As surprising as it may sound, an epidemic and the measures taken to fight it unfold in a somewhat expected pattern. Articles that I and others have written recently in these pages have already described the "fog of war," the phase of containment, the efforts to slow down the spread of the virus by maintaining social distancing, and the harsh implications for countries that choose not to adopt decisive early steps to tackle this pandemic.
In the last few weeks, public attention in Israel has been primarily focused on the generalized social distancing strategy, designed to prevent a widespread public health disaster. Against the backdrop of the coronavirus scenarios in Italy and Spain, the question under discussion had been whether – and to what extent – a policy of isolation and social distancing should be enforced, followed by an even tougher lockdown that confines people to their homes.
Decision makers and the public debated the appropriate balance between the immediate and prolonged damage to the economy, which also seriously impacts the health and wellbeing of the population, and the destructive potential of a subsequent uncontrollable outbreak beyond the health system surge capacity, with the sustained damage it would inflict on both public health and the economy at large.
The current decision-making process in Israel is complex in view of conflicting indications – positive signs that would suggest slowing further movement restrictions, in parallel to worrying indications that call for a more conservative approach.
New lab-positive cases are accumulating in rates that do not continue to grow as quickly. But this general picture may be masking a rapid, dangerous, exponential rise in infection rates in (some of) the ultra-Orthodox and Arab communities.
Mathematical models and past experience show that the spread of infection in communities living in overcrowded conditions can spark a renewed and serious outbreak among all segments of society. From an epidemiological perspective, Israel’s population (as well as, to a large extent, that of the Palestinian Authority) constitutes interconnecting "communicating vessels" with immediate collateral impact.
In the current setting, the most stable and reliable marker of population-based trends in disease dissemination is the trend in the numbers of severely ill and respirator-aided Covid-19 patients. However, this marker lags behind the real-time spread by several weeks. If we continue to see that this marker is stabilizing – a collective sigh of relief will be heard. In the meantime, we must not wait for absolute certainty before planning the next phase of contending with this crisis and its attendant closure: the exit strategy.