Category: Covid-19

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.

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.

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).

A few positive signs from the data on Israel’s fight against the coronavirus:

Test positivity is down

The percentage of tests that come back as positive for the coronavirus is one of the best measures of how widespread the real infection is likely to be.

In late July, Israel was hitting 8% average positivity, but this has dropped down to a little over 6% now. The drop coincides with a drop in new confirmed cases, which suggests that it’s real.

The test positivity calculation only includes tests given to identify infected people. It doesn’t include tests given to people we already knew had the virus, which are now mostly only given to seriously ill people in hospitals anyway. However, it does include survey testing in old-age homes, medical staff etc.

According to Health Minister Yuli Edelstein, if survey testing is excluded then the real positivity rate as of a week or so ago was closer to 10-11%. The number of survey tests isn’t published so I can’t say if the graph above partly reflects a shift in the type of testing or not. But I hope that that the positivity drop isn’t just an artifact of increased survey tests.

Haredi towns are doing better

Throughout both waves, Haredi populations have been the epicentre of Israel’s Covid-19 infections, and Haredi Jews made up 36-39% of all new diagnosed cases, three times their population share.

Haredi towns were consistently the worst infection sites even as recently as a week and a half ago, with Modiin Illit at 27.5% test positivity and 1.5% of the town with active infections, while Elad, Beitar Ilit, Rechasim and Bnei Brak had around 20% positive tests too.

That picture seems to have changed. There are now no Haredi towns with 20% positivity. Modiin Illit is down to just 6%, with Elad and Bnei Brak to 10%.

It’s now a few Arab towns that are now the places with the highest positivity, but these are not at the same level of case positivity that the Haredi towns saw a few weeks ago and the absolute number of cases in those towns is also small.

So overall it looks like Israel’s second wave is tending downwards. If things stayed the same, we could keep things under control.

Of course, things are not staying the same. Haredi schools reopened last week, and the rest of the school system will follow next week. Larger cultural events will be allowed, and the High Holy Days are coming with their large family meals and synagogue attendance. I would expect cases to begin to climb again by mid-September. But these few weeks of dropping cases should, at least, buy the country a bit of room to manoeuvre.