A complete lockdown of public life to fend off the spread of the coronavirus would be counter-productive and ultimately detrimental to the country’s health system, one of Israel’s leading medical professionals warned, voicing an opinion at odds with the views of much of the medical establishment.
The government’s draconian measures enacted so far have already caused great damage to the economy that, if exacerbated, would ultimately hurt the health system and cause more deaths than the current pandemic, argued Dr. Leonid Eidelman, the former head of the Israel Medical Association and an immediate past president of the World Medical Association.
“It would hurt the Israeli economy even more,” he told The Times of Israel in an interview, referring to proposed steps to all but bring the entire country to a halt. In the end, such radical steps would cause the already ailing health system to suffer even more in two or three years, and that would lead to more people eventually dying than from the coronavirus pandemic, he posited.
“We know that the mortality of this virus is between two and four percent of those who are infected,” he said, referring to COVID-19, the disease caused by the coronavirus. “Between 250,000 to 600,000 people die from regular flu every year [globally]. The Coronavirus mortality rate will be much lower.”
While the mortality rate for the seasonal flu lies between 0.1-0.3 percent, Eidelman said he still believes that when the coronavirus pandemic ends, fewer people will have died from it than die every year from the flu, because “epidemics that spread very quick are usually associated with lower mortality.
“It’s a tough sickness. It’s a sickness that needs to be fought. But we need to keep proportions.”
Edelstein’s assessment appears to contradict those of many leading experts across the globe, who believe tough measures are necessary to contain the coronavirus, which is generally considered much deadlier and more contagious than the seasonal flu.
On Tuesday the Health Ministry asked citizens to stay at home as much as possible, and only to go outside for vital activities such as going to work or to buy food or medicine, as Economy Minister Eli Cohen said that a “general closure” of public life remained on the table. And Wednesday, Israel’s Public Security Minister Gilad Erdan said a lockdown was “inevitable.”
“At the beginning, the government’s policy was to broadcast panic. And panic leads to more panic. It’s a chain reaction,” Eidelman, who chairs the department of anesthesia at Beilinson Hospital in Petah Tikva, lamented. The fear spread by Prime Minister Benjamin Netanyahu, Health Minister Yaakov Litzman and other officials led to shortages in many areas, including in protective gear, the senior physician claimed.
“People started using them unnecessarily, and even today it’s being used inappropriately, because people are afraid. I tried to explain that the coronavirus scare causes more damage than the coronavirus itself. Because after all, by now we know that 97% to 98% of those infected get better. It’s not such a devastating illness that kills everyone. It’s very important to understand that.”
The government should have sent calming messages more clearly from the very beginning of the epidemic, but this was not done, he charged. “The Health Ministry is slowly adopting this line, but it was done too late.”
Eidelman’s criticism seems to be at odds with the view of most of his colleagues, as the medical establishment in Israel has been supportive of the government’s measures, with the Health Ministry seeking even harsher moves, including a nationwide lockdown.
While Eidelman contended that the government’s response to COVID-19 was exaggerated, he did not dismiss many of the principles behind it. Social distancing and enhanced personal hygiene are essential tools in the effort to prevent the virus from spreading, he said. The policies enacted by the United Kingdom — which for a long time did not curtain public gatherings — were also not effective, he said.
“One can choose one policy or another. But what I say is that one should have calmed the public and not caused them to panic. Because the stress that these messages created is much more dangerous than the virus.”
Just as disconcerting is the great damage Netanyahu’s draconian measures will cause the economy, Eidelman went on. Senior economists estimate the corona crisis will cost the Israeli economy some NIS 50 billion or more.
“That’s worrisome because there will not be enough money to cope with the regular problems of the health system. The budget for the health system will not go up, and people, during regular times, will die because there’s not enough money in the health system,” he said.
It’s a tough sickness. It’s a sickness that needs to be fought. But we need to keep proportions
“You cannot only deal with something populist like this disease. You have to plan for the long run. The health system has long suffered from a lack of funds, and I am concerned because the current situation will lead to less money flowing into state coffers that would be available for medical expenditures.”
Eidelman said that too much energy was being invested in shutting Israel’s borders and forcing potential carriers of the virus to stay at home, but that not enough was being done to bolster the health system that is overloaded on any given day.
“The main problem is that they focused particularly on stopping flights and on self-isolation and quarantine, and invested less in the strengthening of the health system and on tests,” the physician said.
“Four things need to be done, and they’re not done quickly enough: 1. more tests; 2. more personal protection equipment; 3. strengthen the infrastructure of emergency care. As of today, Israel has a very low number of beds in emergency care compared to other countries; 4. protect elderly people, because we know they are affected by the virus in a more severe way.”
As opposed to some in the health system, Eidelman does not believe that the Defense Ministry should take the lead in Israel’s efforts to fight the spread of the coronavirus. However, he suggested the Home Front Command set up temporary accommodations for corona patients with mild symptoms.
“It’s good that the government has started thinking about that,” he said.
Hunger strike on behalf of an ailing health system
Eidelman, who specializes in anesthesiology and intensive care medicine, has a history of taking the government to task for its alleged neglect of the health system. In 2011, he went on a hunger strike to protest after his negotiations with the Finance Ministry failed to yield the hoped-for improvements.
“The basic problem of Israel’s health system is health expenditures, or what I call health investments. It’s relatively low — only 7.5% of our GDP. That’s not enough,” he said.
This problem finds expression in the fact that the number of hospital beds per person is constantly declining in Israel, he said. “Now it’s already down to less than two beds per 1,000 people. And in the northern and southern periphery of the country it’s even worse, with 1.2 beds for 1,000 people. That’s a very low number.”
With the health system in such a dismal state, the situation quickly deteriorates when an epidemic strikes, he said. “And we knew that a disease would come.”
And COVID-19 will not be the last pandemic to plague mankind, he noted. “I estimate because of the climate crisis there will be new epidemics at a much higher rate, because the environment changed,” he said.
Eidelman was critical not only of Netanyahu, Litzman and Finance Minister Moshe Kahlon, but also of the fact that the Health Ministry’s director-general, Moshe Bar Siman-Tov, is not a doctor.
“He’s a genius in economics,” he said about Bar Siman-Tov, who started his career in the Finance Ministry’s Budgets Department. “But it’s a mistake that someone who is not a doctor is heading the Health Ministry. We need a surgeon-general to make decisions. Today there is not a single doctor who makes any decisions at the Health Ministry. Not the minister, and not the director-general.”
Defending themselves against criticism that their policy is too draconian, Netanyahu and Litzman have repeatedly argued that their early adoption of tough measures to contain the spread of COVID-19 has put Israel in a much better situation than many other countries.
“I agree that we’re ahead of the curve thanks to the policy that was adopted. But having said that, we have to understand that the number of infected is not so small,” Eidelman said. In pandemics you don’t look at absolute numbers but rather at the ratio of infected to uninfected, he explained.
As of Tuesday, 427 COVID-19 cases were known in Israel, a country of nine million. “If you look at infected people per 1 million, our number is higher than in many other countries, including the US, Britain and even Greece,” he said.