Israel’s coronavirus stats are low compared to Europe and the United States, but the highest among all of its neighbors, and with quadruple the death rate of Egypt, current figures show.
Exactly two months ago, Prime Minister Benjamin Netanyahu declared that Israel needed to go all-out to avoid the fate of Italy and Spain. Today, Israel’s death rate is around a twentieth of theirs, but high for its immediate neighborhood.
Israeli scientists are increasingly suggesting that there are unexplained factors that make coronavirus more virulent in Europe and calmer in the Middle East. And some are saying that the local picture shows that drawing a parallel with Europe was mistaken all along.
Epidemiologist Hagai Levine said that Israel was never headed for an Italian-type spike, suggesting that the regional figures highlight this and back up his belief that Israel’s restrictions were too extreme. He told The Times of Israel that the factors in each country are different, but the importance of the Middle East’s climate hasn’t been present enough in Israeli discussions.
“I think we underestimate the impact of climate,” he said. “When you assess the spread of diseases, we look at the pathogen, the host and the environment, and this is important in assessing the spread of the disease.”
Levine, chairman of the Israeli Association of Public Health Physicians and a faculty member at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine, said: “You can’t copy-paste from Jordan and Egypt but you can learn something from them in terms of the impact of climate.”
Israel’s leaders have lauded the country’s coronavirus figures: 16,667 cases, and 279 deaths as of Thursday morning. This translates to 1,929 cases per million and 32 deaths per million. In Italy there have been 3,760 cases per million and 535 deaths per million.
The most similar outcome to Israel’s in its region is Turkey, where there have been 1,811 cases per million and 50 deaths per million.
But in Egypt and Jordan, immediate neighbors of Israel, figures are lower. They recorded 139 cases per million and 66 cases per million, respectively, and their death rates are seven per million and 0.9 per million, respectively. The Palestinians, with their 398 cases and two deaths, stand at 78 cases per million and 0.4 deaths per million.
Syria and Lebanon, also immediate neighbors, have reported three cases per million 141 cases per million, respectively, and morbidity rates of 0.2 deaths per million and four per million, respectively. Slightly further afield, Greece has reported 273 cases per million and six deaths per million.
These nations had lockdown measures, but rarely as strict as Israel’s, and in many respects they didn’t have Israel’s level of technology use and cellphone contact tracing to quarantine people who encounter the infection.
“I’m surprised by the rates we see around here,” said Daniel Cohen, professor of epidemiology at Tel Aviv University and head of the institution’s school of health.
At Bar Ilan University, an interdisciplinary group of researchers that includes a mathematician, a virologist and others, is puzzled by the regional picture — and how it should impact their ongoing research producing statistical models for different pandemic-related scenarios.
“We’re somewhat in the dark,” said Bar Ilan mathematician Baruch Barzel. “Figures from the region raise the question of who should we be comparing ourselves to. Should we be saying we fared much better than Italy, or should we be saying we didn’t fare as well as Lebanon or Jordan?”
He added: “The truth is nobody knows the answer.”
Some scientists are claiming the figures show that politicians overreacted as the Middle East was always destined for a light brush with the coronavirus. “They are wrong when they say we did a great job,” said Yoram Lass, a physician and former director-general of the Health Ministry who has gained notoriety for playing down the seriousness of COVID-19 and criticizing government policy.
Talking to The Times of Israel, he claimed: “There’s a clear conclusion, which is that in the Middle East region, in the eastern basin of the Mediterranean, the coronavirus is not active. Look at Greece and Cyprus and the countries around us. You can always say they don’t really disclose the real numbers, but even in Israel, [the level of infection is] a joke.”
Other experts suggested a more nuanced analysis.
Shlomo L. Maayan, head the infectious disease division at Barzilai Medical Center in Ashkelon, said he believes that there are characteristics of the region, especially the fact that populations tend to be younger than in many other places, which have kept the virus in check.
Yet he has a “high level of suspicion” regarding the quality and accuracy of coronavirus reporting in the region. Testing levels were also lower, he noted. Israel has conducted 60,492 tests per million citizens, while the equivalent figures for Egypt and Jordan are 1,322 and 14,975, respectively. In Syria, where general reporting on coronavirus is believed to be very limited due to the civil war, there are no available statistics for testing rates.
Maayan said: “The epidemiological data is not very strong from countries in our region, so we should compare ourselves to areas where the epidemiological picture is strong, like in Europe.”
He rejected the claim by Levine and others that the Middle East’s climate is important in understanding virus rates. He said: “Are we really very different from the southern part of Europe weather-wise? I’m not sure.”
Barzel and his Bar Ilan colleagues are interested in how a country’s lifestyle impacts coronavirus rates. “There is a difference between Israel and its neighbors, with Israel tending toward a more Western lifestyle, and it’s possible this is relevant, and makes the challenge posed by the virus harder,” he said.
“In countries that have fared badly it may have to do with the way of life: mobility, social interaction, the urban nature of life — in short, things that work well most of the time but may cause problems in a time of a virus,” Barzel added.
Cohen stated that while he has some concerns about reporting, he believes that countries in Israel’s region were spared from the worst effects of coronavirus. But he said it’s not so clear that Israel should be comparing itself to its immediate neighbors.
His logic is that for some relevant factors, like climate and population age, Israel is similar to its neighbors, but there is a far higher level of human traffic in to the country from Europe and America, where the coronavirus has been rife, than from the surrounding region.
“We had the risk factors of cases bring imported from abroad. This was a big risk factor for Israel, and less so for other Middle Eastern countries,” He said
Cohen’s colleagues at Tel Aviv University have just established from genomic analysis that seven out of every 10 Israelis who caught the virus to date were infected with a haplotype — variant — that arrived in the country from the United States.
“In many senses Israel is between Europe and the Middle East, but practically, for this, it is more exposed to America and Europe than other nearby countries were,” Cohen said.
He thinks that Israelis shouldn’t let statistics from surrounding countries dampen their sense of achievement in fighting coronavirus.
”I would say it should go by the standards of Europe, because we had to face big numbers of people who came here carrying the infection,” he said. “We had to contain their infection.”