Is COVID on the way back?
Health experts explain Israel’s latest coronavirus outbreak
Just when Israel thought it had beaten the COVID-19 pandemic, the virus struck again.
On the one hand, health officials continue to say that these outbreaks are expected, and that because Israel is largely vaccinated with a shot that works against the new Delta variant, the country should not enter another health crisis.
On the other hand, in recent days the government has introduced new rules, reestablished the coronavirus cabinet and more.
The Jerusalem Post, together with a team of health experts, tries to answer all of today’s top 10 COVID questions.
1. What is the Delta variant, and how did it end up in Israel?
The Delta variant, formerly known as the Indian variant, is exactly as its name implies: a viral mutation. Every virus replicates. In the process, there are often mutations, most of which have no effect.
Since the start of the coronavirus crisis, there have been four more problematic mutations: The Alpha variant, which is commonly known as the British variant, the Beta or South African variant, the Gamma or Brazilian variant, and now there is the Delta variant.
Delta first appeared in India in the winter. By February, it had traveled to the United Kingdom, and today it accounts for 90% of the country’s cases. It also traveled to the US, where it accounts for around 20% of all cases. And now it is in Israel.
The variant entered the country through Israel’s airport, and health officials have said it started to circulate because people who were required to quarantine, which would have kept the variant contained, failed to do so.
The Delta variant is of concern because it is much more contagious than the original virus.
“If we compare the original strain to the Alpha variant, we know it is up to 60% more infectious than the original strain, and the Delta variant is 60% more infectious than the Alpha variant,” explained Prof. Cyrille Cohen, an immunologist at BarIlan University and a member of the advisory committee for clinical trials on SARS-COV2 vaccines at the Health Ministry.
However, in Israel, where the majority of people are vaccinated, the Delta variant should be less problematic. A large study performed in England showed that the efficacy of the Pfizer vaccine against hospitalization due to the Delta variant is about 96%, meaning it works as well against the Delta variant as the Alpha variant. Moreover, the efficacy for symptomatic disease is 88%, also similar to its efficacy against other variants.
The challenge is that “we don’t yet know what the vaccine’s efficacy is against asymptomatic cases,” said Prof. Galia Rahav, head of the Infectious Disease Unit and Laboratories at the Sheba Medical Center.
And it is starting to look like even in Israel, where about 85% of the adult population is vaccinated with two doses of the Pfizer vaccine, the Delta variant can spread.
2. Why would someone who is vaccinated catch coronavirus?
Because the Delta variant is so transmissible, it is capable of disseminating even in circumstances where the high population rate of vaccination would have otherwise made this exceedingly difficult.
According to Public Health Services head Dr. Sharon Alroy-Preis, as of Wednesday night some 891 people had been diagnosed with coronavirus in the last month, 50% of whom were fully vaccinated. Health Ministry director-general Chezy Levy further clarified that the last 99 infected people over the age of 16 had been fully vaccinated and 39 had not.
“Since in Israel 85% of the adult population is vaccinated, even with 90% vaccine effectiveness against the Delta variance, one would expect among adults to see more infections among vaccinated than unvaccinated because of their sheer relative volume,” said Prof. Ran Balicer, founding director of the Clalit Research Institute and director of Health Policy Planning for Clalit. “People find it difficult to understand. They say, ‘If I see so many vaccinated people infected in Israel, then it has to be that the vaccine is not effective.’ But this is not the case.”
3. If Israel ends up with a lot
of new cases, is the public health system at risk again?
Whatever happens now, Israel will not go back to the situation it had during the country’s third wave in January, Balicer stressed.
On Wednesday, when Levy presented the rising trend in morbidity in recent days, he carefully clarified that “we have not yet seen severe disease among vaccinated people.”
Israel went into three lockdowns in one year because the country was afraid that too high a number of patients would cause the hospital and health fund systems to collapse, said Nadav Davidovitch, an epidemiologist and public health physician at Bar-Ilan University.
Right now, the vaccine is doing its job to prevent serious infection, hospitalization and death.
Nonetheless, he said that many health reforms are needed, and increased funding is essential to ensure that if the number of serious cases does rise, the healthcare system will not once again be at risk.
Already on Thursday, Wolfson Medical Center reported that an unvaccinated 48-year-old man was hospitalized in critical condition. The young man had no underlying medical conditions.
4. The government decided to push off allowing individual tourists to enter Israel from July 1 to August 1. Was this the right decision?
