COVID19 update, February 21-22, 2021: Israel approaching herd immunity one year after the beginning?

The trouble with the hyper-politicized news out of the US MSM is that you don’t know what you can believe at times. In contrast, while Israel’s political landscape has always been contentious, it’s fragmented — which takes away the ‘football game’ character it has in a bipartisan system. Also, in a small country that cannot take its very existence for granted, the handling of major crises like these tends to be fairly nonpartisan.

One of the most precious goods in an epidemic is public trust. Silly, condescending, manipulative ‘fertilizer’ like “two weeks to slow the spread” (now entering its second year) would never fly here. Instead, things that were taboo to even mention in the US MSM— like the economic cost, and collateral healthcare damage, of a lockdown — were openly discussed here from the beginning.

Importantly, we are used to a semi-permanent state of low-level danger because of the ‘neighborhood’ we live in. So the message ‘this is serious business, but not the end of the world nor Spanish Flu 2.0’ sank in much more quickly than in countries where ‘ZOMG we’re all gonna die!’ or ‘it’s just a bad cold’ were the two dueling narratives on the street.

Yes, here too, mistakes were made, and policies had to be adjusted as the ‘fog of war’ about the epidemic gradually lifted. It was not immediately obvious, for example, that outdoor activities were as low-risk as they turned out to be. Thus, in the first lockdown we were basically told to stay indoors except to go buy groceries, while in later lockdowns, walking and physical outdoor exercise were (thank G-d) not restricted this way.

And public health does face some challenges here it would not in a more ‘Anglo’ country. Our population density even in nominal suburbs is staggeringly high by US standards — if you discount the Negev desert, we are the most densely populated country in the world aside from city states like Singapore or Monaco — and like all over the Mid-East, personal space is very rarely respected if at all. For that reason alone, lockdowns may have been more effective here than in other countries. (Greater London or New York City are probably closer to our reality.)

During the second wave, our then-virus czar Prof. Roni Gamzu — who is that rare bird, an economics professor and an OB-GYN by initial training — kept pushing back against pressure for a second lockdown, as he knew what economic ravages it would wreak and — being the CEO of one of our “big four” hospitals in his regular day job — understood very well that in summer our hospitals had plenty of slack capacity. Only when hospitals started crying ‘Uncle!’ that they were at capacity limits even with geographical load-balancing — itself only possible, really, because our country is so small — did he relent.

Our third lockdown is now being lifted since yesterday. During it, we effectively became a massive Phase IV trial for the Pfizer mRNA vaccine. Effectiveness results with a large uncertainty interval (94±4%) from a Phase III clinical trial on 30,000 people (half vaccine, half placebo) have now been replaced by HMO data on half a million or more at a time. (All of us, by law, have to enroll in one of the four licensed HMOs, and a shared electronic medical record keeping system exists that would be nearly unimaginable in the US.) The 94±4% figure turned out to be basically accurate – and of the tiny number of vaccinated people who still get sick, only a handful develop severe illness. Thanks in part to fairly rigorous screening of prospective vaccinees for a history of allergic reactions, adverse events have been minimal, in the same ballpark as ordinary seasonal flu vaccines. What’s more: as the British mutation is now by far the dominant variant here, we discovered that the Pfizer jab (and by extension this will hold for its nominal competitor Moderna) remains effective. [The jury is out about the South African and Brazilian mutations, which so far we have only seen isolated cases of here. Keeping them out was the prime motivation for shutting our airport down.]

A team of researchers at Weizmann around Eran Segal [best known for his microbiome research] has been given access to vaccination and illness data down to neighborhood level. As we discussed previously, not only did they show that hospitalizations in the age 60+ bracket (the first to get vaccinated) started dropping markedly [meanwhile down to a trickle, inside sources tell me] while those among younger people (only becoming eligible for jabs much later) kept going up — but they found that the drop started earlier in towns or city neighborhoods that reached high levels of vaccination early, and later where this happened later.

And finally, we are seeing the drop at the national level in hospitalized severe cases

in new admissions of severe patients (the red horizontal line is the average over the period displayed — note, by the way, the mild oscillation about)

as well as in daily deaths

So this is where we are at now (graphs updated last night at the Ministry of Health dashboard, in Hebrew). Out of our population of about 9 million (of which about 6.3 million in the eligible age brackets — yes, almost one-third of our entire population are children!), almost 4.4 million have gotten at least one jab, of which nearly 3 million got both jabs. (That includes over 90% in the most vulnerable age 70+ bracket, and about 80% in the age 50-70 bracket.) But in addition [data page from the Clalit HMO], nearly 700,000 people already recovered from verified COVID19 infections (asymptotic or symptomatic). Now there is overlap — anecdotally, I know several people who got the shots after they’d had COVID, despite technically not being eligible — but 5 million out of a total of 9 million is starting to approach even first-order herd immunity. If you account for the highly reduced spread among the children’s population, we may be even closer to de facto herd immunity than that. (Keep in mind: herd immunity isn’t a binary state like pregnancy.) [There is speculation the same will happen in the US by April (h/t: Erik Wingren)]

In this year, we have seen 5,577 dead of, not with, COVID so far (our reporting rules are much more stringent than in the US). This is the equivalent of about 205,000 when scaled up to the US population, or about 52,000 when scaled up to the German population. That we have less than half the relative (official) death toll of the US, and still compare favorably to the about 68,500 in Germany with its very stringent reporting rules, is of course cold comfort to the deceased’s families. But hopefully we are starting to see the light at the end of the tunnel.

