As COVID variant Pirola gathers pace, Health Ministry mum on plans to fend off threat

With summer vacation now over, kids are back in school, vacationers are back at work, and COVID-19 is suddenly back in the headlines and may soon be back spreading through the air, health officials say.

With the Jewish New Year around the corner, Israelis gearing up for festive get-togethers with family and friends, services in packed synagogues and travel to crowded locales are watching with concern as the beginning of a new COVID wave appears to possibly be emerging.

Driven by the novel BA.2.86 (Pirola) variant with more than 30 mutations on its spike protein, leading scientists suspect that the Omicron variant may be able to evade existing immunity from prior illness and vaccinations. Pirola was first detected in Denmark and Israel in July.

According to the World Health Organization, there were 1.4 million new cases of COVID globally in August, a 38 percent increase over the previous month.

Countries are not only reporting higher rates of illness and hospitalizations but some are also announcing plans to get a grip on the situation before healthcare systems become overwhelmed during the winter respiratory virus season. In the United Kingdom, testing and genetic tracking is ramping back up, while in the United States, scientists are fast-tracking research to determine the transmissibility of Pirola and  hospitals and schools are considering reinstating mask mandates.

Although Israel’s Health Ministry has shared statistics showing that COVID is back on the rise here, it has not issued any update on whether restrictions will be reimposed to help head off what could be rough months of “flurona,” a double whammy of flu and COVID. (The ministry did, however, begin its annual flu vaccination campaign through the health maintenance organizations on September 5, earlier than normal.)

“At this point, the Health Ministry has no instructions for the public,” a ministry spokesperson said in response to an inquiry from The Times of Israel. “We are monitoring the situation and will issue more information if needed.”

Should Israelis go back to wearing masks and social distancing in medical clinics, hospitals, and crowded indoor spaces — including planes and airports? Should everyone who feels sick do a home COVID test? Do you need to isolate at home for a set period if you test positive? Will PCR testing come back? Will new COVID booster vaccines be available this fall?

People, some with face masks, shop for groceries at the Mahane Yehuda market in Jerusalem on July 7, 2022. (Olivier Fitoussi/Flash90)

With no clear directives from the government, the medical community has been left to merely pin its hopes on individuals trying to avoid infection, testing if they become symptomatic, and preventing themselves from spreading the virus to others, especially the elderly and immunocompromised.

Spreading worries

The Health Ministry reports that the number of people in Israel testing positive for the virus has jumped 13% overall in the past several weeks, and the rate is increasing daily.

As of September 3, the country had 1,081 active cases, with 245 hospitalizations. Forty-two of these patients were in serious condition, including five who were in critical condition. There was no information as to whether there were any deaths caused directly by COVID during this recent period.

Dr. Babiana Hazan, director of the infection disease department at the Haemek Medical Center in Afula, told the Ynet media outlet that her understanding is that most of the cases caused by Pirola and other newer Omicron variants were “imported” by Israelis who traveled to other countries over the summer break. That means the virus, at least for now, is not running amok through local communities.

Prof. Ronit Calderon-Margalit, director of the School of Public Health at Hebrew University and Hadassah Medical Center. (Tal Margalit)

But public health experts and epidemiologists doubt that the Health Ministry’s overall numbers reflect an accurate picture.

“Because there is no mandatory reporting or testing, and there is no obligation to isolate, we don’t really have full, credible information,” said Prof. Ronit Calderon-Margalit, director of the School of Public Health at Hebrew University and Hadassah Medical Center.

“The only thing that is reliable is the number of people who are hospitalized with the virus,” she told The Times of Israel.

In an attempt to get better data on the extent that COVID is making people ill, at least in the hospitals, the Health Ministry instructed public hospitals on September 4 to do PCR testing for the next three weeks on all patients hospitalized in internal medicine departments.

But hospital heads balked at the instruction, arguing that it would produce little helpful data at the cost of unnecessary additional work for their staff.

“The number of patients who are admitted [to hospitals] due to COVID is low, so it would be better to do the testing in the community, where most of the people with respiratory symptoms are,” read a statement signed by the Forum of Public Hospital Directors. “The survey would be more effective there. The public hospitals will continue to do PCR tests where clinically indicated.”

Epidemiologist in protective suit, mask and glasses works with patient swabs to detect the coronavirus (iStock)

More jabs and a moonshot

The Health Ministry plans to roll out “designated vaccinations” for the new variants come winter, a spokesperson said. But the ministry declined to offer specifics about which variants would be included.

In June, the US Food and Drug Administration announced that new booster shots would be distributed for the Omicron XBB.1.5 variant. This marked a break with the existing bivalent boosters which targeted the the original coronavirus strain together with last year’s most common Omicron variants.

But the new shot was developed before the EG.5 (Eris) and BA.2.86 (Pirola) variants emerged over the summer. In August, the Biden administration announced the first funding awards from its $5 billion project for developing the next generation of COVID-19 vaccines aimed at keeping up with the virus as it evolves.

An Israeli man receives a second booster of the COVID-19 vaccine in Modi’in, on January 6, 2022. (Yossi Aloni/Flash90)

As Israelis and others around the world wait to learn more about the new booster shots and when they will be rolled out, the Sheba Pandemic Research Institute is partnering with the US National Institutes of Health, the Walter Reed Army Institute of Research, and the pharmaceutical company Sanofi to develop a pan-coronavirus booster vaccine.

The joint project aims to produce a vaccine that would protect against a variety of coronaviruses, including the SARS-CoV-2, the virus behind COVID-19, and its variants. The research template to develop the vaccine will also be applied to other viruses, including influenza, with the goal of preventing future pandemics.

Prof. Gili Regev-Yochay, director of the Sheba Pandemic Research Institute and Infection Prevention & Control Unit at Sheba Medical Center. (Courtesy of Sheba Medical Center)

But with viruses continuously mutating, even a pan-coronavirus shot may just be the latest in a never-ending arms race between virus and vaccine.

Prof. Gili Regev-Yochay, director of the Infection Prevention and Control Unit at Sheba Medical Center and head of the Pandemic Research Institute, said it was far too early to determine how often a pan-coronavirus shot would need to be administered.

“We’re talking about a respiratory pathogen, which is not something you get once in your lifetime, like measles. So realistically we are not talking about a single shot. It will be a vaccine that people will have to get more than once, but at this point, it is impossible to know how frequently,” she said.