A year of coronavirus, a lifetime of impact

Dr. Talya Miron-Shatz: The vaccine will stop the spread of the virus, “but that does not mean that coronavirus will be over.”

TREATING THE virus at Shaare Tzedek Medical Center’s corona unit, Jerusalem. (photo credit: MARC ISRAEL SELLEM)
TREATING THE virus at Shaare Tzedek Medical Center’s corona unit, Jerusalem.
(photo credit: MARC ISRAEL SELLEM)
On February 21, 2020, one of the 11 Israelis who returned to the country after being quarantined for two weeks on the Diamond Princess cruise ship tested positive for corona – marking the first case of the virus in the Jewish state.
Since then, more than 400,000 Israelis have been diagnosed with COVID-19, which for most people involves few or no symptoms, but for others can lead to severe respiratory disease and even death.
No doubt the virus has turned the lives of the people of Israel upside down. From the Start-Up Nation at its peak of innovation and creation, the country over the past year – like much of the free world – has become marred by a sense of vulnerability, political instability and mistrust.
The coronavirus held up a mirror to Israeli society. On the one hand, it quickly identified the weaknesses of the country’s democracy. On the other hand, it shed light on the strength of Israel’s public health system, which offers immediate and free healthcare to all.
The virus rocked the worlds of nearly every individual and left them with a sense of defenselessness, which many experts believe will take years to shake, if it will ever go away.
“Life had been pretty good for the last couple of decades,” said Dr. Talya Miron-Shatz, founding director of the Center for Medical Decision Making at Ono Academic College. “There were no major threats. Then came the coronavirus and it turned our world upside down in every possible way and on every possible level.”
The coronavirus ravaged the economy, leaving around a million Israelis out of work. Even those who have returned to their offices or found new employment, said Miron-Shatz, have likely been scarred.
“Unemployment told you that you are not invincible,” she said. “It has left you knowing that in an instant and beyond your control, you may not be able to provide for your family. This feeling of uncertainty we all have is something that will carry over with us, even after the pandemic is gone.”
She said the vaccine would stop the spread of the virus, “but that does not mean that coronavirus will be over.”
Miron-Shatz recalled how last week, several hundred cultural centers throughout Israel lit up in red to shed light on the suffering of the industry – anguish that spreads beyond those who work in the field to anyone in society who finds joy in art.
The country’s people have become lonely, she added.
 A PEOPLE not known for their concept of personal space has in many ways become reclusive and standoffish. (Miriam Alster/Flash90) A PEOPLE not known for their concept of personal space has in many ways become reclusive and standoffish. (Miriam Alster/Flash90)
With workplaces emptied of their staff, gyms and swimming pools closed and cafes mostly available only for delivery and sometimes takeaway, a people not known for their concept of personal space has in many ways become reclusive, standoffish and sometimes even fearful of one another.
The Magazine reflected back on some of the ways that coronavirus has altered the reality of 2020 and looks ahead at what is likely to carry over into the New Year and even beyond.
TODAY, ‘HEALTH minister is one of the most coveted jobs’: A Health Ministry billboard in the capital stresses the importance of face masks. (Photo credit: Yonatan Sindel/Flash90)TODAY, ‘HEALTH minister is one of the most coveted jobs’: A Health Ministry billboard in the capital stresses the importance of face masks. (Photo credit: Yonatan Sindel/Flash90)

Health and healthcare
The COVID-19 crisis highlighted the strategic importance of the country’s healthcare system, said Arnon Afek, deputy director-general of Sheba Medical Center, Tel Hashomer.
Before the coronavirus, Israel’s health system was starving from multi-year neglect. Israel had one of the lowest number of practicing nurses per capita among Organization for Economic Cooperation and Development (OECD) countries. The rate of death from infectious disease was more than 70% higher than the second-place country, Greece, according to data provided by the Shoresh Institution for Socioeconomic Research.
The job of health minister, which was held among multiple portfolios by Prime Minister Benjamin Netanyahu for years, was considered one of the most unwanted jobs in the government.
Today, “health minister is one of the most coveted jobs,” said Dr. Eyal Zimlichman, Sheba’s chief medical and innovation officer, “because of the obvious focus on healthcare and the funding that comes with it. I think this is something we are going to see the ripples of in the next few years.”
