Israel’s War Footing Against the Coronavirus

TEL AVIV, Israel—Israel has taken some of the farthest-reaching measures of any country in the world to slow the advance of the new coronavirus, but health officials believe Israelis remain vulnerable due to funding shortages and other issues.

In some ways, the Israeli response has resembled a tactic favored by its military: preemptive actions, disproportionate in scale.

On Monday, the government announced all arrivals would be required to self-quarantine for two weeks, a directive that will affect hundreds of thousands of people and level a blow to the economy.

The decision was aimed at preventing an already taxed hospital system from being overwhelmed, but it prompted criticism that the government may be overreacting, unnecessarily crimping freedom of movement and sowing panic.

“They took every step to make sure that introduction into Israel is delayed for as long as possible. The purpose for this delay is similar to delaying the first battle of a war,” said Eyal Leshem, the director of the Center for Travel Medicine and Tropical Diseases at the Sheba Medical Center. “You let your army prepare the resources to combat this outbreak once it hits. And every week is critical.”

Indeed, one of Israel’s main advantages until now has been its relative physical isolation—Ben Gurion Airport is the main umbilical cord to the outside world—along with a centralized, universal health care system and a population accustomed to being on high alert.

There had been one notable exception to Israel’s proactive posture: For days, the government held off on adopting recommendations from bureaucrats to impose limits on travelers from the United States for fear of labeling its most important ally as a public health risk.

According to the local media, the government decided to widen the restrictions to all travelers from abroad rather than take a step that might embarrass the Trump administration.

And even though the organizers of the recent American Israel Public Affairs Committee convention in Washington, D.C., announced that participants had been diagnosed with the virus, Israel hasn’t required attendees to self-quarantine back home.

“As COVID-19 spreads, medical professionals are growing increasingly worried about political intervention that isn’t necessarily for the public’s benefit,” warned the liberal Haaretz newspaper in an editorial on Monday.

Still, Israel must deal with serious vulnerabilities in handing the pandemic: The public health system in the occupied West Bank is less equipped to treat the 2.7 million Palestinians who live there. Israel is also walking a thin line because its health system is relatively under-equipped compared to those of other developed countries.

So far, Israel has been relatively successful: The number of confirmed cases of COVID-19 in the country stood at 58 as of Tuesday. In the West Bank, some 29 cases have been reported among Palestinians.

“When you try and prevent something, sometimes you overreact,” Leshem said. “In hindsight, we are now at a point that’s very different from the U.S. or Italy. Because we behaved as an island country—we restricted travel, and quarantined people that came in from outbreak countries—we now still have two or three weeks to prepare for the outbreak.”

The government has called off events with more than 5,000 participants, instructed tens of thousands of people to self-quarantine, and required all health care professionals to remain in the country for the next three months.

Once it’s clear the coronavirus is being transmitted among individuals inside the country (rather than from people who brought it with them from abroad), officials say they plan to impose additional social distancing policies. On Monday, Israel’s transportation ministry published a ban on public bus passengers from standing or riding in seats behind the driver.

Public health officials say their objective has been to limit the peak caseload of critical patients and spread it out over a longer period of time.

“That way, at the peak of the epidemic, fewer patients will have to be treated in hospitals and ICUs,” said Itamar Grotto, the associate director-general of Israel’s Health Ministry. “This is why we are trying to perform very aggressive containment efforts.”

Not everyone agrees with the government’s approach. Rivka Carmi, a health sciences professor and former president of Ben-Gurion University, told Israel public radio that the measures have contributed to a public “panic.” Arad Nir, an international affairs commentator on Channel 12 television news complained last month that the virus isn’t more dangerous than the flu and that Israeli health officials “galloped too fast” in shutting down travel.

The extreme measures will come at a cost to the economy. The travel restrictions are expected to wipe out the annual wave of tourism for the Jewish holiday of Passover. On Monday, Israel’s benchmark stock index lost 7.35 percent of its value. And there’s concern that El Al Airlines, the national carrier, could go bankrupt without a government bailout.

Israeli experts say that once the majority of the cases are transmitted domestically, the effectiveness of the strict entry rules will diminish.

“These kinds of measures can only be applied for a limited time. They can exact a social and economic price,” said Nadav Davidovitch, the director of the School of Public Health at Ben-Gurion University. “The line between an alert and panic can be very thin.”

Factors beyond the immediate response have played to Israel’s advantage: The country’s socialized medical system allows for patients to get examined for free and ensures that companies pay employees for time out of the office due to coronavirus quarantines. Israel’s publicly backed health care providers use digital patient records that allow for relatively easy sharing of case data.

Another advantage in pandemic preparedness: Israel is accustomed to operating on war footing, with public servants and institutions easily adapting to what is known in the country as “an emergency routine.”

“Israel is one of the most up-to-date countries in terms of emergency preparedness because of our atmosphere here,” Davidovitch said. “We are much more used to moving from normalcy to a state of emergency, something which is difficult for many countries.”

Despite the country’s relative isolation, the proximity to Palestinian areas in the West Bank—where the medical facilities run by the autonomous Palestinian Authority initially lacked the lab infrastructure to perform coronavirus testing—could increase the spread of the virus.

Last week, the West Bank city of Bethlehem recorded its first virus carriers after it was discovered among a group of Greek tourists who had recently visited. In an effort to help Palestinians respond to the outbreak, Israeli hospitals have trained Palestinian medical workers and analyzed coronavirus tests of Palestinian patients in the West Bank. Israel’s defense ministry is reportedly mulling a complete closure on Palestinian areas.

Though there is substantially more separation with the Gaza Strip, small groups of people do move back and forth into Israel. In a densely packed territory of 2 million people sorely lacking in health infrastructure, the spread of the virus there could be disastrous. Amos Harel, the military commentator for Haaretz, reported that Israeli officials are deeply worried about a potential outbreak in Gaza, noting that many in the international community reject the Israeli line that it has no responsibility for the situation there.

Israeli withdrew from Gaza in 2005 but continues to wield control at the borders and over its air and sea. It has maintained a strict cordon on the territory for years.

Inside Israel, there is little margin for error in case of a stress on the country’s public health system. Despite a relatively efficient single-payer insurance system, the infrastructure is underfunded. The country’s hospital bed occupancy is already near 100 percent, and the number of nurses per capita is well below the average for the developed world.

If hundreds of people get the virus in Israel, the country could face the same shortages that are now wracking areas of northern Italy, said Dikla Aharon, a health reporter for Israel’s Kan public radio and television. 

“That can happen here, and it’s going to be a disaster,” she said. “At the end of the day, when you look at a system with near 100 percent occupancy, and a shortage of doctors, that’s something you can’t solve in a day.”