Despite COVID Resurgence, Public Health Experts Are Not Alarmed … Yet

A variety of factors have contributed to the rise in coronavirus cases in Israel but experts are more concerned with what will happen in winter

Israeli Prime Minister Binyamin Netanyahu said Sunday that the spread of coronavirus has remained the same since in reached a two-month record high last week, with approximately two hundred new cases daily. The spike in cases has impacted all sectors of society, including three of the prime minister’s bodyguards who serve outside his residence. However, he did not reintroduce any of the restrictions that had been lifted. This and the return to schools have been blamed for the increase in cases.

Still, public health experts are not concerned as they are focusing more on the number of severe cases, which has remained stable, despite the spike in overall cases. These professionals are more concerned about the expected increase in winter, for which, they say, Israel is not yet prepared.

Prof. Nadav Davidovitch, director of the School of Public Health at Ben-Gurion University of the Negev, blames the uptick in cases on the easing of school closures and other restrictions, as well as noncompliance with health measures and increased coronavirus testing.

“Municipalities are more liberal in testing asymptomatic patients. According to the results, it is clear that there are more asymptomatic cases than we estimated initially,” he told The Media Line. “It is a true rise but it is not just about comparing where we were two months ago. We have more asymptomatic cases and we need to take a look more now at severe cases that are relatively stable, which is a promising sign.”

On June 13, the Health Ministry said that there were 177 new cases from the day before, with 35 people in serious condition.

It is a true rise but it is not just about comparing where we were two months ago. We have more asymptomatic cases and we need to take a look more now at severe cases that are relatively stable, which is a promising sign.

However, he agrees that focusing on the worst coronavirus cases is a better telltale of whether we should be concerned.

“The number of cases is not really that important if you don’t have many severe cases. The mild cases aren’t going to need much medical treatment,” he said.

“This is much more serious than flu but it is only in those who get a severe form. The people with a mild form will stay at home for a few days and get better like the flu,” he said. “In the winter, we have 10,000 cases a day of influenza – that’s a normal rate – but most people don’t go for medical treatment for influenza.”

Despite the increase in overall cases, Israelis have continued to conduct business as usual, albeit with less regard to safety measures.

“Israelis are not really complying with wearing masks properly. I think particularly in Israel, it’s a little bit more difficult sometimes to get compliance. The emphasis should be on the places that are most risky,” Prof. Manfred Green, head of the international Master of Public Health program at the University of Haifa, told The Media Line.

Prof. Allon Moses, director of Clinical Microbiology and Infectious Diseases at Hadassah Medical Center, said that we needed testing with more rapid results and that Israel may have been too cavalier when it came to how it opened schools.

“Results should be done in 24 hours; right now, the results take too long,” he told The Media Line, “Safety measures and testing must be done prudently in schools. We have a false sense of security that the disease is gone but coronavirus is not gone.

“All the rules of social distancing should be used with very close monitoring and contact tracing, he added. “The notion that children are immune or less vulnerable to the disease is a mistake and we now see the problem of asymptomatic cases and how they are treated.”

In response, a spokesperson in the Education Ministry told The Media Line: “Only 361 students in the country are sick out of 2 million. As soon as there is news of a sick person, we immediately close the educational institution to trace the source of the infection. This brings us to the finding that most of those infected are not necessarily due to the education system.”

The University of Haifa’s Green does not believe that the increase in overall cases requires the reimposition of prior restrictions that have already been lifted.

“We don’t actually have any means of stopping the spread. The only thing we can do is slow it down and that’s what we have been doing,” he told The Media Line. “The idea now is to maintain measures that are a balance between slowing down the pandemic, not letting the number of cases get too high so that the medical system can’t cope, and on the other hand, maintaining a normal life.”

Davidovitch argues that in order to maintain a normal life, Israel has to be more “sophisticated” in reducing the spread of the virus, including a new alert system that is currently being developed at Ben-Gurion University that would test sewage for coronavirus, as well as rapid testing.

“We need to develop more differentiated measures and not just close everything down, instead taking care of red zones.”

All of this has both Davidovitch and Green concerned about the winter, with an expected surge in November and December.

“We are not prepared for winter,” Davidovitch said. “We need to take care of health care workers – there is a lot of burnout; strengthen the epidemiological system with public health nurses; create a more integrated system with continuance of care between hospitals, the community, and homes; and take care of non-corona aspects of health care.”

An example of the latter is a reduction in vaccination rates, particularly measles, as Davidovitch notes that the vaccination rate for measles went down 10% to 85% of the eligible population.

“If it remains at 85%, there is a danger of an outbreak of measles.”

“I’m concerned that in the winter, it is going to get more difficult to control, as far as we can understand now,” Green said. “Obviously we would like to vaccinate as many as people as possible against influenza, get people to work at home where they can, not close down business, and make sure the physical distancing is more stringent and that people are using masks.”

“In the winter, the elderly and those who are vulnerable to other health conditions should avoid going to crowded places. I would encourage people to go for walks,” Green added. “I don’t think it’s good for anyone to stay at home all the time.”

We are not prepared for winter. We need to take care of health care workers – there is a lot of burnout; strengthen the epidemiological system with public health nurses; create a more integrated system with continuance of care between hospitals, the community, and homes; and take care of non-corona aspects of health care.

Prof. Michael Hartal, executive director of Myers-JDC-Brookdale Institute, which has conducted research on the impact of coronavirus on health behaviors, said that according to their research, 60% of the kids and close to 60% of adults reduced their exercise moderately or significantly over a period of months during the lockdown.

“The cumulative effects of having people exercise less can be very substantial for public health, especially if we are looking at resuming some of those restrictions,” Hartal told The Media Line. “As a result of the outbreak at a fitness center in Jerusalem reported today, people are going to be more reluctant to go to gyms and that is going to have another significant impact on physical fitness and it’s going to be months again before we recover from this.”

“The long-term effects of reductions in physical fitness can be significant for weight gain, high blood pressure, and cardiovascular health,” he said.

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