Saying goodbye to Israel’s COVID-19 restrictions

Saying goodbye to Israel’s COVID-19 restrictions, HEALTH AFFAIRS: Health officials say ‘reasonable’ to remove rules, but proper disease monitoring should be maintained

More than a year since Israel first went to battle against coronavirus, victory has been declared.

The Health Ministry announced last Sunday that when the existing coronavirus restrictions expire at the end of the month, it would not request to extend them.

The public is still required to wear masks in closed spaces. However, Health Minister Yuli Edelstein said that professionals will be holding discussions on this obligation in the next two weeks, and that it could be lifted, as well.

Airport restrictions will stay in place and even be tightened, if necessary.

The government made the correct decision in deciding to lift nearly all COVID-19 restrictions beginning on June 1, health officials told The Jerusalem Post.

“I think it is a reasonable decision,” Prof. Eyal Leshem, director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center, said. “Despite intensely normal interactions between Israelis, we don’t see large coronavirus outbreaks.”

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He said that “we see local outbreaks where people have lower immune systems or are not vaccinated, like in long-term care facilities or among children; but these outbreaks don’t grow, because most Israelis are vaccinated.”

Between May 16 and 26, Israel had between eight and 55 new cases diagnosed per day, compared to more than 10,000 new cases per day at the peak of the pandemic. There are less than 500 sick people in the country, including less than 50 serious cases.

However, the reproduction rate, or “R,” has been on the incline. The Health Ministry reported this week that the rate hit 1; recall that health officials required the rate to stay below 0.8 in order to allow restrictions to be lifted during the crisis.

“I think most restrictions could have been lifted much earlier,” Dr. Yoav Yehezkelli, from the department of emergency management and disaster in the School of Public Health at Tel Aviv University, told the Post. “Green passport restrictions were actually never needed in the first place.”

He said that the masking restriction should also be removed now, although “there may be some value to wearing masks in closed and very crowded spaces” when virus levels are high.

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“It could have been lifted already a month or two ago,” Yehezkelli maintained. “Public health is not only COVID-19, but also general well-being; issues of anxiety, depression and employment are all issues of public health.”
But Leshem cautioned that Israel should not become too complacent too quickly.

“‘Forever’ is not a scientific term,” he told the Post in response to whether Israel is done with the pandemic. “There is only one thing in medicine that is truly forever, unfortunately.”

According to Leshem, it is currently understood that the immunity provided by the Pfizer coronavirus vaccine, with which 5.4 million Israelis are inoculated, lasts more than six months. The company is working on a booster shot that could be administered in the event of declining immunity. As such, he said, “boosting the population will not be a substantial challenge.”

So, what are the challenges?

He said the first one is that Israel must prevent the introduction of variants from abroad that could make the vaccine less effective, although until now “none of the variants was dangerous enough to gain a foothold in Israel.”

That’s because the coronavirus is a relatively “stable virus,” Yehezkelli explained.

Unlike the influenza virus which mutates every year and requires a totally new vaccination, the coronavirus variants found are not so dissimilar from the original strain, and the vaccines have therefore managed to protect against them.

The other potential challenge is that Israel still has millions of citizens who are unvaccinated, including more than two million children.

Although the American Food and Drug Administration has approved vaccination of youth between the ages of 12 and 15, Israel has yet to determine if it believes such a move is right for this country.

Leshem said that “when the school system restarts next fall and winter, we will have to ensure it is done in a safe way.”

Israeli schools resumed in full shortly after the Passover holiday. So far, there has not been a spike in infection among students. The latest report by the Education Ministry showed there were only 102 students and two faculty members sick with coronavirus in the entire country.

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An Israeli study published at the end of April in the peer-reviewed Journal of the American Medical Association found that children up to the age of nine are unlikely to spread coronavirus at school and that they have little to do with the spread of coronavirus among the community.

However, the study did find that children 10-19 years of age were three times more likely to contract COVID-19 after returning to school than when they were still at home.

“Children were never actually the driver of infection,” Yehezkelli said, adding that even if COVID-19 did surge again among youth, it is unlikely to “cause such a severe problem like before.” That’s because children are at low risk for developing acute cases of the disease, and the country’s most vulnerable population – elderly and people with underlying medical conditions – are already largely vaccinated.

“Even if coronavirus would emerge again, it should not cause so much of a problem and will probably become more of a seasonal viral disease, much like the flu,” Yehezkelli maintained.

The COVID-19 pandemic could resurface in Israel again this winter, former Health Ministry deputy director-general Itamar Grotto told the Post. He said he believes that the novel coronavirus was always a seasonal disease, although in its first year it did not appear that way.

He explained that while flu season generally peaks around February and is considered a winter disease, cases of flu can already be diagnosed in the summer. Likewise, the four most common coronaviruses known to infect humans are highly seasonal, with most cases peaking in winter months.

“Many times, in pandemics they start out one way, but once they are stable, they become winter diseases,” Grotto said. “We thought at first that COVID would be seasonal. It is very difficult to determine seasonality in the first year.”

Leshem said that Israel will need to watch for such a winter resurgence, in that January will be around a year since most Israelis got the jab, and their immunity could be declining at the same time as the virus could be spiking.

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But he said it is too early to predict.

Rather, he recommended that Israel monitor the behavior of the virus in the southern hemisphere, where winter begins earlier, to help provide insight into what Israel might experience.

LESHEM STRESSED that despite the lifting of nearly all restrictions, coronavirus has not gone away.

“Pandemics are long events. From the global perspective, they can last years,” Leshem said. “Pandemics flare up in specific states, regions or countries and decline in others. This is a classic trend of global diseases.”

As such, the government should better monitor the public to catch an upsurge early, Grotto said.

Although Israel has the ability to test as many as 130,000 Israelis in a single day, only around 30,000 Israelis are being screened per day.

In addition, Israel invested in building a sophisticated system through the military to cut the chains of infection. But earlier this week, the Defense Ministry said it had approved a plan to transfer the work of the Alon Headquarters back to the health system.

However, the ministry said a reserve unit would be established to provide an emergency response for the state in the case of a re-eruption of coronavirus or another pandemic.

“The government is again making the decision not to monitor properly to catch [an outbreak] early,” Grotto maintained. “We saw before that the virus can get out of control. Not only is the system putting less effort into monitoring, it should be strengthening surveillance so we can catch any resurgence in real time.”

Grotto added that even when mask restrictions are lifted, people should carry them in their pockets and bags and stay familiar with the practice, just in case there is a need to use masks again, such as in the winter. He said he also recommends maintaining mask use indoors for people who are immunosuppressed to prevent not only the coronavirus but also other viruses, like flu.

A second recommendation is to maintain good hygiene.

“There are a lot of positive hygiene habits that people started during COVID-19, and also some distancing,” Grotto said. “These measures should continue because they also prevent other diseases.”

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