Israel planned for a pandemic-like emergency, so what went wrong?

Despite preparations in late February, misleading optimistic models showed several weeks of restrictions could have an effect; Jerusalem and neighboring states hold out hope amid pandemic.

By SETH J. FRANTZMAN
A man wears a face mask as he walks in a market in Ashkelon while Israel tightened a national stay-at-home policy following the spread of coronavirus disease (COVID-19) in Ashkelon, Israel March 20, 2020. (photo credit: AMIR COHEN/REUTERS)
A man wears a face mask as he walks in a market in Ashkelon while Israel tightened a national stay-at-home policy following the spread of coronavirus disease (COVID-19) in Ashkelon, Israel March 20, 2020.
(photo credit: AMIR COHEN/REUTERS)
Bruce Aylward of the World Health Organization-China joint mission gave a briefing in Geneva on February 25. Photos of the briefing were captured by Reuters, including optimistic charts that showed how China had implemented “strict traffic restrictions” in Wuhan, where the coronavirus outbreak started.
The chart showed how the intervention had reduced the number of cases each day and quickly lowered the threat of the virus between January 23, when the Wuhan put in place restrictions, and February 8, when there was “resumption of labor and rehabilitation.”
Israel and many countries, including the UK, may not have been prepared for the pandemic and rushed to put in place draconian responses for various reasons.
In Israel, it is worth looking at the preparations made in February and what might have gone wrong in early March.
Israel was preparing for a worst-case scenario related to the coronavirus threat in late February. However, it held elections in early March, and Prime Minister Benjamin Netanyahu was caught in political battles at a key time, while messaging to the public was lackluster.
The same country that distributed gas masks in the past to confront an emergency was unable to distribute things such as personal protective equipment for the pandemic. Lockdowns resulted. Why?
To understand how we got here, it is important to first understand what happened elsewhere and what decision-makers and experts were looking at.
These models have informed government responses all around the world. Governments believed the pandemic, which was announced on March 12, would threaten their societies, but it could be beaten by some intervention. China’s response showed that while cases grew rapidly January 10-22, they peaked January 24-27 and then rapidly declined.
Aylward’s report in February is still online. It says the virus did not spread much in the air; rather, it spread within close families. China sent 1,800 teams of epidemiologists with a minimum of five per team to trace the spread. Some 40,000 healthcare workers were sent.
China fought the virus in three stages: preventing the virus from spreading beyond Hubei province; tracing cases; helping patients and containing it, the report said.
“New technologies were applied such as the use of big data and artificial intelligence (AI) to strengthen contact tracing and the management of priority populations,” it said.
Many of the notions borrowed from China, such as “flattening the curve” and the “two-week” period needed to fight the virus, have been applied with varying degrees of success and failure elsewhere. For instance, the WHO team found that the number of cases had been reduced from 2,479 a day to 409 a day over two weeks.
These numbers are shockingly small when compared to the huge explosion of cases in most countries today, such as 5,200 more in Italy on Wednesday, 10,000 more in the US and even 439 here in Israel.
In short, Israel had more cases after two weeks of varying types of lockdowns and restrictions than China did – and China has more than 150 times more people. Israel’s high level of cases would be equivalent to 75,000 more in just one day in China.
SO WHAT went wrong? How is it that per capita, many countries outside of China now have more cases per day, or every few days, than China had during its entire three months fighting the pandemic?
It is perplexing. Experts talk about the “curve” of infections rising over time, plateauing and then diminishing. If governments enact various measures designed to mitigate the curve or “flatten” it, then the numbers would be reduced.
As late as March 8, Aylward was optimistic that containment of the virus could still be achieved. Ostensibly, Italy had cordoned off areas to stop the spread. South Korea, Singapore and Japan had flattened the curve (on March 26 they had 100, 73 and 114 infections per day, respectively).
The Lancet published a study on March 23 that looked at how Singapore was successful. So far, it had succeeded in preventing community spread, the report said. The scale and disruption of current government responses concerned the authors. They noted that closure of schools, workplaces, roads and transit systems, as well as cancellations of public gatherings, mandatory quarantine and large-scale electronic surveillance, raises ethical questions. This was done without the kind of lockdown done in Israel, the UK, France, Italy and elsewhere.
South Korea put in place measures short of Israel’s response. Kim Woo-Joo, a Korea University specialist in infectious diseases, said such authoritarian measures as lockdowns were not needed there.
“South Korea is a democratic republic; we feel a lockdown is not a reasonable choice,” he said.
