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Analysis

Hospitalizations are spiraling. Is a fourth COVID lockdown at our doorstep?

While medical facilities could approach capacity in 20 days, the benefits of booster shots and restrictions may kick in, and there’s a hopeful precedent abroad

Nathan Jeffay

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

A medical worker takes a samples from a young Israeli at a drive through complex to check if they have been infected with the coronavirus (Yossi Aloni/Flash90)
A medical worker takes a samples from a young Israeli at a drive through complex to check if they have been infected with the coronavirus (Yossi Aloni/Flash90)

Hospitals in Israel could be close to capacity within 20 days based on the current trajectory of the virus outbreak, prompting the public as well as the experts to wonder whether the country is sliding toward its fourth lockdown, but the country’s new weapon against the Delta variant has just been locked and loaded.

As cases rise, Israel is on the cusp of finding out what benefits the booster shots and freshly reimposed restrictions may deliver. Starting last week around 420,000 older Israelis have been given third shots of Pfizer’s coronavirus vaccine, with doctors working under the assumption that, similar to the second doses, it will take around a week after vaccination for the benefits of a third shot to kick in.

It’s unlikely that a government that invested so much in boosters will want to make decisions on a lockdown, which is views as a last resort, before seeing reliable stats on the impact of the shots.

“There are really too many unknowns to make predictions now about lockdown,” coronavirus statistician Prof. Eran Segal of the Weizmann Institute of Science told The Times of Israel on Sunday. “We haven’t yet felt the effect of booster shots, but this could well be felt this week.”

Despite the heated discussions in government about lockdown, Segal predicted that ministers will wait to see how the numbers pan out once booster shots, and other efforts, take effect.

An Israeli receives a coronavirus booster shot at a Maccabi Healthcare Services vaccination center, on August 1, 2021. (Yonatan Sindel/Flash90)

“Currently, there are 350 people in serious condition and 3,500 new daily cases on average. The number of serious patients is doubling in a space of ten days, which means that after two doublings, we could be over the critical limit for hospitals,” he said Sunday.

“In the last wave we hit 1,200 serious patients and that seems to be the critical limit. That’s scary. And if this does happen, or seem to be happening, we should go to lockdown.”

The number of serious cases as of Monday morning stood at 360.

Eran Segal (courtesy of Eran Segal)

But while voicing his concerns, Segal also stresses that there are “balancing factors.”

“There is public behavior, meaning that as numbers go up there is more wearing of masks and working from home,” Segal said.

“The third booster may buy us time, and there is the factor of people recovering who are then freshly immunized by antibodies, which can help. In addition to this there are restrictions that are put in place, such as the reintroduction of the Green Pass,” he said, referring to the system allowing access to some venues only to those who are vaccinated or recovered, or who present a negative PCR test.

“These are all balancing factors, but whether they can help and balance out the numbers it’s hard to know. I don’t think anybody knows,” he said, adding that things will only become clearer in the next week or two.

Making predictions even more complicated is the possibility that the health system’s capacity for treating COVID patients will change. Ministers are reportedly mulling a plan that would attempt to avert lockdown by increasing beds and staffing in hospitals, and would see some patients treated at home by healthcare providers.

In addition to the unknowns of health system capacity, booster benefits, and the impact of restrictions and conduct changes, there is the fact that the Delta variant is still very unpredictable, even for those who have studied earlier phases of the pandemic in great detail.

In London, influential epidemiologist Prof. Neil Ferguson, the mastermind of the UK’s first lockdown, said in mid-July it was “almost inevitable” that the final phase of ending restrictions would bring on 100,000 daily cases.

Surprisingly, the cases didn’t rise, but instead fell. The Delta peak hit just before the unlocking at 54,000 new daily cases. Now the figure stands at about 28,000.

In the Netherlands, there was dismay over rising infections in early July, and following a non-compulsory work-from-home recommendation, new daily cases plummeted from an 11,000 Delta peak in mid-July to around 2,500.

Ora Paltiel, professor at the Braun School of Public Health and Department of Hematology at Hadassah-Hebrew University (Jared Bernstein)

Epidemiologist Ora Paltiel said that the picture emerging in highly vaccinated countries like the UK and the Netherlands may foreshadow what is in store for Israel.

They had a head start on Israel in terms of Delta, and the Israeli curve was only just starting its sharp climb as their infections peaked. If Israel follows their trajectory, it may mean that infections will peak soon and then fall.

There is some mystery as to exactly why cases in the UK and the Netherlands peaked and fell as they did, observed Paltiel.

Even in India, where the variant originated and vaccination rates are low, Delta peaked in May with about 400,000 new daily cases and then fell sharply, to about a tenth of that today.

Paltiel said that the peak-and-fall effect may reflect large numbers of people becoming infected, some without realizing, and the resulting antibodies causing an immunity boost in society.

Illustrative image: A COVID ward at King’s College Hospital in London. (AP Photo/Kirsty Wigglesworth, File)

It’s also possible that for reasons that aren’t understood, some people are susceptible to the Delta and others aren’t, said Paltiel. In this scenario, the variant is reaching many of those who are susceptible, and then, when it has fewer potential targets, declining.

Paltiel thinks that if cases fall, a lockdown probably won’t be imposed, and the Education Ministry will go ahead with plans to start school on schedule, rejecting calls to delay the reopening until October.

“If Israel follows the UK and the Netherlands, Delta could decline, and we could see schools reopen in September as planned,” she said. “But if things unfold differently in Israel, cases could continue to rise, and it’s quite possible we will see the start of school delayed until October. Delta is a new challenge for us and it’s hard to predict.”

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