Mostly ‘shining green’: Experts say Israel not on the cusp of a 3rd COVID wave

The transmission rate has been rising but the full picture is less alarming than widely suggested, with outbreaks highly localized

Nathan Jeffay

Nathan Jeffay is The Times of Israel's health and science correspondent

A medic at a COVID-19 ward at the Galilee Medical Center. (Shlomi Tova)
A medic at a COVID-19 ward at the Galilee Medical Center. (Shlomi Tova)

With Israel abuzz with speculation that a third wave is upon us, the coronavirus cabinet has approved a plan to send most kids back to school.

After an eight-hour discussion on Monday, it was decided to expedite the reopening of the entire education system, which in most of the country now operates only up to grade 6. With the exception of virus hotspots, high-schoolers are now expected to return on Sunday and middle-schoolers a week later.

The decision comes against a background of concern about Israel’s current coronavirus situation, with suggestions it’s much worse than it should be a month and a half after the beginning of steps to exit from the fall lockdown.

Hebrew news sources have been attributing glib warnings to unnamed Heath Ministry sources, and Deputy Health Minister Yoav Kisch raised concerns on Thursday that “morbidity is rising” and that the reopening is happening too fast.

Israeli elementary school students wearing protective face masks at school in Tel Aviv (Courtesy Chen Leopold/Flash 90)

The new pessimism among Israelis started earlier this month when former Health Ministry director Moshe Bar Siman Tov said that “there are signs pointing to a third wave.” On Sunday a military task force warned that a continued easing of restrictions would lead to a rise in the morbidity rate.

Media hosts and members of the public have put two and two together and come up with an imminent third wave and a growing sense of foreboding. But even some of the most cautious experts, those who have decried what they see as past complacency, think Israel just isn’t in this danger zone.

Prof. Gabi Barbash, former director general at Tel Aviv Sourasky Medical Center, on April 7, 2020. (Channel 12)

Former Health Ministry director-general Gabi Barbash considers a third wave a “possibility,” but thinks it isn’t rearing its head at the moment.

Barbash, who claimed in a forthright July interview that the intensity of the second wave was largely caused by a government failure to respond “more and earlier,” was uncharacteristically relaxed when reached by The Times of Israel  on Tuesday regarding the move to send kids back to classrooms.

“It’s a risky decision, but a calculated risk,” he said, specifying that he doesn’t oppose it but believes that the state should avoid opening more commercial venues as schools are returning, as a precaution.

In hospitals, doctors are busy preparing for a potentially harsh winter with the so-called “twindemic” effect of coronavirus and flu, but many say that for now, there is a dissonance between popular talk of a third wave and the reality on the ground.

Prof. Galia Rahav, Head of Sheba Medical Center’s Infectious Disease Unit and Laboratory, looks at data on COVID-19 patients (courtesy of Sheba Medical Center)

“To say we’re getting to a third wave just isn’t correct — we aren’t, certainly not yet,” Prof. Galia Rahav of Sheba Medical Center told The Times of Israel on Monday. At her institution, all coronavirus wards save one are currently closed due to low case numbers, and nationally, there are around 500 people hospitalized with coronavirus, compared to 700 at the start of November and 1,500 at the start of October.

In a country that has taken significant steps back to normalcy in recent weeks, the picture is far from alarming, Rahav believes.

One of the main causes of concern about Israel’s current state is the fact that the transmission rate, or the average number of people that each coronavirus patient infects, is rising.  Just after the initial easing of restrictions started in mid-October, it was 0.65; it is now 1.07.

Another source of the worry is the number of new infections. The government hoped to quickly get to under 500 new daily cases after starting to ease the lockdown restrictions, but the numbers are higher, sometimes by more than 200. Monday saw the highest level of new cases in nearly a month.

