The future of the corona virus - in the world and in Israel

"The real fear is that the people who do not follow the government's instructions - they are the ones who will bring about the realization of the worst-case scenario"

In the last three months, the world has experienced an upheaval of a magnitude, well, global. China imposed a curfew on hundreds of millions of citizens and prevented them from leaving their homes for many weeks. Some are still under lockdown. Two months later, when the corona virus (its scientific name is SARS-CoV-2, and the disease it causes is called Covid-19, but I will call it here the "coronavirus" for short) arrived in Italy, we saw a similar reaction from the authorities. And just in the last few days, the government in Italy decided to impose a complete lockdown on all of Italy, in a move that could finally bury the country's economy.

Oh, and in Israel the Ministry of Health declared war on the whole world, and put tens of thousands of citizens into isolation, including everyone coming from foreign countries.

but why? What is the reason for the anxiety that suddenly attacked the world from a virus that some claim is no worse than the flu?

In this post I want to try to explain the reason for all these dramatic steps - in the short term and the long term. I warn in advance that this will be a scary record, but I believe that the public should also understand the implications of the spread of the virus, and why governments are taking extreme preventive measures, but are afraid to explain their reason to the general public. If we do not understand how serious the situation -=could=- be, we will not know why it is so important that we follow the instructions of the government and the Ministry of Health. My real fear is that the people who do not follow the government's instructions - are the ones who will bring about the realization of the worst case scenario.

So please: read the record carefully to understand what the worst future could be, but keep reading to the end to discover the bright spots as well, and why there is hope - if only we act correctly.

When a new virus appears

In mid-December, laboratories in the area of ​​the city of Wuhan, China began receiving saliva samples taken from pneumonia patients in the city. It took the laboratories about a week to sequence the genetic code of the virus that was present in the samples, and to recognize that there is an eighty percent similarity between it and the infamous SARS... but beyond that, it is a new virus unknown to mankind.

The laboratories came under pressure and conveyed the message to the officials from above, who gently told them to keep their mouths shut and not to cause public panic. And so they did, until one brave laboratory stood up in early January and published the genetic code of the virus. It was closed immediately the next day, at the order of the authorities, but the arrow was already out of the bagIt was clear to everyone that there was a new virus there in China[1].

It took the Chinese government some time to understand the seriousness of the situation, but very quickly it discovered that it had a serious problem in the Wuhan area: residents flocked to the hospitals with breathing difficulties, fever and pneumonia. Fortunately for them, although the new virus was indeed similar to SARS, the associated mortality rate was much lower. If in the case of SARS ten percent of those infected die, then in the case of the new corona virus, the estimated mortality rate in Vaughan was only 2 percent (and this is probably an exaggerated estimate as well, since we do not know the exact number of infected).

Here it is worth stopping for a moment and explaining what we know today about the disease. Out of every hundred people who contract the virus, about eighty of them will develop only a mild illness, or even remain apparently healthy. Fourteen will develop a more serious illness, with advanced breathing difficulties and pneumonia, which will require treatment in the hospital. Five will need emergency treatment, due to infectious shock, respiratory failure and collapse of body systems. andTwo out of a hundred patients will, well, die[2].

These data are not accurate, because a large part of those infected with the virus probably do not develop a significant disease and do not even go to the doctor to be examined, and therefore are not included in the statistics. Because of this, the number of infected people is probably much higher - maybe two times, three times, or ten times or more - than we know. If we rely on the data coming from South Korea, where more than 0.6 people have already been tested - including those who are not suspected of being infected - then it seems that the mortality rate there is 'only' XNUMX percent. Even then, the virus is still six times deadlier than the seasonal flu (which kills 0.1 percent of those infected) [3]. Also, only 1.3 percent of all flu patients in the US in the past year required hospitalization, Compared to twenty one percent of those infected with the corona virus[4].

The big disruptor

China was not ready to shut down the economy of the entire Hubei region that embraces the city of Wuhan, without a very good reason. Wuhan is one of the most advanced industrial cities in China, with 11 million inhabitants and an extensive economy. Or at least she was. However, the Chinese authorities saw within a month of the beginning of the diagnoses, that a large number of people needed hospitalization due to breathing difficulties and lung infections. The corona virus, it turns out, is highly contagious. Each person infected with the virus, in turn infects an average of 2.2 other people. in this respect, The corona virus is almost twice as contagious as the seasonal flu[8]. It is no wonder that in the city of Wuhan, the number of infected people jumped rapidly.

