As more COVID rules axed, Israel in stable state, but not yet at endemic stage
In a Times of Israel Q&A, epidemiologist Michael Edelstein says that while Israel has COVID calm, and is abolishing travel-related rules, big fluctuations in cases still possible
Nathan Jeffay is The Times of Israel's health and science correspondent
Israel is eliminating some of the last remaining coronavirus regulations. From Saturday, Israeli and foreign travelers will no longer need to be tested for COVID-19 to enter the country.
From Tuesday, face masks will no longer be required on international flights, and will be only mandatory in medical centers and senior living facilities. These changes give a picture of a country in exit mode from the pandemic mindset.
In a Times of Israel Q&A on the current situation, leading epidemiologist Prof. Michael Edelstein said that Israel is enjoying a much-deserved calm and responding accordingly in policy terms, but there is a thin line between stability and complacency.
After all, the virus continues to circulate in much of the world, meaning that cases, including new variants, are likely to reach Israel. Currently, immunity against infection is high, but this will change, he emphasized.
“The emergence of a new variant that does have an evolutionary advantage is probably a matter of when, not if, and could cause spikes in infection,” he said. However, in his analysis, Israel can sustain such spikes without ending up in crisis mode.
Edelstein started the pandemic as a top health official in England and has since moved to Israel’s Bar Ilan University and worked on prominent research projects on the coronavirus and on vaccines.
How do you assess the current situation in Israel?
We are in a stable situation in which all the restrictions are pretty much gone, and restrictions connected to air travel are about to go.
But as well as being in a stable place, we’re in a potentially complacent place.
It’s easy to forget that while cases are low in Israel, the virus continues to circulate internationally and reimportation will continue to happen. In parts of the world, we have lots of ongoing transmission and sub-optimal vaccination, which doesn’t just mean high case numbers, but also creates a breeding ground for new variants.
Can we start using the word endemic to describe where we stand regarding the coronavirus?
I don’t think we’re yet at a point to say that COVID-19 is endemic. We’re not at a stage of only small fluctuations and knowing what to expect — rather there could well be peaks in infection. So I wouldn’t start using the word endemic.
Many people think of Omicron, which spread so fast and infected so many, as the last of the worrying variants. Is this correct?
No — or rather, we have no way of knowing. Lots of people don’t realize, but there have been lots of new variants since Omicron. We haven’t heard much about them. This is partly because the news has been so dominated by events in Ukraine and the coronavirus has taken a back seat in the public consciousness.
But it’s largely because none of the recent variants had an evolutionary advantage over Omicron, which means they haven’t spread faster and become dominant. The emergence of a new variant that does have an evolutionary advantage is probably a matter of when, not if, and could cause spikes in infection.
Does this mean it’s only a matter of time until we are back in full-blown pandemic mode, with overworked hospitals and talk of lockdowns?
No. We have become much better at the idea of changing our way of life to adapt to different COVID scenarios, without a sense of being deep in crisis. Secondly, we have a high degree of immunity, both from lots of people being infected and recovering, and from vaccines.
While this doesn’t necessarily stop people from getting infected, it has a very strong effect in preventing deterioration to serious illness. Even in the thick of Omicron, hospitals were not overrun. So, we’ve both become much better at dealing with cases, and immunity means that — assuming future variants cause similar illness — we can manage even with relatively large numbers of cases.
What is the thinking behind relaxing rules related to international travel if importation of new variants is still a concern?
The government’s guiding idea seems to be that those who want vaccines have received them, and if there is further importation we are probably okay. The cost of preventing all transmission at any cost, with travel-related restrictions and cautious policies domestically, has very little appeal, so we accept peaks and troughs of transmission, but think there’s enough immunity in the population — from vaccines and recovery — to prevent crisis.
There are reports of people becoming reinfected just two or three months after recovering from Omicron. Does this indicate that immunity is very short-lived?
It’s possible to get reinfected relatively soon after recovery, but that doesn’t mean that the body isn’t protecting us. Cases of COVID-19 soon after recovery tend to be light as the effect of recovery is still providing strong protection from serious illness.
Do you expect more vaccine doses to be distributed?
Yes, at a certain point, perhaps in a few months, we will see immunity reduce as more time passes since vaccinations, and since the very large number of Israelis who had Omicron recovered.
More vaccine doses are likely to be given, but it’s not clear whether they will be given to everyone. Perhaps as a relatively high level of protection against serious illness appears to continue long after immunity against infection wanes, further boosters may be given just to elderly or vulnerable populations.