Many countries dogmatically believe a lockdown is the only way to stop this virus. Jordan instituted curfews and a total army-imposed lockdown for days. CNN reported on Thursday that it had sowed “chaos,” and people did not have food to eat at home in some cases.
We do not know the results of the 21-day lockdown in India, but photos of security forces using canes to get people off the street illustrate how quickly power is given to enforce these measures.
I'VE REPORTED on Israel’s preparations for various home-front emergencies for years. Israel, compared with many countries, is well prepared for mass disasters – or at least it plans for them and claims to be well prepared. Home Front Command and other authorities are outfitted with the latest technology and have been very successful at aiding other countries during disasters.
In the past, Israel contended with mass rocket threats, and it has plans for earthquakes and biological and chemical attacks. There were biological- and chemical-warfare drills in 2009, 2010 and 2013, new units set up in 2016, multifront wars simulated in 2018 and other drills.
There have also been “mass casualty” drills over the years. There were preparations for national disasters last April at Rambam Health Care Campus and last September at Sheba Medical Center.
Despite all of this preparation, Netanyahu on Wednesday said Israel was liable to find itself with thousands of patients in danger of death.
“The steps that we have taken here in Israel are being taken all over the world,” he said. “However, they are not enough because the number of patients is doubling itself every three days.”
The already harsh lockdown would be increased and there would be “no alternative” in a matter of days. The requisite preparations, logistical and legal, are being made. Israel already has harnessed the IDF, Shin Bet techniques and the Mossad to fight the virus. But the cases are not following the model in Wuhan, let alone Singapore or South Korea.
Israel is not alone: Other countries, including Turkey, are seeing huge numbers of cases added every day. But they did not act as Israel did. Israel ostensibly was very well prepared and careful. It banned flights from South Korea on February 22 and ordered tens of thousands into quarantine in early March, eventually including everyone returning from abroad.
Software is helping to trace cases, as are phones. And yet, weeks after children were sent home from school, the numbers are still increasing.
ONE PROBLEM is that Israel knew what was coming yet did not act proactively on certain fronts. Israeli officials in late February already were planning for a worst-case scenario. Necessary items were being kept here and not sent abroad. That was a key to being prepared.
However, we all know that when Israel has prepared the home front for chemical-weapons attacks, such as facing Syria in 2013 or Iraq in the 1990s and early 2000s, gas masks were distributed. Gas masks but not basic personal protective equipment to slow the pandemic?
That seems inexplicable. In times of crises with Hamas or Hezbollah, all sorts of measures have been taken on the radio and television to prepare people. Yet little of that was done in this instance – and the crisis is much larger.
How is it possible that Israel knew about the worst-case scenarios on February 24, the day before the Aylward briefing, and yet so little was done?
Years of biological-warfare drills – and other preparations, such as how to set up field hospitals – were not put in place. We know that China built at least two new hospitals in Wuhan by February 7. Israel is not China, but it has decades of preparations – and per capita, Israel should have been able to do roughly what China, Singapore or others did.
There is a lack of clarity about the lockdowns. Some countries, such as Sweden and the Netherlands, are not acting with such draconian responses as ordering people to stay within 100 meters of their homes. Israel asserts that people who are social-distancing – such as going to a forest for a hike, as the WHO recommended – are actually endangering themselves and others and need to stay home. This is the general trend across most countries and cities, from the Gulf to New York City.
But there is a lack of understanding as to why Sweden, without lockdowns, has a lower rise in cases than Israel, which has them. That model has not been explained. Neither has the lack of proactive measures, such as distributing information to the public prior to the outbreak.
Optimistic models may have underpinned a less-serious approach. But evidence shows that even studies, such as the Imperial College March 16 report that informed Prime Minister Boris Johnson’s approach, are not being followed either in Israel or the UK.
Both countries have gone beyond the recommendations, hoping total lockdowns will have a desired Wuhan-style affect. This has put a two-week timer on results, while government modifications have generally come every few days, with fears in the base reports that this could go on for months.
It may be that the political crises – the election on March 2 and the March 15 decision to let Blue and White’s Benny Gantz try to form a government – overshadowed Israel’s response.  Netanyahu’s trial was postponed on March 15 due to the pandemic after courts initially rejected postponement on March 10. These key two weeks may have led Israel to a false sense of security as the threat grew.
Beyond the results in Singapore, South Korea, Japan and China, Jerusalem cannot look to other examples of success with the various measures being taken.
The Kurdistan region of Iraq, which began lockdowns on March 14, is still afraid the few daily cases mean they need to maintain their response.
The February 25 press conference with its neatly planned stages and results still looms large in Jerusalem and elsewhere.