Arieh Kovler

Author: arieh

  • 10? 14? Explaining quarantine lengths

    10? 14? Explaining quarantine lengths

    There’s been a LOT of confusion over how long mandatory quarantine (aka self-isolation or בידוד, “Bidud“) lasts in Israel. I probably get a few messages a week asking me about it, and it’s a popular topic on Secret Jerusalem too.

    Basically, there are two categories of quarantine in Israel, as there are in many other countries:

    Infection quarantine

    People who have tested positive for Covid-19 are in infection quarantine. These people have or recently had Covid-19. They must self-isolate for:

    • (Ten days from the onset of their symptoms,
    • OR ten days from their first positive test if they have no symptoms)
    • AND three days from the end of their symptoms if they had symptoms

    So, for example,

    • someone with a positive test and no symptoms has to self-isolate for ten days from the test date.
    • someone with a positive test, a cough and a fever that goes away after five days has to self-isolate for ten days.
    • someone with a positive test, a cough and a fever that lingers two weeks has to stay in quarantine for 17 days.

    It isn’t necessary to have a negative virus test to get out of quarantine, and Israel doesn’t even administer tests to people who are already known cases.

    Exposure quarantine

    Anyone who has not tested positive for Covid-19 but is still in quarantine is in exposure quarantine. These people were in suspected contact with someone else who had Covid-19.

    The precise rules for who has to go into exposure quarantine are complicated. It includes people who were in close contact with a confirmed case, but the definition of ‘close contact’ is unclear; the Ministry of Health says it means being within two metres of an infected person for 15 minutes. In practice, though, people who were in the same shop or room as a case are sometimes sent to quarantine, too.

    Exposure quarantine rules in schools are also applied differently. And then there are people who are sent into self-isolation by the General Security Service’s phone tracing. Basically, it’s all a great big mess.

    Travellers who arrive from abroad are considered to have been exposed in transit unless they came from a ‘green country’. So travel quarantine is just a special case of exposure quarantine.

    People in exposure quarantine must self-isolate for 14 days from the exposure. If the person tests positive for the virus, then they move over into infection quarantine rules (above). If not, out in 14 days.

    Why is infection quarantine shorter than exposure? That seems backwards but it actually makes sense and is the international standard. It’s because exposure quarantine includes four days of hypothetical incubation period to develop the virus, plus the ten days of hypothetical asymptomatic infection.

    On the other hand, once someone actually tests positive for the virus, they’re probably not infectious for very long. In fact, for mild or asymptomatic cases, it seems like people are at their most infectious in the first few days. Ten is already on the safe side.

    In reality, though, many Israelis will spend less time in exposure quarantine anyway, because often the exposure was a week ago or even more. I know lots of people who were in exposure quarantine for just two or three days by the time they found out about it.

    Did I say two categories? Well, there’s sort of a third one too:

    Symptom Quarantine…?

    You wake up in the morning with a cough and a temperature. You call your doctor who tells you to get a coronavirus test and writes you a referral. The next testing slot is tomorrow afternoon.

    In this case, where there is no known contact with a confirmed case, the law says are supposed to be in quarantine from the time you get the doctor’s referral for a coronavirus test until the test results are returned. This is likely to be a day or two assuming the test is negative. Despite this, the major HMOs are telling people with symptoms to remain self-isolated in this case even with a negative test, until 48 hours from the end of your symptom

    But… the form for notifying the Ministry of Health about entering quarantine doesn’t include having symptoms alone as an option; that form is only for people who’ve been near a confirmed case. And it seems like the legal requirement for quarantine doesn’t kick in until the sick person gets referred by their doctor for a test. So a person with symptoms is under no legal obligations at all to see a doctor; they can go around infecting people. I hope I’ve misunderstood this, and will correct it if I have. I suspect that a lot of Israel’s infection chains are caused by people with symptoms like this.

    There are a couple of other cases where I’m not sure what happens.

    Imagine a traveller arrives in Israel on Monday morning, develops a fever on Monday afternoon and gets a coronavirus test which tests positive. Then say the fever goes away within a couple of days. Does the traveller get to leave quarantine after ten days like a ‘normal’ infected person? Or do they have to stay for the full two weeks as a ‘traveller’? I assume the former, but I don’t know for sure.

    One thing I’m asked a lot is if I’ve heard that travel quarantine will be shortened. I see no real prospect of the 14-day exposure quarantine being shortened any time soon. It’s a global standard based on incubation times, and there’s no indication that the government plans on shortening it. That said, as more countries join the Green List with no quarantine requirements, perhaps it doesn’t matter very much.

  • In the Red Zone

    In the Red Zone

    Earlier this week, the Israeli Government, via the Coronavirus Cabinet, adopted Prof. Ronni Gamzu’s plan, which is officially called the rather dramatic “Shield of Israel plan” but everyone just calls the traffic light plan.