Specifically, Afek said, the importance of maintaining a strong public healthcare system has been a result of the pandemic. Israeli-born Dr. Dorit Nitzan, who serves as director of emergencies for the World Health Organization, has said that universal health coverage has been the hallmark of those countries who best managed the coronavirus crisis from a health perspective.
“Every person in the country has to have access to quality and continuous health services, from public health to primary care, to emergency care, to hospital care and rehabilitation,” Nitzan said. “Israel has those values; it is part of the country.”
The impact of the public health system has become most obvious in recent weeks, as Israel launched its mass vaccination campaign. Being able to inoculate nearly half a million people in a week is something that most countries cannot achieve – certainly not countries like the United States, where access to healthcare is one of the foremost challenges.
“We are first in the world for vaccinating people per capita,” Afek said. “This does not occur in countries without a strong public health system.”
From a delivery of care perspective, there have also been shifts, mainly in the use of technology to communicate with care providers.
“Telemedicine has become the new norm,” said Zimlichman.
Doctors were for a long time resistant to telemedicine, he said, but the crisis forced them to use new tools that Sheba had been pushing for nearly a decade. Now, he believes, “For the next generation, seeing a doctor face-to-face will seem weird.”
The crisis will also leave its mark on medical personnel who directly treated coronavirus patients.
For Prof. Sigal Sviri, director of one of Hadassah University Medical Center’s intensive care units and at its peak its largest coronavirus intensive care unit, COVID-19 has been like balancing glass balls in the air while standing on one foot.
“I had to protect the staff, take care of the patients, their families, comply with management decisions, ensure standards of care, make sure that my staff – the doctors and the nurses – did not become burned out and that they were safe from catching corona,” she said, “and we have been doing all this already for more than 10 months.”
Although she believes the staff is resilient and will recover from the crisis, she envisions that there will need to be extra support provided to medical staff as they try to transition back to routine from the crisis. Moreover, she said it is likely that Israel will start to see a second kind of medical crisis in the coming year, even after the vaccines are effective: Prevention and treatment services for noncommunicable diseases have been severely disrupted by the pandemic, and the result will be sicker people.
In the first wave, hospitals were asked by the Health Ministry to halt elective procedures and some outpatient clinic work to make beds available for an expected flood of coronavirus patients. Although many of these patients returned in May – worse off than if they had come when they first needed care – others did not, partially for fear of catching the virus at health funds or the hospital.
Afek said Sheba saw a 50% to 60% decrease in a number, if not all, of non-urgent operations or treatments during the peak of the pandemic. Many people who needed treatment for diseases like cancer, cardiovascular disease and diabetes have not received the health services and medicines they needed since the COVID-19 pandemic began.
“It has been a very difficult dance between not putting too much staff and resources into coronavirus and neglecting the non-corona patients, and not putting too much into the non-corona patients and neglecting the corona patients,” Sviri lamented.
“When diagnoses are not made, treatments start later and people present with more severe diseases,” Afek said. “The result is that patients will be sicker when they come in for care and more deaths.”
‘Prozac Nation’
The title of the 1994 memoir by the late author Elizabeth Wurtzel, Prozac Nation, centering on her struggles with clinical depression, could well have become a catchphrase for Israelis in 2020 – with anxiety and depression on the upswing as a result of COVID.
According to a study led by Dr. Bruria Adini of the Emergency and Disaster Management Department at the School of Public Health at Tel Aviv University, some one in five Israelis reported suffering from high or very high levels of depression, up from one in 18 pre-coronavirus.
Likewise, the study found that at the peak of the second wave, almost one in three people in Israel (29%) suffered extreme or highly extreme symptoms of anxiety. Here too the data presents a sharp increase – from 23% in May to 27% in July and now 29%. In 2018, only one in 10 expressed suffering from such anxiety levels.
Adini, who has been conducting her survey on more than 800 Israeli adults, said she does not expect these numbers to grossly improve in the near future because “we don’t see any increase in the level of hope or morale.”
While her study identified that the increase in depression and anxiety occurred during the coronavirus crisis, she added, the emotions result from perceived political and economic threats more than from fear of catching the virus.
“If you look at the statistics, the percentage of the population in October who considered the health threat to be high or very high was 24% of the population,” Adini said. “When you look at the economic threat it was 45% and when you look at the political threat it was 49%.”
