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6 steps “Israel must take to avert COVID chaos” — government’s former top adviser

Israel’s leaders need to stop focusing on “medieval” solutions for COVID-19, such as lockdowns, and take long-overdue smart steps if they are to avert a health service meltdown, a former top government adviser warned.

Prof. Eli Waxman charged that Israel’s current virus woes were no surprise, but rather stemmed from a lack of planning and a cavalier attitude on the part of politicians toward public trust.

Waxman headed the National Security Council’s Expert Advisers’ Committee on Combating the Pandemic. He used the position to urge a clear strategy to deal with the virus and minimize the impact of a second wave, but, he told The Times of Israel, he felt like he was “bashing my head against a brick wall.”

Now, he believes that Israel is on course for a “dangerous scenario.”

“When the number of ICU patients reaches 1,000, the quality of care will be strongly affected, the mortality rate will rise significantly, and mortality of other illnesses will also increase,” he said.

As of Tuesday morning, Israel has 664 coronavirus patients in the hospital, 264 of them in serious condition. There are 29,434 people currently infected, according to official figures.

Waxman, professor of physics at the Weizmann Institute of Science, left his NSC position in May, after handing in a report that was largely ignored. It suggested steps that should be taken, including the establishment of an emergency control center that brings together various state players under the leadership of former military brass, and dilutes the role of the Health Ministry.

He said that he now watches “in frustration how the government fails to do so, leading us to another crisis.”

But he believes there is still time for Israel to turn things around. “There is hope,” he said. “We can live with this pandemic; it is possible, but we have to take the right actions now.”

Talking to The Times of Israel, he outlined six steps he thinks should be taken.

1. Recognize that lockdown is a “medieval tool”

Waxman thinks that lockdown has been overused, and shouldn’t be on the agenda today. He believes that the initial lockdown was overly strict in mostly confining people to 100 meters from their home, which he says lacked an epidemiological basis.

Waxman said that after the lockdown, when Israel should have been building capabilities to ensure that things didn’t deteriorate badly again, leaders were basking in the success of the closure. He argued: “Another lockdown now would be a sign of our failure to build alternative tools to manage a pandemic without lockdown.”

“We had months to build capability and we didn’t do it, so for this reason we seem to be left with a single medieval tool of lockdown. It’s not the way it should have gone.” He wants leaders, now, to stop pushing for another lockdown and instead invest heavily in developing other capabilities that he believes offer far better pandemic-management potential.

2. Latest measures too late, but needn’t be too little

Israel is in the process of imposing renewed restrictions, especially over weekends. In the latest development on Tuesday morning, restaurants were closed to in-house seating by the cabinet, though that decision was subsequently reversed by the Knesset.

Waxman said the government procrastinated before enacting the latest measures, that they aren’t enough, and that the idea of imposing some of the rules only over the weekends is mistaken as they are needed all week long to have an impact.

He said Israel should halt all activity except for work and essential interactions.

Waxman commented: “I think we should stop all leisure and recreational activities, and this includes the beaches. Density on the beaches is very high, and this is high risk.”

The Knesset’s Coronavirus Committee voted Monday to keep pools and beaches open on weekends, contrary to a cabinet decision last week.

He wants summer schools for children in grades four and older to stop immediately, and for their September return to school to be delayed unless virus cases are significantly reduced.

Prime Minister Benjamin Netanyahu on Monday said summer schools would remain open for now. Education Minister Yoav Gallant said Monday: “Schools will open on September 1. Period.”

Waxman said of the latest measures: “They have been taken with delay. They should have been taken earlier. They are partial and they are leaving loopholes. There is no benefit in waiting.”

He added: “The more we wait, the less decisive action we take, the more damage there will be. We are at risk of endangering the hospitalization system in Israel, and we will pay a high price. We need to take decisive action.”

3. Re-diagnose: The pandemic “was never a medical crisis”

Waxman is convinced that the pandemic should be treated as a general crisis, while he thinks Israel’s government has pigeonholed it as a medical crisis.

“The crisis we are facing was never a medical crisis,” he said. “It has a medical aspect but the challenges were professional and managerial and to do with collecting and analyzing data and tracing contacts and building infrastructure for [managing] isolation. These challenges often have nothing to do with health capability, and it is unfortunate that management of it has landed with the Health Ministry.”

Waxman argued in his NSC report, and continues to argue, that the broadness of the challenge means it needed a national alliance tackling it — not an initiative led by the Health Ministry, which he believes lacks the relevant capabilities.

He thinks it is common sense that such a body — heavily drawing on military expertise — would give Israel the best shot at keeping the pandemic in control, and said he has no idea why the government isn’t endorsing the idea.

4. End the cavalier attitude to public trust

Waxman believes that the government’s attitude toward the public comes across as cavalier, while leaders should have handled citizens with care. He thinks it should have imposed restrictions as necessary, while clearly communicating objectives, time-frames and aims. Instead, the government is generating a constant sense of uncertainty. In his view, this uncertainty resulted unnecessarily from last-minute, late-night decisions that changed rules and left the public confused.

Waxman argued that by failing to communicate clearly and transparently, the government exhausted public goodwill too quickly, and citizens now lack patience to follow new instructions. In his analysis, clear communication that wins public trust should be a top priority in government.

He said: “It is crucial to present an overall plan with clear steps of restrictive measures associated with different parts of the pandemic, and a clear explanation of how they will run the pandemic in the long term and how we’ll deal with it without [another] lockdown.”

5. “There just wasn’t a plan.” Make one now.

The government has failed to manage public expectations because it lacks its own clear plan, said Waxman.

“It’s not that the plan was thought through on a government level but not communicated,” he claimed. “There just wasn’t a plan.”

The government should quickly plan for different scenarios, deciding what actions it will take in various circumstances, and make these plans largely transparent to the public.

“We should define several states of emergency that are clear to the public and decision-makers, and allow people to know from looking at the numbers if we’re reaching a higher level of emergency,” Waxman said.

6. Stop failing to harness the power of testing

Waxman noted that Israel performs lots of coronavirus tests, but that many patients haven’t had contacts traced, as this capacity hasn’t been well developed.

In countries such as the United Kingdom and Germany, along with many US states, the per capita number of epidemiologists conducting contact tracing investigations of those who have contracted the coronavirus is 100 times higher than in Israel, figures released Thursday by the Military Intelligence Directorate showed.

Israel is instead relying on the controversial Shin Bet surveillance program to trace those exposed to the virus, though the tracking has proven to be faulty.

In Waxman’s opinion, the limited contact tracing capacity reflects a missed opportunity, and Israel is paying the price.

“In order to suppress outbreaks, one needs to complete the cycle of test, trace [contacts] and isolate [the contacts in quarantine] within 48 hours of a person being sent for a test. If this is done, you may reduce dramatically the number of infections caused by the contacts, and thus ‘kill’ the spread of the pandemic,” he said.

“If you only do the testing, or if you complete the process in too long a time, the contacts infect [others], and you do not affect the spread of the pandemic. The attitude of the Health Ministry is that tests are for identifying carriers for treatment, not for cutting off the chain [of infection]. Hence, they fail to complete the test-trace-isolate process in a timely manner.”

Source: TOI