Magen David Adom workers wearing protective clothing seen outside the coronavirus unit at the Hadassah Ein Karem hospital in Jerusalem on October 19, 2020. (Fitoussi/Flash90)

But experts still say that these indicators don’t add up to a new national wave. Firstly, they note that the increase in new daily cases correlates to increased testing, much of which consists of screening drives in municipalities and industries that catch cases that wouldn’t normally get picked up. Secondly, and more significantly, they point out that outbreaks are highly concentrated.

Almost half of new infections are among Arab Israelis, who account for just 20 percent of the population, the National Security Council reported on Thursday, according to local media. A spate of weddings is widely blamed for the spikes, and also gives clues as to why, within the Arab sector, infections are highly focused in specific hotspots.

Prof. Nadav Katz, who heads quantum research at the Hebrew University of Jerusalem, speaking at The Future of Quantum Technology Conference in Jerusalem on Dec. 11, 2018 (Noam Moreno)

Most of the country is “shining green,” a shorthand for relative absence of the coronavirus, said Nadav Katz, a Hebrew University statistician, adding this is not how Israel would look if it were on the edge of a new outbreak.

The strong regional concentration is also the reason that Barbash considers school reopening a “calculated risk” rather than an irresponsible move. He noted that, even in ultra-Orthodox areas, where cases had been sky high, they are now under control. For the return to classrooms, “the rate in the general population, including the Orthodox, is not too high,” he said.

Number crunching by another expert, Eran Segal of the Weizmann Institute of Science, explains why it is that much of Israel looks relatively COVID-clear, while the R hovers around 1. He calculated at the end of last week that in the preceding seven days, some 82% of Israeli locales had fewer than five new verified cases. This is despite widespread testing drives.

He also found that, taking a snapshot of the Israeli population that excludes the two segments of society most prone to infection, Arabs and the ultra-Orthodox, some 92% of people live in areas that had fewer than five new cases in a week.

Eran Segal (courtesy of Eran Segal)

On Sunday, Segal looked at another parameter. What percentage of the population lives in locales with fewer than five coronavirus patients per 10,000 residents? This is seen by international experts as a safe benchmark for opening schools.

The answer among non-Haredi and non-Arab Israelis is 91%. In the Haredi community, where infection levels have fallen dramatically in recent weeks, it is 61%, while among Arab and Druze Israelis, the figure is just 9%.

While the picture is very worrying for parts of the Arab and Druze population, the Hebrew University’s Katz said it is not the nightmare feared by many Israelis of another impending national spike.

“What we’re seeing is that it’s very, very localized, limited to certain hotspots,” he commented. “And the good thing is that if we can control the virus in these hotspots, we can avoid a further wave — it’s by no means inevitable and determined from above.”

Katz said that in recent weeks the state has shown increased willingness to tackle outbreaks on a local level, including with pinpointed lockdowns. On Friday, ministers approved the Health Ministry’s recommendation to impose temporary lockdowns in the northern towns of Nazareth and Isfiya due to rising virus case numbers in the largely Arab Israeli and Druze locales.

Local spikes can be contained if improved contact tracing, to see exactly whom the infected people have encountered, is deployed in hotspots, said Katz.

Furthermore, Katz, who is part of an interdisciplinary research group, said, “We support opening the schools, especially where the levels are low. Of course we strongly recommend extensive testing, masks and capsules where possible. The schools, when properly managed, are not driving the disease, as can be learned from countries in Europe.”

With numerous challenges ahead, from the right pace for commerce reopening to the effective quarantining of Israelis returning from winter travel abroad, he believes that a major new spike is a real possibility. But he thinks it is one that can be avoided through strong local measures, at least for now, even with children back at school.

“It’s become clear in recent weeks that it is possible to open up schools without an immediate outbreak,” said Katz. “This is true of general education and also of Haredi schools, which are complying with reporting and testing.”

He added: “What we have is a situation not of wildfire, but of embers, and with this virus there will always be embers. We just need to ensure they don’t cause flames that spread.”

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