She said what this means is that people are less concerned about the danger of the virus and more about the impact of the disease on their lives, the country’s political instability and the economic repercussions.
Adini added that a striking finding of her work thus far has been that the younger generation in their 30s and early 40s have been the highest impacted – they are the ones who have higher levels of anxiety and depression.
“When you look ahead, this is a problem,” she said. “This is something we really need to focus on. We need to put a lot of effort into this age group, to empower them so they are more connected to the country, more optimistic concerning the future, to ensure that their level of national and community resilience is growing and not the other way around.”
In her survey, Adini asks respondents if they agree with the statement, “Israel is my home, and I am never going to leave Israel.” She said that in May, 13% did not agree with the statement. That percentage rose to 17% in July and 18% in October – a significant spike, which she said should also raise a red flag.
INCREASING MISTRUST of government: Activists wearing masks of (from right) Alternate Prime Minister Benny Gantz, Prime Minister Benjamin Netanyahu and Finance Minister Israel Katz protest at Tel Aviv’s Habima Square, December 2. (Photo credit: Miriam Alster/Flash90)INCREASING MISTRUST of government: Activists wearing masks of (from right) Alternate Prime Minister Benny Gantz, Prime Minister Benjamin Netanyahu and Finance Minister Israel Katz protest at Tel Aviv’s Habima Square, December 2. (Photo credit: Miriam Alster/Flash90)
Politics and public trust
As Adini noted, the political crisis in Israel has fired up the public as much as the virus has burned across the country.
“I think we have the COVID challenge and the political campaign, and it has become clear that the government was not stable from the early months [of the crisis],” Prof. Yuval Feldman of Bar-Ilan University said.
He said that since coronavirus came at a time when Israel had a transition government, was at its peak when the unity government was formed and is now being managed during a fourth election, political campaigning is always in the background of leaders’ decision-making.
“They could not allow the experts, the medical doctors, to take the front seat because if you are in a campaign, you have to show that you are the one in charge,” Feldman said, “that you are the one calling the shots. Otherwise, you will not get the political benefit.”
The result has been increasing mistrust in the government.
A survey published in December by the Israel Democracy Institute, where Feldman also works as a researcher, showed that both Netanyahu and Alternate Prime Minister Benny Gantz have low or very low credibility among Israelis. Some 62% of respondents said that Netanyahu has moderately low or very low credibility, while 60% said the same thing about Gantz.
Moreover, he said the crisis has been marked by a parallel phenomenon: A government that is deeply mistrustful of the Israeli public.
“Many COVID instructions are based on the assumption that you cannot trust Israelis,” Feldman noted. He cited the notion that people can be fined for not wearing masks even if they are walking alone at night – when seemingly they cannot spread of contract corona – or the idea that during lockdown one cannot drive more than 1,000 meters from home without a verified reason, because it is assumed that otherwise people would be driving somewhere to break the rules.
He said the public senses this mistrust from its leaders and in some sense almost rebels against it by acting out and being noncompliant.
“We should not fall into this position that Israelis are a nation who could be governed by deterrence, with sticks and monitoring,” Feldman cautioned. “This is a view that the government has and somehow, even the public has started to believe it.”
Work and the economy  
Israel has been slapped with three lockdowns, each one sending workers home on furloughs or to carry out their duties from their living rooms and home offices.
A study by the international accounting firm Binder Dijker Otte (BDO) found that those who work from home spend an average of two hours browsing social media.
“Workers seemed to follow their own pre-inclinations when working from home,” Dr. Guy Bahor, who led the study, explained in a press release. “Those who were effective workers in the office became more effective at home. Those who were less productive in the office became even less productive in their private space.”
In addition, lost is the camaraderie of the workplace, which cannot be replicated via Zoom, according to Prof. Naomi Feldman, as associate professor in the Department of Economics of the Hebrew University of Jerusalem.
“The throwing around of ideas with people you pass in the hallway – all of that has been lost,” she observed.
Feldman said she believes the future will hold more flexibility, including the ability to work from home, but that once the crisis subsides, she believes people will return to their offices – at least part of the time.
“Some companies might think that if people are working from home more, why do they have to have offices in downtown Tel Aviv where it is very expensive,” she said, noting that some companies could opt for new locations in the periphery to bring down costs.
