries,” Katz said. “But [at the same time] it’s not that different from Italy.”
While the measures Israel has put in place have certainly helped, he said, there is “always a very long delay” because symptoms take a week or two before they show.
“The future is always unknown, but the trends are pretty clear,” Katz continued. “The next week is going to play out with a large increase in critical patients.”
To stem the rise, Katz recommends that the government implement “much stricter” isolation measures, especially with at-risk populations such as the elderly, whom he argued should not be going out at all.
While he acknowledged that Israel’s response has been stronger than those of many countries, he said the current measures did not go far enough.
“The analogy to a brush fire is very strong,” he stated. “If you don’t put it out everywhere, it continues to burn. Half-measures won’t work.”
Medical Research Goes into High Gear
Medical researchers around the world are racing to develop treatments and vaccines, which will have to undergo several rounds of testing and clinical trials before going into production. While a vaccine is expected to take upward of a year to develop and test, other treatments could be just a few months away, health experts say.
“More than 20 vaccines are in development globally, and several therapeutics are in clinical trials,” a WHO spokesperson recently told The Media Line. “No treatment and vaccine exist yet, but researchers around the world [are working] hard on it.”
The state-run Israel Institute for Biological Research (IIBR) last week announced it had made “significant progress” toward developing a vaccine it will test on animals. It has been working on a prototype since early February.
Even though a vaccine will probably take between 12 and 18 months to be proven safe and effective, other treatments could emerge much sooner.
Dr. Rivka Abulafia-Lapid, a senior virology lecturer at the Hebrew University of Jerusalem, said COVID-19 treatments will likely become available within six months, barring unforeseen developments.
“Israel already has 11 different drugs for trial… so I would say that the first thing to come out will be a drug that is commonly agreed upon by the world’s scientists and the FDA [the US Food and Drug Administration], followed by a vaccine,” she told The Media Line. “In a couple of months, they will come out with a future treatment or maybe a cocktail of drugs.”
Abulafia-Lapid, who for 25 years headed a research team in Israel dedicated to developing a viable vaccine against HIV and other autoimmune diseases, said a vaccine would have to undergo a lengthy testing period involving several phases of clinical trials.
Among the pharmaceuticals being examined in the meantime, she said, Gilead Sciences’ experimental antiviral drug Remdesivir − originally tested on humans with the Ebola virus − is a front-runner. The California-based biotech company’s medication is already being used in several coronavirus-linked clinical trials.
In the quest to repurpose existing drugs, researchers are testing more than 6,000 compounds, according to Israeli media. The drugs are already approved as being non-toxic to humans.
Others Join the National Effort
Israel’s defense and security establishments are devoting considerable effort to the struggle against COVID-19.
In collaboration with the Defense Ministry, the medical firm Inovytec and Israel Aerospace Industries have converted a missile factory into an assembly line for ventilators. The government body has also recruited a number of Israeli businesses to produce ventilators, masks and other protective equipment.
“The State of Israel is developing independent capabilities in its fight against COVID-19,” Defense Minister Naftali Bennett said in a statement last week. “This independence is essential to the national effort. We must not remain dependent on procurement from other countries.”
The ministry’s Directorate of Production and Procurement (DOPP) is helping the Health Ministry obtain the urgently needed medical equipment.
In a statement sent to The Media Line, the Defense Ministry said it was focusing on three main fronts: the purchase of protective gear and medical equipment; the “Hotel Initiative,” in which the DOPP is helping identify facilities that are appropriate for quarantining COVID-19 patients; and the import of essential medical equipment.
On Sunday, the ministry announced that 63 ventilators had been manufactured locally and delivered to the Health Ministry, and hundreds more would be produced in the coming weeks. Sion Medical, located in the southern city of Sderot, will meanwhile produce 35 million masks and hundreds of thousands of uniforms for medical professionals.
Israel’s security forces have also been mobilized and are helping to enforce Health Ministry directives.
The Shin Bet internal security service is tracking confirmed and suspected COVID-19 patients via cellphone-location data. Hundreds of Israelis have received text messages notifying them that they must go into quarantine because they came in contact with infected people.
Thousands of police officers have been deployed across the country to ensure that lockdown directives are respected and no gatherings take place. Soldiers are assisting the police, especially in Bnei Brak, where they are also distributing food to the elderly.
To date, police have visited more than 73,000 Israelis who are required to be in isolation. There are 144 investigations into individuals suspected of having broken quarantine.
Looking to the Future
Even with optimism over Israel’s stringent health measures, the economic fallout is a major source of concern.
As of Monday, the country’s unemployment rate stood at an unprecedented 25.1%, with more than 1 million Israelis registered as jobless and nearly as many requesting unemployment benefits.
“This situation will continue at least until after Passover,” the INSS’s Even told The Media Line.
“The quarantine has very serious economic and social consequences,” he explained. “For example, economic damage to the gross domestic product this month is an estimated NIS 40-50 billion [$11-14 billion]…. Since this is a global crisis, it is appropriate that the crisis be managed on a global level as well.”
In expectation of a global recession, the Bank of Israel’s Monetary Committee lowered interest rates from 0.25% to 0.1% on Monday, marking the first such cut since 2015. The central bank also reported that the economy contracted by 5% in the first quarter. It further stated that the unemployment rate was expected to decline gradually and would reach pre-coronavirus levels only toward the end of 2021.
Despite the heavy economic costs, health experts warn that lifting restrictions too early could lead to a surge in new infections and undo all of Israel’s efforts.
“There’s a significant trade-off between mitigation and suppression, the economy and the welfare of the population,” Ben-Gurion University’s Moran-Gilad cautioned.
“There needs to be a balance,” he stated. “The next steps will have to try to offer the optimal way of balancing these factors. [We have to try] to get as many people back to work as possible, while keeping the risk for infection as low as possible. It will need to be very carefully monitored.”
Others agreed that the country needs to begin formulating a long-term exit strategy.
“Compared to other countries, I’m quite optimistic [for Israel],” Bar-Ilan University’s Cohen told The Media Line.
“There’s no doubt that COVID-19 is here to stay and we have to start learning how to deal with this long-term,” he said. “We have to hope that the research being done is going to result in a new therapy and give us the chance to win this fight.
For more stories, go to themedialine.org