Hayadan > What do we do about the changing virus? A strategy for continuing the fight against the plague

What do we do about the changing virus? A strategy for continuing the fight against the plague

We must start thinking far ahead - on the order of at least a year - to prevent the fourth, fifth and sixth closures. Or, if these are the obligations of reality, then at least we will enter them prepared.

A little over a year ago, the original strain of the corona virus (or as close to it as possible) began to spread around the world. Today we have already reached more than a hundred million infected worldwide and 2.2 million dead. Israel has successfully passed two closures, and is still in the middle of the third closure, at least in the coming days.

The main focus at the moment is on the level of the next month or two. Not many try to think long term. This is exactly the course of action that led us to the second and third closings. We must start thinking far ahead - on the order of at least a year - to prevent the fourth, fifth and sixth closures. Or, if these are the obligations of reality, then at least we will enter them prepared.

In this post I will present three possible directions that are based on forward vision, based on everything we know today. Of course, these are not the only possible directions, but they will at least provide a starting point for thinking and opening a dialogue about the new image of the world, and how we can deal with the situation years ahead, and not at the level of "Hey, let's decide how long to continue the closure!"

But before I review these directions, we need to agree on what is happening right now. Here is a brief summary of reality as I see it.

The world, Israel and the virus today

Even the most skeptical have already realized that the virus poses a real danger to public health. In the United States, where a large part of the public did not take the danger seriously, about 450,000 people have already died from the virus, and the epidemic is still in full swing. A similar death rate in Israel would have brought us to 12,500 dead, and as mentioned - the epidemic has not yet ended in the United States[1].
This month alone, 1,336 Israelis died from the virus, after two weeks of a loose lockdown and another three weeks of a tight lockdown[2]. The hospitals are extremely overcrowded, people wait for hours in ambulances to get into the hospitals, and even there - they are provided with an oxygen cylinder, they see that they feel better, and they are released home because there is no room for them in the hospital. When their condition worsens, they will again wait for hours in ambulances, go to the hospital and back again, God forbid. Some of them will not survive this cycle, and as a result of the overload, more patients die - a fact that has already been proven in several studies, including one in Israel.
The closure that was supposed to help - helped and failed at the same time. It failed because the morbidity these days is not decreasing, and it helped because it flattened the infection curve. Why is the morbidity not decreasing? Because the new variants, such as the British variety (and probably soon the South African variety as well), took Israel by storm. They spread faster than the previous variety, and apparently the British variety is also more deadly. The result is that our predictions regarding the effectiveness of preventive measures, formulated for the previous strain, are no longer as successful as they were. We are in new, uncharted territory, and the situation will worsen as more new varieties appear.
The opening of the lockdown will lead to a health disaster in the short and long term. In the short term, the new strains will spread to every corner and cost the lives of at least 18,000 people (I calculate according to Prof. Audie Kimron's easy argument, according to which the virus may kill 'only' 0.2 percent of the population)[3]. Most likely the cost in human life will be higher, because the burden on the hospitals will increase the mortality rate significantly, as we have seen happen in the world and in Israel[4] [5]. In the long term, the side effects of the virus are still unknown, but from what we know, it seems likely that at least some patients will suffer health damage that will last for months or years[6].
The vaccination campaign was (and still is) an unparalleled success in the world. The vaccine works with high efficiency[7], and he is probably the one responsible for the fact that morbidity and mortality remain constant, instead of continuing to rise. It does take a few weeks to have an effect, but after the second vaccination, about 92 percent of the recipients are resistant to the virus [8]. This is a very impressive resistance rate, given the fact that many of the vaccine recipients are old and therefore their immune systems are not functioning well to begin with. Unfortunately…
...the virus undergoes mutations at a higher rate than we thought and hoped. Today we can name the British, South African, Brazilian, Californian variety and this is just the beginning-la-la. Some are vaccine-vulnerable, but the South African variety is almost certainly partially vaccine-resistant (with ~50 percent or so protection rate) [9]. This means that it can be expected that the effectiveness of vaccines will decrease with the spread of the South African strain in Israel. And although we have found so far only four Israelis infected with the South African strain, it is quite certain that more can be found, and that this strain has already started to spread here.
The virus is not going to stop mutating. Each new person who is infected, serves as an incubator for the virus, where it can accumulate new mutations. And such hatcheries will be plentiful in the next year or two, and perhaps long after that. It is going to take a very long time to vaccinate the entire world, and vaccination operations are proceeding with excruciating slowness in almost all countries. In Europe, a large part of the population is not at all interested in taking the vaccine [10]. Assuming that the virus can continue to multiply for at least another year, it is likely that by the end of 2021 a vaccine-resistant strain will be found, or - no less serious - one that can also infect people who have already been infected with another strain[11]. It's hard to see how this scenario can be avoided, as long as people are catching the virus all over the world. And when there are strains that will also infect vaccinated, we will enter an endless loop of infection -> mutations -> infection.
There are countries that have successfully dealt with the virus, but these are almost exclusively Asian countries. In Japan, citizens were careful to keep their distance and wear masks. China had extremely strict closures. In Singapore, people who are supposed to be in isolation are being continuously monitored via mobile phones[12]. Those who violate the isolation must pay up to 10,000 Singapore dollars, which is equivalent to 25,000 NIS, and/or imprisonment for six months. Breach of isolation twice? to prison, plus NIS 50,000 to the state coffers[13]. In New Zealand, they started a seven-week lockdown in March and stopped only when no more patients were found[14]. Then they followed a strategy of careful and smart border closure.
There are big differences between all these countries and Israel. In those countries there is no debate about the need for masks, people keep their distance, those who must be in isolation - stay in isolation. Whoever violates isolation - removed from the company. Citizens do not lie to investigators who are trying to understand who they came in contact with. There is no where and where: if there is a closure, it applies to the whole company, and not just to 'suckers'. These conditions are violated in Israel time and time again - and we all pay the price in human life and in the paralysis and destruction of the economy.
Israel will find it difficult to withstand another blockade in its current format. Emphasis on "current format" (this is important, as I will argue later). Social cohesion is at an unprecedented low, with a complete lack of trust in politicians and between the various sectors. The ultra-orthodox will not want - and even if they want to, it will be very difficult - to close the educational institutions and stay with seven children in one house. Education in general is faltering, and that's putting it mildly, and at least one parent has to 'work' from home while he looks after the children. The economic situation is on the rocks. Everyone agrees - things cannot go on like this.