Remember the World Health Organization statistics? Out of every hundred carriers of the virus, twenty one will need emergency treatment. Let's assume for a moment that most carriers really aren't identified as carriers, so the proportion of seriously ill patients is much smaller. Let's say, for example, that it is only twenty seriously ill out of every 500 carriers, and not out of every hundred. That's a big discount, but let's go. Suppose. Let's also assume that the virus - which, as mentioned, is more contagious than the flu - reaches the infection levels of the 1889 flu epidemic, in which an estimated sixty percent of the world's population was infected (the virus that was behind that epidemic was contagious at a rate similar to that of the corona virus, so that every person infected about two people).

We will do the calculations quickly. If sixty percent of the 11 million population were infected with the virus, Wuhan's hospitals would have to treat 264,000 people who could die without urgent medical care.

The hospitals should not be able to handle such a load. By comparison, the average hospital in the United States contains only 190 beds, And a large part of them are not intended for patients in emergency situations[9]. I don't know how many beds there are in the hospitals in China, but what is certain - they too could not handle the emergency that the corona virus brought upon them. The government immediately realized it had a problem, imposed a lockdown on all of Wuhan, and established two new hospitals within two weeks, in an operation that can only be done in China. Immediately after that, she imposed a curfew on all residents, preventing them from leaving their homes for weeks (perhaps except for one small foray once a week to purchase food), just to prevent the virus from spreading and infecting healthy people.

Say now - what was China so afraid of? Then the hospitals will collapse - so what? Is the alternative of stopping all life in the city better than the collapse of the hospitals?

The importance of hospitals

The answer is that the hospitals are much more essential than it seems to the economy and society.

Here are some of the things that will happen in a situation where the hospitals are full to capacity. I apologize in advance for the apocalyptic picture, but it is not far from the situation in which the hospitals in Wuhan found themselves, from which they managed to escape mainly thanks to the 'excessive' response of the Chinese government, which opened two more hospitals as mentioned, and imposed a lockdown that prevented the spread of the virus.

• The members of the medical staff will work around the clock, get tired, make mistakes - and will also get infected with the corona virus themselves sooner or later. And along the way, they will also infect everyone who comes to the hospital.
• The stock of drugs to reduce fever, to prevent and stop convulsions (resulting from fever), to anesthetize patients (necessary in case they need to be intubated), etc. will run out quickly - within a few days - so that patients will not be able to receive the modern medical services they expect.
• The small number of ventilators will not be enough for all patients in critical condition. The supply of oxygen cylinders will also run out.
• Corona patients in critical condition will die in their beds without being able to receive treatment from the medical staff - some of whom are sick themselves with fever, chills and other shameful things. In any case, there aren't enough ventilators, drugs or oxygen to help everyone, did we mention that? Indeed, there is already evidence coming from Italy - where there is a severe shortage of ventilators - that hospitals are transferring ventilators from old people to younger corona victims.
• Chronic patients will not be able to come to the hospitals to receive medical treatment. These are cancer patients, heart disease patients, neurological diseases, metabolic diseases of any kind and so on. The hospitals will be congested with corona patients, and in any case - there will not be enough medical staff to treat the chronic patients. And if any of the staff leaves the corona patients to take care of the chronic patients - he will infect them as well.
• Pregnant women will not be able to give birth in the hospitals: there will not be enough staff members to care for them and ensure their well-being, and they will be infected with the virus immediately after giving birth. Many will choose to give birth in their homes - a dangerous and not simple matter, especially when those with professional medical training will have to be present in the hospitals and will not be able to assist in the birth.
• Victims of road accidents will find themselves treated and removed. Did you arrive at the hospital with a compound fracture? They will prescribe it for you in the most basic way, and send you home with Nurofen. And yes, the fracture will unite in a sub-optimal way, and you will suffer some disability and pain for the rest of your life, but there is no other choice when the hospitals are full.
• Anyone who comes to the hospital with a health problem that requires immediate treatment - an elderly person with a heart attack, a child who swallowed a marble - will find that they have to wait days for adequate medical treatment, if at all.

Now think for a moment about all these people who are not at all directly related to the virus: the cancer and heart patients, the victims of road accidents, the women who gave birth hastily at best and all the rest... the hospitals cannot help them, and they will be sent to their homes, where they will need continuous supervision and constant assistance. Who will provide them with this supervision? Their families, of course. These are the same people who were supposed to go out to work, to continue to preserve the economy and its pulsating activity - and find themselves stuck in their homes, looking after their families, instead of working.

