Half a year after the onset of the COVID-19 epidemic, morbidity in Israel is on the rise (the important figure is the number of serious patients) and a decision was made by the government to impose a general re-closure, as if it were the most effective and effective measure available to us. A general closure, after which the innovative system for “amputation of the infection chains” will be activated, followed by the vaccine, whose development in Israel is expensive and unnecessary, and will come to the rescue. But like the “exit strategy” from quarantine in the first wave, these are actions whose effectiveness is unclear and whose implementation in the field is unlikely to succeed.
The increase in morbidity and the imposition of a second closure are the result of the failure of the Israeli government to treat the epidemic. The delays in decision-making, their politicization and the loss of public trust, for which the government is responsible, are events that thwart the eradication of the epidemic. Would it have been conceivable during a war that the government would delay for weeks a decision on an action plan offered to it by the military professional echelon? This is exactly what happened with the projector’s traffic light plan appointed by the government itself, which did not receive its backing.
A general closure has not been shown to prevent mortality from an epidemic. It just “flattens the curve” and repels the disease and eventually the area under the curve does not change. A full closure has devastating health, social and economic side effects. The loneliness, anxiety, depression, neglect in balancing chronic diseases, the delay in treating urgent situations, the educational deprivation among children and the violence in closed homes are an unbearable health price to pay for a full closure. This is a price that has not yet been researched and quantified enough, but anyone who works in the field in the first line and treats people, and does not sit in front of the plasmas with the graphs, until he daily and feels it in his flesh. On the heavy economic and social price I think there is no exaggeration. A night curfew is generally a step devoid of any professional logic, as the reduction in contacts he achieves is minimal.
The new corona virus has a special feature that makes dealing with it particularly challenging. Patients with the virus are also contagious when they have no disease markers or in the two days before the first signs of the disease appear. This is why the effectiveness of epidemiological investigations in identifying and isolating contacts is limited in stopping the spread of the disease. The concept of “cutting off the chains of infection” may therefore turn out to be a failed brand, and the huge investment in the huge investigation system that has been established, important as it is, therefore deserves further examination.
What can be done? When in trouble return to base. The basis for stopping disease transmitted from person to person through the air are the physical distance measures, 2 meters and masks indoors, the same behavioral change that the public has not yet understood and internalized its importance, due to lack of trust in the establishment. When we set up the epidemic treatment team in the late 1980s, its members included a psychologist who specializes in population behavior, so that the treatment of behavioral aspects and the public’s involvement in the right actions will be reflected in crisis management. At this time there is no proper treatment of this critical component, the central condition for achieving which is the existence of credible leadership. In the absence of confidence in decision-making and financial compensation for the harm to livelihoods, the public’s willingness to cooperate with a draconian move as a full closure is questionable. Imposing a decree that the public will not abide by and mass disobedience can have heavy implications.
Professional logic must underpin the plan and be clear, understandable and assimilated in each and every one of us, in day-to-day behavior, personal responsibility and mutual guarantee. The responsibility of the younger generation, who are immune to a serious illness, for the older generation is much more vulnerable to the complications of the disease and mortality from it. The distinction between closed spaces and the open air should also be emphasized in the guidelines. The safest in the open air: As long as there is no crowded crowd, there is no professional need to wear a mask outside. On the other hand, wearing a mask indoors is very important.
After the first wave the health system did not receive the resources needed to reinforce it. Precious time went down the drain. Reinforcement, as much as is done at all, today focuses on “irons” instead of the human aspect, on the addition of beds instead of focusing on the addition of manpower and concern for the well-being of worn-out crews and their safety. The limiting factor in the health system’s failure is not the respirators and beds, but the shortening of the breathing of the doctors and nurses. There is something to be done: Recruiting physicians and retired nurses for bureaucratic tasks that do not involve direct contact with patients due to the risk of releasing medical staff to care for patients. Reducing elective surgical activity will make it possible to strengthen the staffs in the internal medicine departments. Hospital administrators still bear the trauma of the Ministry of Health’s decision, then wrong, to shut down elective activity in the first wave of revenue loss that involved, but if they knew they would be fully compensated for such a move economic considerations would not prevent them from making the right decision now.
There has been a lot of talk in recent days about a red flag that the health system has waved to the government in the face of the difficulty. The health care system is busy, the staffs are worn out, but it is far from collapsing. The message that needs to be conveyed is a message of resilience. The real red flag that medical teams wave is to the Israeli government, for the neglect of the health care system, for the politicization of decision-making in the professional field and for the abandonment of medical staff.
The World Health Organization defines health as follows: “Health is a state of perfect physical, mental and social well-being, and not just the absence of disease.” Decision-makers need to see the big picture, so that we do not pay in public health to prevent disease. There is no need for a full closure at this time. Leadership is needed that knows how to make brave decisions, based on professional rather than political considerations, and withstand pressure. Physical distance measures, in which deep professional and logical thought is invested, with uniform criteria for all, and which true leadership will know how to harness the public to follow, may restore public confidence and achieve a better overall result.