Israel could have controlled the coronavirus outbreak without a lockdown, according to a team of Hebrew University researchers.
In a new study published on www.arxiv.com, Professors David Gershon, Alexander Lipton and Hagai Levine argue that in countries where the number of intensive care beds per million people is above the threshold of about 100, closures are “unnecessary.”
“It was published that before the COVID-19 burst there were 2,000 beds in Israel and currently around 3,000 beds,” Gershon told The Jerusalem Post. “This means that the lockdown was unnecessary and could be stopped and replaced with a responsible policy of hygienic behavior in public places.”
To come to this conclusion, Gershon and his colleagues developed a model to calculate the consumption of ICU beds, and hospital beds in general, during the spread of the pandemic. The model considers each of the stages of the disease and separates between different population groups, and calculates the rate of infection, hospitalization and ICU beds for the different populations.
“When the numbers that correspond to Israel are plugged into the model, then under the worst assumptions and without any lockdown the number of ICU beds for COVID-19 patients will not exceed 600,” Gershon said.
The model assumes that the goal is not to overburden the healthcare system, as opposed to reducing the amount of infection or saving lives.
If lockdowns are being implemented to buy time until a vaccine is developed or a treatment for the virus found, then lockdowns may potentially protect people from dying of COVID-19. “However, such an approach will lead to economic mayhem, with many people dying from the consequences of economic and financial destruction,” the 24-page report reads.
On the other hand, if the lockdowns are to ensure the pandemic spreads slowly -“flattening the curve” – to ensure that healthcare systems with limited capacity are now overwhelmed, “such an approach can lead to reduced mortality, even if the total number of infections remains the same,” according to the paper.
“We are not trying to minimize the number of people infected – the price of the lockdown is too catastrophic,” Gershon said. “The price of more than 1 million people unemployed is so crazy that to say we want to minimize the number of infected people is ridiculous.”
Expected consequences of the lockdown include enormous unemployment, isolation and loneliness, low access to healthcare, drug abuse and domestic violence, hunger and social unrest, Gershon said.
So how did it happen that Israel shutdown the country?
Gershon said that in the early stages of COVID-19, governments were using “simplistic models for the spread of the pandemic because the last time the world treated a pandemic in a serious way was a long time ago. In the early days, people talked about crazy numbers of death rate. Prime Minister Benjamin Netanyahu even predicted that 5% of the population would die.”
In contrast to those models, the HU model is calibrated with real-time data from recent research articles about COVID-19 in different countries, with information about infection rates, hospitalization and death cases, as well as number of patients in ICU.
“We base our analysis on a detailed heterogeneous epidemiological model, which takes into account different population groups and phases of the disease, including incubation, infection period, hospitalization and treatment in the ICU,” the paper states.
It adds that the authors’ “conclusion is predicated on the widespread implementation of sensible pandemic response measures, such as wearing face masks, following strict hygiene routine, social distancing, paid self-quarantine, and ongoing surveillance via testing and possibly phone tracking. Authorities can enforce such measures by imposing fines for violations of the regime and help employers to provide paid leave related to quarantines.”
Evidence provided by the Gertner Institute research of the Health Ministry showed that on March 9 – before social distancing was implemented – the infection rate was high, at around 1:3. By March 22, the rate dropped to 1:1.3. This was the before the lockdown period. Since then, the rate has stayed basically the same.
Gershon said that in Israel there are around 1 million children and only about 13% of the population would be considered high-risk, which gives it an edge.
In other countries that the team also explored, such as Sweden, Singapore, Taiwan and South Korea, there was never a lockdown and the health system never got close to full capacity, even though the number of ICU beds per population is less than in Israel.
However, he said there are countries for which he would recommend a lockdown, such as the United Kingdom, which lacks beds and protective gear like masks, and Germany, which he said is on the threshold and could benefit from at least a partial lockdown.
Gershon said the Israeli government acted too drastically and too fast “before we had supporting evidence that the situation was severe. Ninety percent of countries in the world waited for signs before locking down, even if they had bad models.”
Dr. Talya Miron-Shatz, founding director of the Center for Medical Decision Making at Ono Academic College also described Israel’s response as “swift and almost hysterical.” She said Israel “did not respond to reality but was looking at the predictions.”
However, she drew an opposite conclusion: “Israel did not wait for Italy,” she said. “To flatten the curve, you look ahead. You don’t let it go to where you cannot control it anymore.”
Public Health expert Manfred Green said of the HU research that “the best modelers are the retrospective modelers. The best diagnosticians are the pathologists. Unfortunately, I am not impressed with these arguments.”
But the HU team plans to take their research further. Next, they are planning to carry out a systematic investigation of the death cases that are caused by the lockdown itself in the short and long term.
“Such an investigation might show that the growth in the number of death cases related to lockdown is higher than the death cases related to COVID-19,” the paper said. “It may have a similar effect to ‘Iatrogenesis’ in medicine, a phenomena where the medicine is more detrimental than the disease itself.
“It is important that all decisions regarding public policies and restrictions be taken based on real time data, and published to the public,” they concluded.
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