the meaning

So far what is known. I apologize if I sound pessimistic, but I tried to describe the situation as it is, with supervised eyes and by combining all the evidence that exists in our possession today.

If we combine all these data about the virus, it means that it is about to become a part of our lives. If we hoped that it would turn into a flu-like background illness, the new strains make it clear that this is a false hope. If he continues to undergo mutations, then we will have to continue receiving vaccinations - each tuned to the new strains - once a year or so. And if the new variety resistant to the previous vaccine already arrives in Israel, then we will have to go into quarantine before the new vaccination operation.

In short, and as I wrote six months ago, there is no point in thinking about reality 'after the virus', but alongside the virus.' We can hope that the situation will change in two or three years, when we can begin to vaccinate large parts of the world, and thus we will also slow down the rate of creation of new strains. But for at least the next two years, we have to act on the assumption that we will continue to live alongside the virus - and that it could easily become more contagious or deadly somewhere in the world.

אז מה עושים?

I divide the solutions into two extreme paths, and one in the middle.

The first path is simple in concept, but almost impossible to implement: continuing the existing lockdown and even worsening it, with uncompromising enforcement, until the number of patients drops to single digits, or to absolute zero. The only way to maintain such a closure over time is by harnessing the entire economy and government budgets for the benefit of the matter. Unemployed people should receive minimal grants that will allow them to support themselves and their families at a modest standard of living. Haredim will close the educational institutions, the elderly will be isolated at the highest level and will receive food deliveries to their homes.

And all this will last a month or two from today. We will not get out of the current lockdown at all, because it would be a shame to lose what we achieved during it.

crazy? Definitely. But we don't live in normal days, and extreme solutions like this can prevent the economy from going into lockdown on Wednesday, Thursday, Friday and so on. We will cleanse the country of the virus - of every strain - and then we will adopt a strict policy of closing borders, which requires every person who enters to undergo at least one corona test, and enter a two-week isolation from the moment of their arrival. The policy of closing the borders will be maintained as long as the virus continues to spread in the world.

If we take this path and do not cut corners, we will reach the situation where China and New Zealand are now, and we will be able to hold mass and public events within three months from today.

This is one extreme solution, and it is probably the most effective - but there is no certainty that the Israeli economy or society can bear it.

The second extreme solution

The second extreme solution is to open up the country. People will go back to work, earn money, serve others in malls and stores and so on.

Alongside the opening, we will continue to vaccinate at a high rate to delay the spread of the new strains in Israel. If the South African virus is stopped, there is a good chance of reducing the morbidity within two to three months. If it continues to run around in Israel, and proves partial resistance to the Moderna and Pfizer vaccines, it will take much longer for the epidemic to pass. In any case, we will have to cope with a huge load in the hospitals, which will be mitigated by opening temporary hospitals and recruiting reserve medics and MDA volunteers to fill junior positions that do not require extensive medical knowledge (carrying stretchers, personal care, etc.).

The hope is that both the British and the South African strains will be stopped thanks to the vaccine within a few months, before they are killed... how much? It is not clear. How much is one person's life worth to the economy, to his family, to the national morale? These questions will be dealt with by the people of ethics and economics, who will provide smart and serious answers that the government can accept or ignore. One can hope that the scope of the vaccination campaign from the last two months will bear fruit in a month, and will result in the rate of new hospitalizations in the hospitals decreasing rapidly.

