COVID19 update, September 10, 2020: Second lockdown in Israel? Not so fast, says Dr. Amir Shachar

Israel has been ramping up testing capability, with about 44,000 tests per day yesterday and the day before. Considering that there are probably 10 undetected cases out there in the community for every positive case, it should surprise exactly nobody that now positive tests also have gone up, reaching a high of nearly 4,000 a day.

There is thus now a push for a renewed lockdown over the High Holidays and Sukkot. The reasoning goes that, since so much of the country’s economy is on a pilot light during these holidays, a lockdown now would be less costly from an economic point of view. Our coronavirus czar, economics professor and obstetrician Roni Gamzu (on leave as CEO of Ichilov/Sourasky Medical Center, the largest hospital in Tel-Aviv proper) has been fighting a rearguard battle against lockdown as he believes (IMHO rightly) its costs (economic as well as collateral morbidity and mortality) will outweigh its benefits.

A list of 40 “red-zone” towns and neighborhoods has been released in which an evening curfew is in force. Almost without exception, these are Arab, Druse, and Chareidi (“ultra-Orthodox”) communities, which between them account for the majority of new cases. This has been linked to mass weddings in the Arab sector (it being the wedding season there now, and ‘personal space’ being a novel concept in this part of the world), as well as to the reopening of yeshivot (Talmudic academies), traditionally one month before Rosh HaShana. In the secular and national-religious Jewish sectors, schools have reopened since September 1.

Today I saw an interview on Channel 12 news with another opponent of lockdown — none other than the director of emergency medicine at Laniado Hospital in Netanya, Dr. Amir Shachar.

The interview is in Hebrew, though you can get the gist in English from this article. Let me summarize some quick points directly from the video in English though:

  • he is one of the founding fathers of modern emergency medicine[*] in Israel; over 30 years ago, he set up the new emergency department at Sheiba/Tel HaShomer hospital and ran it for many years, before leaving for a position with the Shin Bet (Israel’s domestic intelligence agency). After surviving a bout with leukemia, two years ago he came out of retirement to lead the emergency department at Laniado
  • He is thus in the COVID19 frontline now, despite being in a risk group himself
  • His view is that yes, COVID19 is a serious disease, but one with which we will need to learn to live at least for some time — not shut the planet down
  • Collapses of the medical systems in Spain and Italy in the first any wave resulted from mismanagement of said systems, not from objective medical factor. They triggered a first wave of lockdowns that was, with hindsight, unnecessary
  • “decision makers then were not medical professionals” — he mentions former health ministry director-general Moshe Bar-Siman Tov by name, a seasoned bureaucrat who came from the Finance Ministry without any medical background. (Don’t get me started on the minister.) “Then you get idiocy like racing to get 3,000 ventilators which turned out to be completely unneeded.”
  • “In the future, people will look back on how we responded in 2020 and shake their heads”
  • the number of “severe cases” is inflated because of changes in the criteria for classification. “A patient with a pO2 [blood oxygen saturation level] of 93% was ‘mild’ until July 12, when they suddenly became ‘severe’ — even if they need nothing [he means: oxygen, respirator,…]”
  • the average age of COVID19 deaths is 81, the majority with multiple pre-existing conditions
  • “people age 90 or 100 die, not because of COVID19, but because they have [any] disease [at all]”
  • “the second wave” should really be called “the testing plague” (his term: magefat ha-bedikot). “We go into a panic because we test so much. If we didn’t, then the serious cases would show up anyhow, and the rest would get over it and develop immunity.”
  • the hospital’s director, Dr. Nadav Chen, adds remark about another plague: chronic shortness of financial breath. “We haven’t been able to pay our suppliers for PPE they rushed to us during the first wave. Now they’re out on the streets demonstrating because they are going under.”
  • In this context should be seen Dr. Shachar’s earlier remark that hospitals are dramatizing and exaggerating the degree of COVID19 burden as a means of getting financial relief. (And no, he is not suggesting the hospitals need that to pay for frivolities.)

In the article I linked, we can read that:

A New York Times article entitled Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be, said: “The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious. […] This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are. In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.”

Channel 12 News reported that while Germany uses 30 amplification cycles, Singapore 32, and the United States 34, Israel uses up to a full 37 amplification cycles to detect viral genetic matter. Many experts agree that anything higher than 30 amplification cycles will result in inactive, dead, or clinically insignificant amounts of the virus being detected, therefore causing the test to show as positive.

[…] Shahar spoke with Sivan Cohen and explained why he felt the Swedish method of fighting the virus should be adopted, expressing his opinion on the expected closure: “It’s an epidemic but it harms the weak, the sick, and the elderly. The virus does not pose a threat to society.” He went on to comment on the high coronavirus data and corrected: “We only have about 50 new [actual] patients in Israel a day, and not 3,000. The health system should be given the means to cope long-term.” “Most of the people identified as carriers are not sick, or they are very lightly ill, and I’m trying to say that this figure of 3,000 or 4,000 new patients a day is simply using wrong definitions. There is no disease that is diagnosed by identifying the contagion in the throat. There also need to be symptoms and most of the people identified as positive and get the label ‘sick’ are not sick.” The interviewer answered Dr. Shachar, “They’re carriers…” “They’re not even carriers,” answered Dr. Shachar, “They’re people who were exposed to the virus. Hundreds of viruses pass our way every day.”

Controversial words, for sure. But not those of a conspiracy nut or political hack, but of a veteran, respected medical professional. Food for serious thought.

[*] as distinct from trauma/battlefield medicine, with which this country sadly acquired ample experience.

One thought on “COVID19 update, September 10, 2020: Second lockdown in Israel? Not so fast, says Dr. Amir Shachar

  1. Hello, Just wanted to thank you for your blog. I read it everyday and your perspective along with those of the authors of the articles that you link brings a well needed shot of sanity to what is the most insane year in my life yet.

    Cheers

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