Lessons from Israel

The Jewish Holidays are drawing to a close in Israel. The dynamism that emerges as well as the meals shared to the sound of prayers and songs emanating from the synagogues of the country make it difficult to believe that this country, a “model” of vaccination, is currently experiencing its largest increase in COVID-19 cases since start of the pandemic.

In recent days, the small country of 9 million inhabitants has recorded between 5,000 and 11,000 new cases daily. For the Israelis who, at the start of the summer season, had put away their masks very far, the irony is great.

Israel was among the first countries to start vaccination against COVID-19, last December. The country was proud of the agreement signed with Pfizer to purchase eight million doses needed to launch a rapid vaccination. In return, because of the reliability and efficiency of its health system, Israel would provide the pharmaceutical company and the rest of the world with information and data on its herd immunity.

Measures lifted promptly

If from the beginning of winter 2021, vaccination had enabled the Hebrew state to get out of the third wave, “Israel’s mistake was to bet only on the vaccine”, believes Ronit Calderon-Margalit, professor of epidemiology at the Braun School of Public Health in Jerusalem.

Since the start of the pandemic, Israel has adopted and then lifted various measures: confinements, closure of borders, restrictions on gatherings, wearing of masks inside and outside, vaccination passport (” Green Pass “), notably.

Then, last spring, internal measures, including the wearing of a mask and the vaccination passport, were all lifted. The eyes of the whole world were riveted on the small country, as if it embodied the “world after”. The few new daily cases of COVID-19 justified the decision … until proven guilty. Ten days after authorizing the lifting, following a new outbreak, the authorities had to change their mind, again requiring the wearing of a mask and reinstating his vaccination passport.

Was Israel too quick to suspend measures to counter an upsurge in the virus? Had he overestimated his vaccine coverage or the effectiveness of the vaccine?

“In April, after the elections, when [Benjamin] Netanyahu was trying to form a government, there was political pressure to say that the pandemic was over, ”said Nadav Davidovich, epidemiologist and member of the National Expert Advisory Group on COVID-19 in Israel. Yet as restrictions fell and a sense of invincibility developed among the population, the immunity of those vaccinated in Israel plummeted. “At that time, it was unclear whether this increase was related to the new variants or to a decrease in immunity,” explains Davidovitch.

Today, experts know it’s a bit of both: yes, the more contagious variants have helped restart the spread, but a drop in immunity seen five to six months after the last dose of the vaccine has also helped. play a role. This drop in immunity does not surprise Karl Weiss, microbiologist and specialist in infectious diseases at the Jewish General Hospital in Montreal, who recalls that it is notably observable after the annual flu vaccination.

A worrying situation?

While the situation may seem worrisome, experts note that the majority of people who are currently tested positive in the country are very little sick. The data show that around 60% of new cases concern people under the age of 18. While most of them are still not vaccinated, they rarely develop complications. In severe cases, however, unvaccinated people are still overrepresented, accounting for about 70% of them. “The effect of vaccines on the number of cases was therefore lost, but it persisted on hospitalizations and severe illness,” explains Karl Weiss.

The microbiologist also invites us to put the recent figures from Israel into perspective. “The number of cases is high due to an extraordinary screening system. In Quebec, with a more or less comparable population, we do 20,000 to 25,000 tests per day. They make about 120,000. “

What lessons for Quebec?

Israeli experts like Nadav Davidovich especially want the world to learn from the Israeli management of the pandemic that vaccination is “extremely important”, but that it is not “sufficient”, at least until it is. general.

It will therefore be important to find a balance, which would run into the slightest bit of mistrust and citizen fatigue. “During the first wave,” explains Calderon-Margalit, “we acted like a lot of countries. We have implemented very strict containment. But four waves and three lockdowns later, the professor no longer believes that this measure “magic solution” can be reimposed in Israel.

The experts consulted therefore suggest the adoption or maintenance of a number of measures which, without being too restrictive, can save the lives of many people. Measures including an exterior arrangement of various installations, wearing of masks indoors, limits on indoor gatherings, installation of better ventilation systems, for example. In schools, Israel will also favor rapid tests over the automatic imposition of a quarantine, except, of course, in the case of the presence of a super-propagator.

“There are things you can do and things you can’t do,” admits Dr.r Weiss looking towards Israel. In the current situation, data from the Hebrew state, however, offers a few weeks of reprieve for decision-makers to assess, imitate or correct in the short and long term this management of the pandemic. Because the experts agree: this pandemic will not be the last.

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