    If you’re a regular, you know I’m sceptical about the plan because it currently calls for a significant easing of social distancing restrictions in all but the worst-affected towns, and relaxing restrictions now seems very risky. Yesterday, Israel identified a record 2,183 new cases and also saw 20 deaths, the highest death total in a single day.

    Yesterday, the list of ‘red’ towns, with the highest rates of infection, was released. This list is NOT the same as the towns which the Health Ministry listed as red in its regular data, because it is calculated differently. The old Health Ministry list gave a lot of weight to absolute number of cases, which made big towns look disproportionately bad. The new system looks at the per-capita number of new cases, the growth rate of the cases, and test positivity percentage.

    The full list isn’t out with every town’s classification, but the red towns were named. They are mostly Arab towns and cities, with several Haredi towns included too, as well as the city of Tiberias. After the list was released, the coronavirus cabinet finally voted to keep schools closed in these towns (though, of course, the Haredi schools had already reopened a week ago).

    Anyway, it made me wonder: maybe the real plan is for much more significant measures to be imposed on red towns. Since the plan was voted through, Gamzu himself has now acknowledged that full town lockdowns are an option, complete with travel and entry restrictions. Maybe he knew he could never successfully pass a plan that openly called for such measures from the beginning.

    And then there’s Bnei Brak.

    Bnei Brak isn’t Beitar Illit; it’s one of the capital cities of Haredi life in Israel, maybe moreso even than Jerusalem. Much of the Haredi leadership, its Rabbis, Rebbes and fixers, live there.

    Throughout both waves of Covid-19, Bnei Brak was consistently a virus hotspot in both absolute numbers and rates of infection. Bnei Brak was locked down with additional measures in early April, which proved extremely unpopular with the Haredi leadership. In July, as cases skyrocketed, Bnei Brak was left alone even as other towns were briefly locked down.

    Bnei Brak isn’t on the red list right now; it’s actually had a bit of a drop in new cases over the last two weeks. But I’m pretty sure that if it had been included, the Government would never have agreed to shut schools in red towns.

    But the coronavirus cabinet doesn’t control the traffic light list itself. The list is drawn up based on (theoretically) open and objective criteria compiled by the Health Ministry.

    So perhaps this is the plan behind the Gamzu plan:

    1. Get the framework of the traffic light scheme adopted while the list of towns doesn’t include very many Haredi towns, especially not Bnei Brak.
    2. Impose stricter measures on red towns because it’s politically possible to do it now, eventually coming close to local lockdowns.
    3. Expect that many Haredi towns, which are probably orange areas at the moment, will dip into red status in two weeks when the list is recalculated, and will inherit the tougher measures.

    This is a long and inefficient way to stop a pandemic. But it’s all we have.

  • Covid Roundup 30 August

    Gamzu plan authorized…ish?

    The Coronavirus Cabinet today finally voted unanimously to adopt the Gamzu Plan, which is known in Israel as “Tochnit HaRamzor”, the traffic light plan. Under the plan, cities will have different rules according to the level of infection, with additional restrictions on red cities and relaxations in most everywhere else. It will come into effect after passing through the Knesset, which won’t happen until the second week of September .

    Votes on the plan had been delayed for three meetings running after opposition from Haredi parties, who opposed the tighter restrictions because many red cities would be Haredi (due to the high infection rate in that community). So why did they accept it now?

    The answer is predictable: because the plan has been partly neutered already. One of Gamzu’s key recommendations was that schools should close in red cities. The Coronavirus Cabinet voted to ignore this part of the plan. Prof. Gamzu condemned this decision tonight, saying it would cause new outbreaks and that he would continue to campaign against it. But some of this is moot, as Haredi education restarted two weeks ago in any case.

    Cultural reopenings

    As part of the Gamzu Plan, cultural centres in green cities will be allowed to reopen with up to 1000 people, as long as the hall is maximum 60% full and only 100 people use each entrance.

    Of course, there is no law or rule to stop people who live in red cities going to these cultural events in green cities, so I don’t see how this can possibly be a good plan, but I suppose we’ll see.

    Hospitalizations, serious cases still rising

    Last week I noted the sharp rise in serious coronavirus cases in Israel’s hospitals and speculated on the cause. Well, some of the cause was actually a counting error in the Health Ministry’s system, where the most critical patients were counted in the ‘serious’ category twice.

    However, the real numbers of both hospital admissions and serious cases are up. The weekend jump in hospital admissions last week never went away. Today’s weekend jump brings us close to 900 patients admitted, half of whom are in serious condition.

    Deaths also continue to be high. Throughout August, an average of 12 Israelis a day have passed away from the virus. While not as high as the spring disasters in New York, Italy or the UK, Israels per-capita daily death toll is high for developed countries at this phase of the pandemic.

    Teachers’ union: “Reopen schools more!”