Here, health experts seem to disagree. On the one hand, Dr. Talya Miron-Shatz, founding director of the Center for Medical Decision-Making at Ono Academic College, stressed that “I don’t think [tourists] should be let in.”
She said that Israel needs to keep its borders closed to prevent variants from entering.
“You have to draw the line between, ‘I welcome you as a person, but not as a person who potentially endangers my country,’” Miron-Shatz said.
In contrast, Cohen said that the government should have moved forward with its plans but just put a better screening system in place at the airport. He recommended requiring three tests for all people who enter Israel: a PCR test at the airport, an antigen test at the airport, and another PCR test three or four days after arrival.
“From the moment you do a PCR test, you can leave the airport,” Cohen explained. “You can spend 12 hours without knowing you are infected and spreading the virus to other people. It is unacceptable.”
An antigen test, which is about 80% accurate and takes about 15 minutes to swab and process, would catch most people with the virus before they leave the airport complex. Moreover, a test taken a few days later would nab those who contracted the virus on the plane or very shortly before and hence did not have enough viral load to test positive on arrival.
Finally, Israelis should also be careful about their summer decisions, Rahav said, recommending that parents not take their unvaccinated children out of Israel, because it is “problematic” and “dangerous.”
“This summer don’t go abroad,” she instructed. “Wait this summer, and hopefully next summer tourism will come back.”
5. The government also rolled out a set of new regulations. What are they?
The following is the new government’s road map for conquering corona, according to a release by the Prime Minister’s Office:
• Launch a national operation, including a dedicated PR campaign, to vaccinate everyone over the age of 12. In addition, the government will run an information campaign to encourage citizens to strictly maintain the obligation to quarantine.
• Resume operations of the network to cut off the chain of infection, in cooperation with local authorities. Alroy-Preis said that there are currently 168 epidemiological investigators working, which is enough to cover the required investigations.
• If cases spike to more than 100 new cases a day, every day, for a week, it will become obligatory to wear masks in all closed spaces. Coronavirus commissioner Prof. Nachman Ash said Thursday that the mandate is expected to go into effect on Sunday, although at the time of this writing, health officials are only “recommending” that people wear masks, except at the airport and medical facilities, where they are required to do so.
• The bodies involved in managing the fight against the coronavirus (such as the Health Ministry control center) will continue operations, which will be boosted and strengthened, as necessary.
• A plan will be formulated to increase enforcement of verified cases that violate quarantine.
“They will be tried, and punishments will be severe,” the Prime Minister’s Office said.
• The “Magen Avot’’ plan will resume operations, testing around 10,000 elderly in senior living facilities a day. The number of people being screened each day from the general public will also be increased.
• All people traveling through Ben-Gurion Airport will be required to wear masks. Those
traveling abroad will sign a declaration before boarding their planes to the effect that they promise not to go to high-risk countries. This declaration will be checked at the boarding desk. The same rules will be applied to land crossings.
Do masks really help?
Health officials say that masks can stop the spread of infection – especially at the airport.
“The airport is a place where you have more people that are not vaccinated than anywhere in Israel except schools,” Cohen said. “There are lots of families in close proximity to one another, waiting in lines. This is a crowded environment.”
Last Friday, a huge group of travelers arrived at the airport at the same time, and there were such long lines so close to Shabbat that a decision was made to send thousands of them home without being screened.
Since then, the Health and Defense ministries have expanded the number of testing booths at Ben-Gurion Airport and have committed to quickly create an additional testing complex.
“We know that 85% to 99% of all infections happen in closed spaces,” Cohen said.
7. If asked again to wear masks again, social distance or take on other restrictions, will Israelis be willing to do it?
“I think if we will give advice, it will be largely heeded,” Balicer told the Post.
Miron-Shatz said that if logical rules are rolled out, officials must enforce them to protect the people – whether the people like it or not.
“If someone is diabetic, they are diabetic. That is their problem,” she said. “If someone has COVID, it is the problem of everyone
around them, who can catch the virus.”
She said there were some people who resented the green passport system or other restrictions put on unvaccinated citizens, “but the truth is, you have to protect yourself and society, and we have been lax with that.”
Miron-Shatz bemoaned, however, that the previous administration sometimes put in place rules that made little epidemiological sense, such as not being allowed to wade in the sea, which also made people resentful. So, if this government is going to issue new regulations, they should “make sense and be seen not as a way of controlling me but, rather, of protecting me.”
So far, the Health and Transportation ministries and the Airports Authority appear to be willing to collaborate for the benefit of the public, Davidovitch said. “This integration is so important.”