At the same time, in order to prevent new strains from entering Israel, we will have to implement a strict border closure policy like the one presented in the previous solution. If we don't do this - then as soon as a new and vaccine-resistant strain appears in the international arena, we can be sure that it will also arrive in Israel in a short time.

This solution is more likely than the first. It will probably cost the lives of a few thousand people, and maybe more than "a few thousand", but as long as we keep the borders closed, and hopefully the South African strain is not completely resistant to the vaccine, it may succeed... in the end.

The third solution - in the middle

Which brings us to the third solution: somewhere in the middle. We will not open the country completely, but gradually and excruciatingly slowly. The schools will probably reopen first, but we will wait another two or three weeks until the businesses reopen. The cinemas, the theaters, mass events - all these will have to wait at least another two months until they are allowed.

The hope is that if we continue to vaccinate quickly and effectively, the rate of infection will not rise to unbearable levels before the vaccine proves its effectiveness. At the same time we will have to strengthen the hospitals, prepare plans for field hospitals and prepare for the enormous load that will be here.

This solution is not going to satisfy anyone. There is a good chance that as soon as we release the relief even a little, the rate of infection will jump up - and the leaders will have to stop the release there. The public will be outraged, and the public representatives will have to be genuine leaders, explaining the long-term strategy and why we must continue to make sacrifices for a better future. Or we will continue to release more and more restrictions, at a rate that is too fast that will actually lead to the disaster of the second solution. And maybe it's not a bad idea - but only if we know what we're getting into, and understand the size of the price we'll have to pay as a company.

If I had to bet, I would say that this will be the solution the government chooses, and perhaps it is the only possible solution given the circumstances. We are not China, not Singapore, not New Zealand. We live in Israel - and we have to work with what we have. And this statement is valid both for the representatives of the public, and for the public itself.

and what else?

Please note that these three solutions require strict closing of the borders. There are a number of other steps that I would recommend the state consider whichever way it chooses. These include –

Establishment of a vaccine factory in Israel: The mRNA component of the vaccines is easy and cheap to produce, but it is also necessary to mass produce the vectors (the polymer shells around the mRNA) and the sterile vials that will contain the vaccines. The factory will be able to quickly produce any new vaccine that is produced in the world and its effectiveness is proven.
Recruitment of junior medical workers: Every hospital needs employees without significant experience in medical care. These include stretcher bearers, interpreters for foreign language speakers and the deaf, and more. These junior workers can come from the public, with priority given to the vaccinated.
Flooring, flooring, flooring: We must understand which strain each patient is infected with, so that we can understand the ways of spread of the strains and carry out proper monitoring of them.
Investment in the development of artificial intelligence tools for predicting, monitoring and treating patients: The startup nation or not? It is time to encourage entrepreneurs to develop algorithms and sensors that can reduce the burden on the medical teams through continuous monitoring of the patients.
Taking legal action against primary distributors of conspiracy theories online: People who have taken it upon themselves as a profession to spread anti-vaccination conspiracy theories will find themselves in the (online) court with similar penalties to those accepted in Singapore, to prevent further spreading of false information dangerous to public health. I am not referring here to all of Israel who share conspiracy theories, but to those who are at the head of the official and unofficial organizations that spread false information.
Cultivating advanced intelligence capabilities on the spread of the virus in the world: It is not possible for the Prime Minister to complain that he was not aware of the British breed[15]. We are now experiencing the consequences firsthand. There is a need for a body that will monitor what is happening in the world, identify new strains and begin efforts to understand their properties and develop a vaccine against them as soon as possible. Such a body is especially important in the event that the virus changes its properties so that carriers remain infectious for more than two weeks, or existing test methods fail to detect the new variant.

In conclusion

As you can understand, a lot of work is still ahead of us. It is not the end of the world, but we must brace ourselves as individuals and as a public and mobilize for the benefit of the great task - to eradicate the virus from the country. You have to support the government and the Knesset when they make the appropriate decisions for the situation, and understand that you have to suffer a little (or a lot) before the happy ending.

It is possible - and it also depends on us and our demands from public representatives.

Success for all of us.

Dr.Roey Tsezana is a futurist, lecturer and author of the books "The Guide to the Future" and "Those Who Control the Future"

More of the topic in Hayadan:

[1] https://www.worldometers.info/coronavirus/country/us/

[2] https://datadashboard.health.gov.il/COVID-19/general

[3] https://www.ynet.co.il/news/article/HyGnqR00AD

[4] https://www.medrxiv.org/content/10.1101/2021.01.11.21249461v2.full.pdf

[5] https://www.medrxiv.org/content/10.1101/2021.01.11.21249526v1.full.pdf

[6] https://www.theguardian.com/society/2021/jan/28/scientists-liken-long-covid-symptoms-to-those-of-ebola-survivors

[7] https://www.timesofisrael.com/vaccine-found-92-effective-in-israel-in-first-controlled-result-outside-trials/

[8] https://www.timesofisrael.com/vaccine-found-92-effective-in-israel-in-first-controlled-result-outside-trials/