COVID cases are rising worldwide, is next variant on its way to Israel? - analysis

As colder weather hits, people gather more indoors, which increases the likelihood of spreading the virus. 

Colorized scanning electron micrograph of an apoptotic cell (greenish brown) heavily infected with SARS-COV-2 virus particles (pink), also known as novel coronavirus, isolated from a patient sample. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Ma (photo credit: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES - NIH/HANDOUT VIA REUTERS)
Colorized scanning electron micrograph of an apoptotic cell (greenish brown) heavily infected with SARS-COV-2 virus particles (pink), also known as novel coronavirus, isolated from a patient sample. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Ma
(photo credit: NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES - NIH/HANDOUT VIA REUTERS)

With Israel’s reproduction rate creeping toward one and COVID-19 infections rising again in many parts of the world, could Israel be on the verge of a fifth wave?

And, if so, then why did Health Minister Nitzan Horowitz agree to allow travelers to enter Israel carrying only negative results of a rapid antigen test as opposed to a gold-standard PCR?

On Wednesday morning, the Health Ministry reported that the reproduction rate or “R,” the number that reflects how many people a sick person will infect, had risen to 0.95 - up from 0.73 only a month ago.

Health officials have long stressed that morbidity would only decline if the R were at 0.8 or below, and that if the rate was around one then morbidity would likely plateau, which is what has happened in Israel.

There were about 540 people diagnosed with the virus on Tuesday, the Health Ministry said, and the number of serious patients also rose slightly overnight to 138 from 134. The number of new daily cases has been around 475 this entire month.

 Empty beds in the intensive care unit at the Coronavirus ward of Shaare Zedek hospital in Jerusalem on October 14, 2021. (credit: OLIVIER FITOUSSI/FLASH90) Empty beds in the intensive care unit at the Coronavirus ward of Shaare Zedek hospital in Jerusalem on October 14, 2021. (credit: OLIVIER FITOUSSI/FLASH90)

“The transmission rate in Israel has plateaued at several hundred cases a day,” according to Eyal Leshem, director of Sheba Medical Center’s Center for Travel Medicine and Tropical Diseases. He explained that this does not indicate the start of another wave but rather more of a stabilization of the previous wave.

However, in June, when Israel had hit a plateau, cases rapidly spiked when the Delta variant entered the country and vaccinated people’s immunity had waned. Leshem said the hope is that a quick and effective children’s vaccination campaign would keep the number of daily cases steady or even on the decline by adding another population to the country’s circle of protected people.

THE VACCINES for children were approved earlier this week and were expected to arrive in Israel on Wednesday, but the shipment was delayed, and it is unclear now when they will come. Once they do arrive, there is also a question of how quickly parents will bring their kids to the vaccine complexes to get them inoculated. Surveys have shown that a high percentage of Israeli parents are hesitant about giving their kids the jab.

On the other hand, more than four million Israelis turned out to get a booster shot, which was the main force behind Israel’s declining morbidity rate in the last month. But there is still not enough data on when the third shot will wane, and it is possible that by February – six months after more than a million Israelis got the booster – the vaccines will be less effective.

This could hit just as Israel enters the height of flu season, according to the chairman of the Association of Public Health Physicians, Prof. Hagai Levine.

“We are now entering winter,” he said, despite the unusually warm weather. “We do not know how the winter will look. We do not know what respiratory diseases there will be.”

Moreover, as colder weather hits, people gather more indoors, which increases the likelihood of spreading the virus.

Around the world, cases are already rising.

There is an average of 83,000 new, confirmed coronavirus cases in the United States every day, Bloomberg reported, noting that the true number is likely even higher. In certain areas of New York, for example, cases are spiking. 

New York Governor Kathy Hochul warned citizens to get their booster shots and avoid large indoor gatherings this week, according to reports in US media, because “we are heading into a vulnerable time.”

She said the state was considering re-implementing some restrictions to help slow the spread of the virus.

Leshem said that while each country is a little different, “what we are seeing in Europe is a [region] that is two or three months behind Israel, and so the waning of immunity after a mass vaccination campaign.

“We know that five to six months after vaccination the vaccines wane, so the increasing infection that is in most of Europe is probably attributed to that fact,” he said. In Eastern Europe, vaccination rates are even lower.

DESPITE THESE concerns, Horowitz announced on Tuesday that there would be yet another lightening of travel restrictions and that people who wanted to enter Israel would only have to take a rapid antigen test, which is considered less accurate than a PCR test.

The policy still needs to be approved by the government, but it is expected to go into effect next week. The decision was made because of the prohibitive cost and sometimes difficulty in getting a PCR test abroad before travel.

Travelers will still need to take a PCR test at Ben-Gurion Airport when they arrive.

Levine said there were advantages and disadvantages to the policy, given that a PCR test can be taken up to 72 hours before one’s flight, meaning a person could contract the virus during that window, while an antigen test is within 24 hours of takeoff. He also said there are differences between antigen tests and the better ones are certainly more accurate.

Additionally, Leshem said, the airports have not been a major driver of new cases in recent months. Since hundreds of Israelis are already diagnosed with the virus every day, “if we miss a handful at the airport, it is not substantially important in terms of impact.”

More important is the need to ensure that those entering Israel are getting tested – and when a positive result is found that it is genetically sequenced to watch for new variants.

“We need an epidemiological unit for the airport that collects the data, publishes reports, and adds their expertise,” Levine said. “We should aspire to be as professional as possible.”

But even then, Leshem warned, “if you allow entry of people from the outside, then you accept the fact that new variants will enter your country. Then, depending on population immunity, they may become established.”

Experts agree that the next variant of concern is likely to enter Israel. And the challenge is that health experts generally do not know how concerning a variant really is until it is too late. The Delta variant was identified via genetic sequencing early on, he said, but nobody realized its importance until it had already spread around Israel.

“At some point, it is very likely that we will see a surge in cases,” Levine said. “That should be our working hypothesis – and we should prepare for it.”