InterviewBetter plan needed before ‘deja vu’ with winter wave

End COVID ‘haggling,’ impose a blanket ban on 10+ people indoors — gov’t adviser

‘The virus doesn’t differentiate,’ and adjusting policy to accommodate interest groups wrecks public trust, warns epidemiologist Ran Balicer

Nathan Jeffay

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

Ultra-Orthodox men pray at a synagogue in the neighborhood of Mea Shearim, Jerusalem, on May 20, 2020 (Yonatan Sindel/Flash90)
Ultra-Orthodox men pray at a synagogue in the neighborhood of Mea Shearim, Jerusalem, on May 20, 2020 (Yonatan Sindel/Flash90)

Israel must put an end to the “haggling game” that is hampering coronavirus policy and introduce a simple blanket rule banning all indoor gatherings of more than 10 people, according to a government health adviser.

Prof. Ran Balicer told The Times of Israel that the shaping of health policy to accommodate different interest groups is undermining public trust.

“There’s no way to explain why you’re exempting a ‘Type A’ establishment and not ‘Type B,’” he said. “It has a detrimental effect on the public’s openness to take part in this public effort.”

Balicer, an epidemiologist who directs health policy planning at Clalit Health Services, advises the prime minister and the Health Ministry, and is a member of the national epidemic management team, said: “We find ourselves in this haggling game and I believe we should completely change the way we manage this crisis.”

Professor Ran Balicer, head of innovation at Clalit, Israel’s biggest health services provider, in Tel Aviv on June 10, 2020 (EMMANUEL DUNAND / AFP)

The coronavirus death count has risen to 480, according to figures released by the Health Ministry on Tuesday, an increase of six since its Monday update. There are currently 32,052 active cases, more than triple the peak during the first wave.

Balicer argued that under the current circumstances, 10 people should be the limit for all indoor locations — both public places and private homes — apart from a tiny number of exceptions including supermarkets and hospitals.

“I don’t care if it’s a gym, a shop, a workplace or a synagogue, the virus doesn’t differentiate,” he said, adding that rules can be more relaxed outdoors, as there is less risk of infection. Recreation at parks, beaches and elsewhere should continue, he said.

Religious parties are exerting heavy pressure to increase the number of people allowed in synagogue, and ministers announced on Monday that they will allow more people to gather ahead of the upcoming Tisha B’Av fast, which starts Wednesday night.

Meanwhile, representatives of various business sectors are also trying to shape policy. They have enjoyed some success as the Knesset’s coronavirus committee has overturned various government decisions, including the closure of gyms, and its head has plans to eliminate others.  On Tuesday, a union representing event hall owners threatened to reopen for business next week in defiance of government orders.

A patron exercises at the Holmes Place gym and country club in Modiin on July 14, 2020. (Yossi Aloni/Flash90)

Balicer said there are no grounds, at the moment, to take risks on indoor locations.

“The overall situation is pretty clear,” he said. “There is a continued increase in the number of patients admitted at our hospitals with severe and moderate cases of COVID-19. They are becoming an increasing burden on the health system and may eventually lead to a point of functional insufficiency that leads to an increase in mortality of COVID-19 patients and other patients who may need intensive care.

“Once you’re there, there is no magic wand for reducing the overall number of admitted cases. It takes time to reduce the influx, and the patients usually remain admitted for two to three weeks. Once you’re there, there is no quick way out.”

He declined to put a figure on how many patients would cause this “insufficiency” but noted that that 800 to 1,000 severe COVID patients has been mentioned as an estimated threshold. Currently, there are 321 severe cases.

Looking to the future, Balicer said that the state needs a clear plan of exactly what restrictions are enacted at what point.

“It’s time for an over-arching plan that describes the the phases of restrictions, color-coded, building up to black which is a full lockdown that you never want to reach,” he said. It should be a “very clear program, pre-agreed on what happens at every color-coded step.”

People walk next to empty chairs and tables at restaurants on Jaffa Street in Jerusalem on July 7, 2020 (Yonatan Sindel/Flash90)

Balicer thinks that if such a program exists, as case numbers rise, there will be no bargaining over synagogues, pools, restaurants and other institutions, as leaders and the public will already know what happens in the next phase.

He believes this will give rise to an improved sense of public solidarity and government transparency.

“If things get worse, what you need to discuss isn’t what restrictions [to enact] but just, ‘are we at a point in which we need to move from orange to red or red to black?’” he said.

Such a plan will prove essential as Israel has more pandemic woes to come, said Balicer.

“This coming winter we’ll have a deja vu of all of this. Whatever happens in the coming weeks, we’ll have to relive this in December,” he said.

He predicted a “wave of morbidity” and said that it will be at least as big or bigger than the current wave. He added: “We will confront very similar challenges in winter time because of the combination of flu and coronavirus. We should expect a rise in infections and severe cases.”

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