Winter arrived late this year, so Israel only now seeing surge in COVID and flu

With hospital beds filled with the war wounded, the healthcare system urges people to get vaccinated while there is still time to keep themselves and others healthy

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

A woman suffering from the flu (monstArrr_ via iStock by Getty Images)
A woman suffering from the flu (monstArrr_ via iStock by Getty Images)

Winter has arrived late in Israel this year, along with a correspondingly delayed beginning to the respiratory disease season. Health Ministry data and medical experts are pointing to a surge in cases of COVID-19, respiratory syncytial virus (RSV), flu, pneumonia, bronchitis, and other seasonal illnesses starting last month.

Amid the ongoing war with Hamas, since the terror group’s savage attack on southern Israel on October 7, and with hospital beds filling with the war wounded, doctors are urging the public to make every effort to keep healthy and out of the emergency room.

As usual, the winter season kicked off with an uptick in COVID cases, along with a surge in RSV cases. Flu, which tends to follow, is showing up now.

“It’s a public health issue. We want to avoid avoidable hospitalizations,” said Prof. Gabriel Izbicki, director of the Pulmonary Institute at Shaare Zedek Medical Center in Jerusalem.

Izbicki urged Israelis to get vaccinated against flu, at the very least. According to Health Ministry data, as of December 31, only 1.34 million people —14 percent of members of Israel’s four health maintenance organizations — had received their annual flu shot.

There was a notable decrease from the same date in 2022, by which time 17.3% of Israelis had been vaccinated against flu. Of most concern is the difference among adults aged 65 and up. By the end of 2022, 57.2% of Israelis in this age category had been vaccinated, while in 2023 it was only 49.5%.

“It’s the eleventh hour. It’s really the last minute to get the vaccine and get the protection, so people should do it,” Izbicki said.

Illustrative: A man receives a fourth dose of the COVID-19 vaccine at a Meuhedet vaccination center in Jerusalem on January 4, 2022. (Yonatan Sindel/Flash90)

In light of the drop in flu vaccination rates, the Knesset Health Committee directed the Health Ministry to cooperate with the HMOs in launching a pilot program to vaccinate some adults aged 65 and older with high-dose flu vaccines. These vaccines either have three to four times more virus antigen or have the usual amount of antigen but are boosted by an immune-building adjuvant.

Since regular flu shot doses tend not to provide sufficient protection for the elderly, the high-dose versions have been widely used in other countries, while Israel has yet to adopt them.

Izbicki also recommended COVID shots for the elderly and those who are high-risk due to immunodeficiency or chronic illness.

The main COVID variant circulating now is the new JN.1 variant, which accounts for half of the current COVID cases in the United States, where there has been a surge of infections in the last month.

Prof. Gili Regev-Yochay, director of the Sheba Pandemic Research Institute and Infection Prevention & Control Unit at Sheba Medical Center. (Courtesy of Sheba Medical Center)

Prof. Gili Regev-Yochay, director of the Infection Prevention and Control Unit at Sheba Medical Center, told The Times of Israel that she recommends that all Israelis get COVID shots, regardless of age.

The most updated vaccination, manufactured in mid-2023, targets the XBB lineage of the Omicron variant.

“Being vaccinated with the shot against XBB should prevent you from becoming seriously ill if you are infected by JN.1,” Regev-Yochay said.

Unlike the other two diseases, there is no effective vaccination in Israel for RSV, which is most dangerous for babies and the elderly.

A sick baby with an inhalation mask to treat Respiratory Syncytial Virus (RSV) on a hospital bed. (GOLFX vis iStock by Getty Images)

Not a pandemic, definitely an outbreak

Physicians want Israelis to take the situation seriously and not expose themselves and others to unneeded health risks.

“It’s important to understand that we are not in a pandemic, but we are definitely experiencing a winter disease outbreak. We hope it will be mild, but we don’t know yet,” Regev-Yochay said.

While the situation does not compare to the height of the COVID years, the Health Ministry data published for the week ending December 31 indicated that the number of people who visited Maccabi clinics because of flu-like illness had reached just under epidemic levels. (Clalit, Israel’s largest HMO, did not report its information, but Maccabi is the second largest with 2.7 million members and its data is statistically representative of the entire population.)

Illustrative: An ambulance at Shaare Zedek Medical Center in Jerusalem on June 20, 2023. (Noam Revkin Fenton/Flash90)

December saw significant numbers of adults arrive at hospital emergency rooms with pneumonia, and children under two with bronchiolitis, swelling and irritation, and a buildup of mucus in the small airways of the lung usually caused by a virus.

For the last week of 2023, Israeli hospitals reported that they had 47 hospitalized patients with new positive diagnoses for flu, 272 for RSV, and 125 for COVID.

According to the Health Ministry, as of January 4, there are 891 active cases of COVID in the country, with 20 of them serious. The percentage of positive diagnoses in the community rose by nearly 31% last week over the week before, with 13.74% of tests coming back positive. The number of people tested for the disease went up 11.3%.

Since some people may be ill and not seek medical attention, and positive results of home COVID tests are not included in official statistics, the number of Israelis with COVID is likely higher.

Prof. Gabriel Izbicki, director of the Pulmonary Institute at Shaare Zedek Medical Center. (Courtesy of Shaare Zedek)

On December 24 — the day with the highest number of newly ill that month — 139 people were diagnosed with COVID. However, 10 days before that, the Health Ministry said it was already seeing a worrisome rise in cases due to the crowded conditions of evacuees from the north and south in hotels and other living and educational facilities set up for them.

In response to the increase in hospitalizations due to COVID, especially among those with compromised immune systems, Magen David Adom has called on the public to donate lifesaving plasma. Men and non-pregnant women who were sick with COVID in the last three months and for whom at least two weeks have passed since their full recovery are asked to donate.

With thousands of wounded soldiers and civilians treated in hospitals and displaced families living in hotels for months on end, this winter will be like none other, the experts stress, and it would be preferable for Israel to not have to also deal with a major outbreak of disease.

People can help by masking up more often, isolating when sick, and getting vaccinated.

“There is still time to get the shots. People should go now,” said Izbicki.

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