8. The United Arab Emirates is one of the most vaccinated countries in the world, yet it has a high level of infection right now and has been the culprit for a large percentage of the infection brought into Israel. Why?
Different vaccines have different levels of protection.
The Chinese Sinovac vaccine, used in large parts of the Emirates, is called an inactivated vaccine, in which one takes the original virus and chemically modifies it to kill it and then injects it in the body. Inactivated vaccines have been around for more than 100 years.
“We know that when you do that process, by boiling the virus or adding a chemical compound, what you might do is that you destroy the original structure of the virus, and what you are injecting is not enough reminiscent of the original virus, and therefore the antibodies you are generating
are not optimal to fight the real virus,” Cohen told the Post. “One of the Chinese vaccines – they expected 78% protection, but reallife data in South America and other places are showing protection is more like 50%.”
Similarly, the AstraZeneca vaccine has been found to be only around 60% effective in protecting against getting symptomatic cases of COVID following exposure to the Delta variant, and 92% effective at preventing hospitalization.
“You might be sick, but you can stay at home. This is a huge difference,” Cohen continued. “Some protection is better than none – especially if you do not have a choice.”
9. Should children 12-15 vaccinate? Why or why not?
Here, too, health officials have different perspectives.
Rahav said the effectiveness of the vaccine in adolescents trumps its side effects.
“There have been about 150 cases of myocarditis [heart inflammation] in Israel, and no one is really sure it is related to the vaccine,” she said. “More than 95% of the cases were very mild, and they were only diagnosed because the vaccine is suspected of causing such a thing.
“The risks of having contracted coronavirus and having dangerous coronavirus are much higher,” Rahav stressed.
But Cohen said he is not yet sure.
He admitted that one in 1,000 youth can develop an inflammatory syndrome due to the virus, but said that “if there is no urgency and the disease is manageable and we want to have more data about the potential [long-term harm] of those vaccines on teenagers, you could wait.”
On the other hand, Cohen noted that if there is a new variant
that might compromise the vaccine’s protection and you need to reach higher vaccine coverage to preserve herd immunity, then this should be considered.
“Even if it is only to help kids feel better psychologically that they are protected, then it is worth considering vaccinating,” he added.
More important than the young people, however, are the 200,000 people over the age of 50 who have still not gotten the jab, said Davidovitch.
10. Will coronavirus ever go away?
“COVID is going to stay with us,” Davidovitch maintained.
“We like to think of coronavirus like the flu. You have the flu, get over it and move on with life,” Miron-Shatz said. “But this is more like having diabetes.”
Diabetes is a chronic disease, and living with it requires much more discipline.
“You have to stay on top of it,” Miron-Shatz said. “That is the nature of the COVID beast, and we need to prepare for that.”
Nonetheless, health officials believe that, at least in Israel, COVID-19 will probably drop from the headlines once again soon and the public will move on – until there is another outbreak, something that Cohen said he believes there will definitely be.
“Israel showed that you can take off your masks and live again,” he said. “COVID will be here, but I think we will get into a much better scenario [than now] – especially as vaccination spreads around the world.”
“I cannot think of a weaker and more emasculated message to our enemies in Iran,” Netanyahu added. “From now on... the regime knows that it can sleep silently, with no surprises.”
The truth is that Israel has historically favored a “no daylight” position with the US, and officials working under Netanyahu’s leadership have said as much.
Ashkenazi said at a briefing in March that he and Blinken had agreed that they would not surprise one another on matters relating to negotiations to return to the Iran deal.
Former ambassador to the US Michael Oren described in his book Ally how crestfallen Israel was when Obama said he sought greater daylight with Israel, because, “historically, that principle [of no daylight] applied to the alliance as a whole .... By illuminating gaps in their political positions, the administration cast shadows over Israel’s deterrence power.”
However, Oren also gave credence to Netanyahu’s remarks this week, telling KAN Bet that the Obama administration leaked Israeli attack plans to the media.
Netanyahu is right that it will be a challenge for a new prime minister and foreign minister, with far less experience on the world stage than Netanyahu, to assert itself before Washington, Israel’s greatest strategic ally.
But Bennett and Lapid are determined to show that they are up to the task, and that there is more than one way to make Israel’s voice heard.
As Bennett made clear in his remarks last week, he does not view talking to the Biden administration to get as good an outcome as possible as binding Israel to the Iran deal. After all, he said: “Israel is not a party to the deal, and will maintain total freedom of action.” •