Oh, and this is assuming that they themselves, as mentioned, have already recovered from the virus. Don't forget that it causes flu-like symptoms, with high fever and weakness. Have you ever tried to work while you have the flu? Not a pleasant experience, to say the least.

In other words, if the Chinese government had allowed the virus to spread among the population just like that, there is a real chance that the economy there would have collapsed anyway, or at least suffered greatly.

Sound apocalyptic? well yeah. But that's how such events are always heard from the sidelines. Even in the case of a severe earthquake, or a widespread war, the hospitals are the weak points. In the hospitals there is always a lack of resources, and an especially large amount of people flocking to receive help, will bring them to collapse or will force them to make difficult decisions such as prioritizing patients, sending them to hospital even when a hospital is better, and above all - a lot, a lot of commotion that will lead to many people not will receive maximum medical care.

And all this may happen in Israel as well.

Let's apply the statistics I mentioned about Israel for a moment. Israel has 9.1 million inhabitants. We subtract from them 2.9 million children (who develop very mild signs of illness, if at all) and we get 6.2 million potential infected. Let's assume that only sixty percent of them will be infected, and that only 25 in 20 infected (that is, 500 out of 150,000) will need intensive care. If this is the case, then within a few months we will need almost 1,500 beds in the hospitals in Israel. And this when Sheba Hospital - the largest in the country - has only XNUMX beds.

I repeat the number again: 150,000 beds.

This number stems from two extreme assumptions: that a large number of people will get sick, and that everyone will get sick in a relatively short period of time of a month or two. Both of these assumptions may come true, but there is good reason for optimism: the Ministry of Health is doing everything possible to prevent this from happening.

Reasons for optimism

Did I scare you? Very good. You also need to know what the worst case scenario is and be able to prepare for it and mitigate its effects. And our Ministry of Health here in Israel is doing a pretty good job so far.

What is the Ministry of Health trying to do, with all the extreme measures recently? The people of our health system are urging many to go into isolation. There is a good reason for this. Isolation can slow down the spread of the virus among the population, thus preventing a situation where 150,000 people will arrive at the hospitals all together. Instead, even if the virus continues to spread in Israel, it will infect people slowly so that the visits to the hospitals are spread out in 'trickles' over six months or a year. It will still put a huge burden on the hospitals, but it will still be bearable.

The closing of the borders serves a similar purpose. The United States has messed up big, as of now, and is facing a serious outbreak of the virus. Every tourist who arrives from there without undergoing isolation increases the risk of accelerating the spread of the virus in Israel. There are indeed ways to improve the situation - to provide alternative means of transportation instead of Israel Railways for those who are suspected of being carriers, or to develop an application that requires tourists to report their health status (as they did in South Korea). But the very demand for isolation makes sense on the whole.

I know there is a lot of indignation against such extreme measures, but we have already seen in China that the virus can be stopped with these measures. It is possible that in the most extreme situation we will have to impose a curfew on entire cities, let the high-tech economy continue to work telepresence via the Internet, and define that the farmers will continue to produce food for consumption and export in relatively isolated conditions. We may even have to isolate the sensitive populations - that is, the elderly - and establish a volunteer system that serves them in quarantine. These are extreme possibilities, but they exist.

This is the place to remind that basic disinfection measures such as automatic hand disinfection facilities in every public place, frequent disinfection of trains, buses and taxis, and instructing the public to observe hygiene rules will help reduce infection and "live with the virus" in the country.

There is a real reason for optimism: countries that took all these ways effectively, managed to stop the spread of the corona virus. South Korea conducts more than 10,000 tests a day, some at roadside stations, and uses a variety of technological means to monitor all data in isolation to ensure that it will not be breached. Government officials check twice a day those who are in quarantine, and everyone who enters the country should Install an application on the smartphone and report on his health status daily[12]. As a result of these measures, the number of new infections in South Korea has been decreasing in recent days. Singapore and Taiwan are taking similar steps, with similar success. The population in these countries is more disciplined, and their health systems are in good shape to begin with. Their economies are enjoying a breathing space. Where is Israel on this map? I think we are in a good place. Maybe except for the matter of the disciplined population.

Even if we don't succeed in completely eradicating the virus, in the meantime, in the breathing space that the isolation and the closing of the borders gives us, the health system is doing one big and important thing: it is preparing and equipping itself for the virus.