But once again, you see the value of public trust in such a pandemic. Without any form of compulsion,[*] just being level with the public, this is the vaccination rate by age brackets (light green=both jabs, dark green=1st jab, in 3-week wait for 2nd):

You don’t achieve that by vacillating and zigzagging for political expedience, Fauci (Faux-Xi?) style. Would we have gotten vaccinated if we had lived in the US? Of course, but I’m not representative of the target audience — while my training is in physics, I have enough knowledge of the relevant biology, and enough day-job experience evaluating research papers in disciplines other than my own, that I am able to reach an informed decision fully independent of whatever came out of Faux-Xi’s orifice. I can even tap into the country’s top virologists and epidemiologists with a single “dear colleague” phone call. So we’d get vaccinated despite rather than because of the tainted messaging of the US public health establishment. And aye, there’s the rub — despite.

ADDENDUM: Mortality drops 98.9% compared to unvaccinated. Beware of the “Nirvana fallacy” where every solution that’s not 100% effective is rejected.
And no, despite the unfunny jokes of some literal clown on SNL, Israel does not reserve the vaccine for Jews only. Everybody, even foreign residents, is eligible, and vaccination clinics have been set up in Arab villages since the beginning of the vaccination drive. We live in an insane age where Disney slaps an “offensive content” label on The Muppet Show, while modern-day blood libels pass for “humor”.

ADDENDUM 2: Pfizer 1st dose alone 85% effective after 2-4 weeks. [Hat tip: Jeff Duntemann]

[*] some ‘trial balloons’ were floated about various types of incentives and ‘name and shame’. None of these got very far. The ancient military maxim “never give an order that you know won’t be obeyed” has a civilian cousin, “never force people to do something if they are reasonably willing to do it on their own” [because you will get refusal out of suspicion, or simply orneriness].

5 thoughts on “COVID19 update, February 21-22, 2021: Israel approaching herd immunity one year after the beginning?

  1. Looks like the UK will be releasing similar data – admittedly this is mostly one jab only.

    Scotland reports 85% for Pfizer and 94% for AZ (albeit in a shorter time frame) and England is expected to announce similar results later today.

    The UK’s fall in cases, deaths etc. is also looking very similar to Israel – from a peak about a month ago hospitalizations have dropped ~40%, severe cases 30% and deaths down by over 50%

  2. Mind you Japan is showing similar falls (from much lower total numbers) with no vaccinations what so ever and only a fairly limited “lockdown”, which has impacted tourism and evening entertainment but not the rest of the economy.

  3. Nitay, thank you for your blog. My wife and I find it best for un-corrupted information regarding the Covid issues. We have both received one shot of the Pfizer and are trying to determine if there is any compelling reason to get the second shot or not. It seems that the data from Israel would indicate only a very small advantage to getting the second shot. Is that the way you see it also? Also, what exactly is meant by terms like “80% effective”. Does that essentially 80% of vaccinated individuals will not get sick if exposed? or will not get very sick? or what? Thanks again.

    • In a word, “80% effective” means that, compared to an unvaccinated population, your chance of getting infected is reduced by 80% compared to a population of the same composition in the same community at the same time.
      The most detailed PEER-REVIEWED work I know of that breaks results down by (asymptomatic) infected vs. symptomatic vs. sick vs. VERY sick, in our local setting (600,000 people each in the vaccine and control populations), is

      Dagan, N.; Barda, N.; Kepten, E.; Miron, O.; Perchik, S.; Katz, M. A.; Hernán, M. A.; Lipsitch, M.; Reis, B.; Balicer, R. D. BNT162b2 MRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N. Engl. J. Med. 2021, NEJMoa2101765.

      My short summary in table form of the main findings:

      Effectiveness relative to control group (95% confidence intervals in parentheses)
      1st dose both doses
      documented infection 46% (40-51) 92% (80-95)
      symptomatic COVID 57% (50-63) 94% (87-98)
      hospitalization 74% (56-86) 87% (55-100)
      severe disease 62% (39-80) 92% (75-100)
      death numbers too small for meaningful statistics

      This was published by the research arm of the Clalit HMO. We’re talking about 600,000 people each, vaccinated and control group (not yet vaccinated), i.e. 40 times larger than Pfizer’s original Phase III trial. Note that the uncertainty intervals grow larger as severity goes up, since you are more and more engaged in “statistics of small numbers”.

      There are more up-to-date non-peer-reviewed data from the 3 competing HMOs out there (every Israeli has to be enrolled in one of the four licensed HMOs, for better or worse) — I’ll try to run a blog post on them later today or tomorrow.

      • Thank you very much for linking that study. That is just the kind of un-filtered information we need. My opinion is that the second dose of the vaccine is clearly beneficial.

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