Israel just spent the entire High Holidays season under fairly tight lockdown. The choice of dates was at least partly motivated by a desire to mitigate the economic impact by choosing a block of dates that includes many national holidays, and in which many people normally take their annual vacation in any case.
Predictably, no improvement in epidemiological data was seen until about two weeks into the epidemic, but now public health officials are at least guardedly optimistic
- the positivity rate among tests, at its peak about 15% in the general populations (and as high as 33% in the chareidi and Arab sectors!) has now fallen below 8%, the lowest in a month
- occupancy in COVID19 wards nationwide, from a high in the mid-900s, has been steadily declining over the past week to about 850. (This only represents moderate and severe cases — mild cases are treated at home or, if home isolation is not feasible, in so-called “corona hotels”.)
- The total number of active patients (i.e., confirmed infections minus confirmed recoveries and deaths) is finally declining (see 1st graph below)
- The 7-day moving average of daily new cases (applied to smooth out weekday-weekend testing variations) is likewise clearly trending down (see 2nd graph below).
As an aside, our overall CFR (case fatality rate) stands at 0.85%. It was generally assumed in our epidemiological community, from earlier serological testing, that our Dunkelziffer (undetected asymptomatic or minimally symptomatic infections) is about ten times as much, which would correspond to an IFR (infection fatality rate) of just 0.085%. A more recent serological survey by the health ministry between July and September found that 5.5% of the population had been exposed to COVID.
According to the study, up to half a million people may have caught the virus, about double the number of cases that had been confirmed by the end of September, and about four times the number who had been confirmed infected at the start of September.
It seems we still have a ways to go before we reach even second-order herd immunity.
There is widespread grumbling among the general population that the general lockdown “was forced upon us by the misbehavior of two minority groups” — Arabs and chareidim (so-called “ultra-Orthodox”). In the Arab sector, it was wedding season, and mass wedding parties are the norm there (as well as, through cultural influence, among Israeli Jews whose parents immigrated from Islamic countries). Predictably, packing hundreds of people into wedding halls, with lots of shouting, hugging, kissing, and no social distancing to speak of, is a recipe for ‘super spreader events’. Apparently, after Arab medical professionals reached out to the community with impassioned pleas, the community internalized the message and infection rates are now leveling off toward those of the general population. In the chareidi (“ultra-Orthodox”) sector, however,
Channel 12 also cited figures from Weizmann Institute of Science Professor Eran Segal showing that “46% of the contagion at the moment is in the ultra-Orthodox community,” in what appeared to be a reference to the percentage of active cases countrywide. The ultra-Orthodox make up some 12% of the total population in Israel.
On Friday, Prof. Moti Ravid, the chief of the Ma`ayanei HaYeshua hospital in the largely chareidi town of Bnei Brak resigned after he lashed out vehemently at [certain elements in] the community. (It must be noted that Israeli public discourse tends to be very ‘direct’, to the point of bluntness, and at times hyperbolic.)
Ravid said that, while most of the city’s residents were trying to abide by government regulations, in Bnei Brak there are “Hasidic neighborhoods that are flouting the rules,” and that “talking to the rabbis will not help .. [they] have lost control of their communities to a certain extent.”
“Until today there has never been an entire group of people that has disregarded authority like this, and killed people… I don’t understand what religion has to do with what they’re doing. They were taught to get everything and give nothing back for years,” he said.
Asked about what was happening in the non-Hasidic Haredi community, Ravid said, “The people of Bnei Brak are mostly different, they are people like you and me who try to follow the guidelines. [However,] they don’t really succeed because the city is tightly packed with people, and that is part of their way of life.”
[…] Last week, the government’s COVID-19 czar, Ronni Gamzu, told ministers that ultra-Orthodox Israelis are 2.5 times more likely to test positive for the coronavirus and that 40% of recent cases were in the ultra-Orthodox community.
To be fair, one must not regard this community — no matter how much one disagrees with its way of life — as a monolithic bloc. Anglo-Chareidi rabbi Menachem Bombach lays out the differences between the various subgroups, and what motivates the “social distancing refuseniks“. And here is a report from a small chareidi town — Kiryat Yearim outside Jerusalem — where the community pulled together and got the infestation under control.
Being a rather ‘live and let live’ sort, I am rather more concerned with the role of some specific elected politicians from that community — in particular the incompetent and truly nauseating Yaakov Litzman who was recently forced to resign following a police indictment. As I have mentioned here many times before, our coronavirus czar Prof. Roni Gamzu actually fought against a national lockdown tooth and nail — being an economics professor as well as a doctor (OB/Gyn), he was keenly aware of the catastrophic cost thereof. So he developed a so-called “traffic light plan” for implementing containment (or relaxation thereof) on a town or neighborhood basis, rather than nationally. Health Minister Litzman torpedoed it, together with his Interior Ministry colleague Aryeh Deri (who in the past served time in Ramle prison for accepting bribes) on the tiresomely predictable grounds of being “discriminatory”.
[In tangentially related news, to my great surprise, a senior WHO official has just urged world leaders to “stop using lockdowns as your primary control method”.]
“We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus,” Dr. David Nabarro said to The Spectator’s Andrew Neil. “The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large, we’d rather not do it.”
Our second lockdown was avoidable and more or less forced upon us by spiraling infections that exceeded the capacity of our track & tracing infrastructure (no thanks to the current health minister Yuli Edelstein, who seems more concerned with protecting the health ministry bureaucracy from unwanted ‘competitors’ than with working with others towards an effective and scalable T & T infrastructure). Hopefully, de-escalating will now be done smartly, in a way that prevents having to go through this exercise a third time. For some of us — we’re the lucky ones — it’s merely annoying. For many others, it ruins their livelihood.
So what’s the plan? Eight, or rather nine, stages, separated by two weeks
- First step: fewer than 2,000 confirmed infections/day and R=0.8. Then non-customer facing businesses would return to normal operation, restaurants would be allowed takeaway service (rather than only deliveries as now) beaches and nature reserves open up, as would kindergartens. This could realistically happen as early as next Sunday
- Reopening classrooms in grades 1-4
- Reopening customer-facing businesses, B & Bs, and synagogues. (Outdoor prayer with adequate distancing is already allowed — and possible because of the weather.)
- Restaurants, cafés, gyms reopen. At this point, the “traffic lights” plan would finally be implemented.
- Hotels and public pools reopen
- Remaining grades of school reopen
- Culture, events, concerts reopen
- Event halls reopen
- Sports stadiums allowed to open to the public.
According to Alroy-Preis, the epidemiological logic of these stages is that places will open early where there is a low risk of infection and those with a high-risk will stay closed until wait until later stages. The higher risk places are those in which people do not wear masks or that are inside.But she cautioned that in order for the exit strategy to work, there is a principle that cannot be broken and that is to manage Israel’s opening of the economy not based on dates but morbidity. She answered a question from The Jerusalem Post about whether populism would get in the way of carrying out the program to plan with the simple answer: “I am not sure.”