I can assure you that every hospital and health fund these days is trying to purchase every ventilator that is still offered for sale in the market, refreshing equipment that has become obsolete in warehouses and ordering plenty of medicines and masks for the future. Thanks to this equipment, they will hopefully be able to treat patients even in a situation of extreme overload.

And along the way, she also expects a 'miracle' - that is, an unexpected event that cannot be predicted in advance.

The joker on the sleeve

There is one joker - a card that can be pulled from the pack and may change the whole picture in the coming months. But for that we need to be very, very lucky.

The 'miracle' I'm talking about is that the corona virus will dissolve and disappear with the arrival of summer. In recent days, a new study (which as of now has not been peer-reviewed) was published that showed that the virus spread in China at the highest speed at a temperature of exactly 8.7 degrees Celsius. When it's warmer, it should spread less easily. But the study does not take into account other data such as humidity, and the researchers themselves admit that - "the weather in itself... will not necessarily lead to a decrease in the number of cases without implementing measures for a comprehensive intervention in public health. "[10]

As is the way of scientific studies, there are also opposing opinions. Experts say there is no evidence that the more deadly relatives of the new coronavirus - SARS and MERS - have been adversely affected by the summer. And in any case, when it's summer on one side of the globe, it's winter on the other side. The virus will simply continue to spread to other countries - and return to us at its peak a few months later.

Mike Ryan, one of the top officials at the World Health Organization, has already warned against hoping that the warm weather will stop the spread of the virus. As he said - "We must assume that the virus will continue to enjoy the ability to spread. It is wishful thinking to say that yes, it will go away like the flu... we cannot assume so. "[11]

But one can hope, right?

It will be good - if we act wisely

Finally, two last words: it will be good.

But only if we act wisely.

Futurist Stuart Brand once said that he is "pessimistic in the short term and optimistic in the long term." He is pessimistic in the short term because he sees everything that can go wrong and all the trouble that can befall the world. He is optimistic in the long run because we humans are good at finding solutions to all these problems.

I do not believe that the worst situation - the scenario in which the hospitals completely collapse - will materialize in Israel in its full severity. This record is intended to clarify why the people of the Ministry of Health are so anxious, and why they take the extreme measures we hear about in the media. These exact steps are supposed to prevent the same scenario and lead to a better future, but for this we must listen to the instructions of the professionals and obey them.

I'm not saying it won't be difficult. It is unpleasant and uncomfortable to sit in isolation, to disinfect your hands every few hours, or to press the elevator button with your elbow instead of your finger. It is not pleasant to take a taxi back from Tel Aviv, instead of using the train. It is not pleasant to walk with a mask on the street when you only have a small tingling in your nose. But these instructions are intended to prevent the scenario in which the hospitals will collapse, and in which mainly the weakest population will be harmed: the grandparents of every One of us. Anyone who follows these instructions should know that they are saving many lives in Israel.

In a longer-term view, the first vaccines will appear by the end of the year or a little later, and there is a good chance that they will wait and curb the next attacks of the virus. If that happens, then it will disappear completely, or it will become another type of winter illness that will burden our health system. But his time is up. The huge advances in medical science will produce in the next decade or two a solution for this virus as well, as insidious as it may be. In a long-term view, we are in good shape and will only get better as the years go by. Already today, the virus is accelerating the development of medical and remote diagnosis technologies, and we are witnessing the opening of hospitals with advanced robotic services.

The corona virus - one of humanity's new enemies - makes life difficult for us in the short term, but along the way it helps the medical services leap forward. The health systems, which have always had difficulty adopting modern technologies, will reluctantly move to them. We are expected to see rapid adoption of advanced systems and innovative technologies that can improve our lives and health.

Only health, for all of us.

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Thanks to good people like Gilad Greenbaum and Roy Kidar who went through the article and provided important constructive criticism thanks to which I made it much more serious and practical.

If you want to know more about the virus and be updated daily, here are some good places to find reliable information:

• Ministry of Health website
• "Talking about vaccines" group of an informed association on Facebook
• Medint Community on Facebook
• Yael Furman, who provides hourly reports on what is happening in Israel and the world
• Special coverage on the science website

More of the topic in Hayadan:

• Corona has been declared a worldwide epidemic - what is the difference between a disease outbreak, an epidemic and a global disease?
• The new corona virus: the last epidemic to hit the human race
• No country in the world is prepared to deal with the corona virus, and most of them are unable to receive data in real time
• The Corona epidemic - a source of conspiracy theories