E COVID-19 Cases Surge In Israel

Looking at the plans being bandied about to handle the coronavirus explosion in Israel, I see this continued emphasis on bringing infection to a stop. I'm curious whether people think this could actually work at this point. Even in Israel, which has conducted a lot of tests, only 30% of cases have been detected (according to serological studies in August).

I don't see how we'll capture the massive spread of cases that must be underway, but completely undetected. The cat, almost inevitably, is out of the bag. So instead of capturing the cat, shouldn't we stop the cat from causing widespread damage?

To use resources effectively I'd focus on:

1) Building more treatment capacity, including building field hospitals and importing health professionals for temporary placement. There are lots of Arabic, English and Russian speaking doctors out there who can treat large swaths of the Israeli public.

2) Protecting the at-risk (if they want to be) - including buying Sonovia masks for them and offering financial support to enable isolation.

3) Regularly test healthcare workers to protect the vulnerable. There are about 70,000 healthcare professionals in the country. Every one could have a weekly test and only require 20% of testing current capacity. Israel could even use the NBA's spit tests and process far more samples.

4) Giving the elderly vaccinations as soon as they pass initial safety and efficacy tests (e.g. in the next few weeks - because the long-term health effects and effects on child-bearing don't matter as much)

5) Actually enforce masks to cut dosing - which seems to impact health outcomes substantially

As of August 23rd (when the last serological survey was done) 318,000 of Israelis had coronavirus antibodies and 819 had died - indicating a death rate of 0.25% (this is far better performance than others have seen and it doesn't even assume a expiration of antibodies). In addition, the average age of death was 81. By protecting the elderly, including selective vaccinations, Israel can bring the 0.25% death rate down substantially. They might even lower it to the range of the flu (according to the CDC), this is between 0.04% and 0.15%). It would still be a major cause of death - but it wouldn't be *the* major cause of death.

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Susan Miller 3 weeks ago Member's comment

Is your lockdown working?

Joseph Cox 3 weeks ago Author's comment

Not yet. To be fair it can be hard to tell. I don't know if our rise in cases is exponential as it was. It looks like the rise may have gotten a bit slower. On an anecdotal basis: since the lockdown started 2 of 3 clinicians at my wife's clinic have been diagnosed. One only lost sense of smell and taste. Two had flu-like symptoms and have since recovered. Two of my children have been put in isolation but not tested (no symptoms). So it is certainly getting close to (if not on top of) my family.

The Good Doctor 3 weeks ago Member's comment

Lockdowns work. The science and data do not lie.

Joseph Cox 3 weeks ago Author's comment

The science and data aren't so clear - there are definitely disagreements. Without a statistical analysis I'd point out the following:

1. You lockdown, but the virus remains to break out later - and so you end up bouncing alone and perhaps never actually moving past the virus. This is probably what France, Spain and the UK are experiencing. A lockdown saved very few lives (judging by how many died relative to, say, Sweden) - but slowed down transmission so that people didn't get widespead exposure. Sweden is *not* seeing a resurgence of deaths.

2. The US story is very unclear in this regard. Arizona, Florida, Texas and Georgia were all criticized for not locking down enough. Arizona has 76 deaths/100,000. Georgia and Florida have 64 and Texas has 53. Some states with lockdowns have been far better. But many were far worse. NY 170, MA 136 and so on...

I think the effect of lockdowns varies massively by many other factors. If people live 13 to a 3 bedroom apartment (Bnei Brak) in very dense neighborhoods a lockdown probably does very little. If a virus spreads by aerosols (as the CDC is considering) or sewage a lockdown might do very little. If it can spread in harvested or processed food packaging then not much is helped.

To me, our recent evidence suggests lockdowns can slow things down - but the price is terribly high and the long-term benefits might not be there. If we're only waiting a few more weeks for mass vaccines of high-risk patients then they might be the right path. If not, it is harder.

Danny Straus 3 weeks ago Member's comment

A big part of the problem is that so many don't listen to the rules. Even in Israel:

www.israelhayom.com/.../troubling-study-finds-israelis-lie-about-contracting-corona-put-lives-at-risk

Leslie Miriam 3 weeks ago Member's comment

I think schools are the real culprit. Whenever a country opens schools, infections spike. Kids can be carriers but usually show know symptoms, and go around infecting others. Plus they are notoriously bad at wearing masks and be socially distant.

Joseph Cox 3 weeks ago Author's comment

This does seem to be a trend. But do we just stop life indefinitely because of this? Or do we fundamentally change the way we live - going online and virtual for everything? In my personal case the impact is quite limited. My kids are learning as much as they were before and they are basically self-managing. Plus I work from home so my ability to earn a living is not challenged by them being home. But my situation is unusual.

I actually wrote a short story about a world in which everybody lives remotely to avoid spreading virus.

medium.com/.../the-cost-of-life-fiction-268cb891e075

Adam Reynolds 3 weeks ago Member's comment

Also, I don't understand this sentence - "There are lots of Arabic, English and Russian speaking doctors out there who can treat large swaths of the Israeli public." Why does it matter what language the doctor speaks?

Joseph Cox 3 weeks ago Author's comment

Because patient-doctor communications can be helpful - we aren't cars. So being able to take a history and communicate is helpful.

Adam Reynolds 3 weeks ago Member's comment

It's Israel. doesn't everyone speak Hebrew?

Joseph Cox 3 weeks ago Author's comment

Hebrew or Arabic. But foreign doctors don't - so you can't import lots of Hebrew-speaking doctors. Many people have another language - Arabic, English or Russian. This opens up foreign medical personnel.

Adam Reynolds 3 weeks ago Member's comment

How can you possible know only 30% of corona cases there were detected? Undetected cases are just that - unknown.

Ayelet Wolf 3 weeks ago Member's comment

The author linked to a Bloomberg article that said they tested Israelis, and found that 3X as many people had covid as were previously known. They knew this because they had the antibodies in their system. But only 4% of the population is still very small. That leaves plenty who can still get infected.