    Unlike in many other countries, Israel’s Teachers’ Union thinks that schools aren’t reopening enough. The Government plan allows older schoolkids to only have two days in class a week with the rest as distance learning, though this is up to each local government to decide. The Teachers’ Union demands that all pupils are back in class fulltime despite the virus, or they will strike on the first day of school…

    …but the same union says that reopening schools is unfair on vulnerable teachers, who could catch the virus. The union demands that these teachers should be put on indefinite paid sick leave, or they will strike on the first day of school.

    So that’s one thing that’s normal, at least.

    Other short points

    • The coronavirus labs are on strike. For now they’re only giving people positive results but that might stop in a day or two, shutting down Israel’s testing.
    • Uman… do I have to write about Uman? No. I don’t. And you can’t make me.

  • Hospital numbers should be down; they’re up

    In some sense, hospital numbers and deaths are the only ‘real’ measure of how a country is tackling the coronavirus pandemic. On that measure, things have taken a turn for the worse this week.

    The drop in test positivity led me to predict that hospitalisations and serious cases would fall this week. In fact, the opposite has happened. Hospitalisations are up. Serious cases are up, too.

    So what’s going on?

    First, I wasn’t the only one to predict a decline in serious patients based on confirmed virus cases.

    The Coronavirus Information Centre’s graph plots new cases (upper blue line) and predicts that 2.5% of them will become seriously ill. This prediction held up well since early July but has diverged this week. The graph above is exponential, so the small gap between the lines is a bigger miss than it looks. More people are getting seriously sick than we would expect. Eran Segal at the Weismann Institute also noted the seriously ill rising faster than his own predictions.

    A higher percentage of cases are older people.

    Throughout most of the second wave, the over-80s have been 1-2% of daily cases. That number has bumped up a bit to 3-4%, and the 60-79 group has also increased.

    This graph from Eran Segel shows that until early August, the proportion of new cases that are over-60s and under-60s was basically stable, but that since early August, proportionally more over-60s are diagnosed with the virus every day.

    If the cohort of new cases is older than in June and July, then that would mean proportionately more sick people as a share of the total caseload.

    Hidden infections?

    Eran has a further hypothesis: actually, let’s assume the breakdown of new infections is the same as in July. The decreased percentage of younger people would then be a result of fewer under-60s choosing to get tested. From the graph above, it would suggest about 300 cases a day that are being missed due to people choosing to not get tested.

    Who chooses to not get tested? People who were exposed to a Covid case but don’t want to notify the Health Ministry and be forced into a 14-day home isolation. People with minor symptoms, perhaps, who don’t want to be blamed for sending their family, friends and colleagues into a 14-day home isolation. It’s frustrating, embarrassing to be the cause of such chaos; easy to stay home a week and tell yourself it was probably just a cold.

    There’s also a communal aspect here. Haredim make up nearly 40% of all Israel’s virus cases, but that proportion was a lot higher until the last few weeks. Suddenly, Haredi towns have gone from virus hotspots to safe in just two weeks. Haredi schools have already reopened, too.

    But the Health Ministry is concerned that Haredi communities are avoiding getting tested inside the official system. Some are rumoured to take private tests that don’t get reported to the government, while others may be avoiding tests altogether.

    Nobody can completely confirm this theory, but the Haredi political parties have been heavily lobbying for more relaxations of the coronavirus rules, especially on synagogues. The community was very eager to ensure their schools and yeshivot opened last week without any closures or lockdowns. And they are threatening to bring down the government in opposition to the Gamzu Plan, because targeted lockdowns will disproportionately affect the infection hotspots, which in turn had been disproportionately Haredi.

    So perhaps the drop in cases is because sick people are avoiding tests. Perhaps the fall in Haredi towns is because Haredi leaders are trying to massage the data to keep the synagogues and yeshivot open. Or perhaps it’s all a weird fluke in Health Ministry reporting cycles again and numbers will level out tomorrow (they’ve already dipped a little this evening).

    The only thing we can say for sure is that things aren’t getting better in the hospitals right now. They’re getting worse.

  • Covid Roundup 25 August

    Just a few brief updates:

    • Serious Covid-19 cases in Israel are up to 427, the highest recorded number since the start of the pandemic. 121 are on ventilators, the highest since the last wave. I suspect that this increase is because of the higher age profile of recent new infections — more on this in the future (it’s the future now so more here).
    • On Monday, Israel reported processing over 30,000 tests, breaking 30k for the first time in over a month.
    • Gadi Yevarkan, a Likud MK and deputy minister, was diagnosed with the coronavirus. A few days ago, Immigration Minister Pnina Tamano-Shata (Blue and White) was also confirmed infected with Covid-19. Several Knesset members who have been in contact with them are now in self-isolation.
    • The Government once again delayed a vote on the Gamzu Plan, instead renewing the current social distancing rules (20 indoors, 30 outdoors).