For herself, she said she used to look at days working from home as a “treasure trove” but now heads into the office more than she did prior to COVID because the tables have turned.
“You want to see people, to get out a little bit,” she said.
Perhaps Ben Dansker, the head of planning at the Mandel Foundation-Israel, said it best in an opinion piece he penned for The Jerusalem Post:
“We have learned that not everyone is able to work productively at home, and that not all managers are capable of managing remotely,” he wrote in the article published in October. “Some work tasks are easily performed remotely and many others, such as manufacturing, are obviously not.
“We have also learned that there are living situations that are conducive to remote work and others in which working from home is all but impossible,” he continued. “Perhaps most importantly, we have learned that there are many positive aspects to working in an office that can’t be easily replicated by even the best online solutions, and that for most people, work is more than the sum of its tasks, and more than a workstation with good connectivity.”
Will Israel’s economy recover?
According to Prof. Elise Brezis, director of the Aharon Meir Center for Economic Policy at Bar-Ilan University, if the vaccine starts to work quickly, much economic recovery could already start to be seen in the new year.
Israel went from 4% unemployment before the crisis to as high as 20% at its peak and during lockdowns. Brezis predicts that at the end of 2021, unemployment will hover around 7%.
“Seven percent is higher than 4%,” she admitted, “but remember, we were around 20%, and it’s going down.”
Brezis said the country should look at the “cup half-full” and at the economic gains it will ultimately achieve due to coronavirus. She said the crisis spurred Israel toward a more digital economy, which is where it needed to get anyway.
“What would have taken 10 years to adapt to a new digital economy, we have changed in one month,” she said. A professor, Brezis noted that a year ago she was teaching with a blackboard and chalk “as if I was in the 1960s.” Today, she uses an iPad and communicates with her students in ways she could never have in the traditional classroom.
She said remote work saves two-hour drives in congested rush-hour traffic and, ultimately, even if not at first, could increase productivity.
“Israel will go out [of the crisis] more rapidly than other countries,” Brezis predicted, “because we are a hi-tech economy.”
Schoolwork
Feldman agreed, but said there could be long-term impacts on the economy that Israel cannot yet predict due to the decision to shutter schools for so long.
“This is something we might realize for a decade or more,” Feldman said.
She explained that while some students were able to handle distance learning and had the support of their families during the crisis, others did not fare as well. Students from poorer families might not have had the technological resources to enable their children to learn from home. Those from big families might not have had a quiet room in which their kids could study. The results would be gaps in learning that could take years to be repaired.
“What is it like to miss a year-and-a-half of schooling?” Feldman asked. “This is not something we are going to see next year, but when these kids get into high school, college or beyond. The situation is not going to be good for income equality.”
Prof. Izhar Oplatka, a professor of educational administration and leadership at the School of Education at Tel Aviv University, said the pandemic has had a combination of positive and negative impacts on education.
On the glass-half-full side, he said that teachers have been talking for decades about the need to adapt new instructional strategies and more flexibility into teaching methods and classrooms, and the pandemic forced them to do so.
“On Zoom, they had to find new ways to challenge and attract their students,” Oplatka said.
He added that it opened the world of learning to parents who could not observe their students’ classrooms and ensured more teacher accountability.
However, he said that school is not just book learning and that many children have experienced issues of isolation and emotional loneliness during the crisis.
“Zoom cannot, and will never be able to, replace human interaction,” Oplatka said.
He expressed confidence that learning gaps would be closed if the Education Ministry was flexible regarding the curriculum, but he said these emotional gaps may never be closed.
“The ‘childhood’ time, the time in school when kids play in the yard and laugh and interact with each other, this will never come back,” he concluded.
Lessons learned
“There is actually a lesson that I hope and pray to God we will take from corona, though I am pretty sure we won’t, and that is that health is really important,” Miron-Shatz said.
She said that while the world was focusing on the pandemic, more people were dying of chronic diseases, cancer, air pollution – some of which were preventable if people had taken care of themselves by eating right, not smoking or drinking too much and taking care of the environment.
The media has put an inordinate focus on the crisis; newspapers run sick and death tallies daily on their front pages, she noted. The government, too, has invested large budgets in buying vaccines and looking for treatments and cures.
Every year, around seven million people die from air pollution, according to the World Health Organizations, she said, asking why cars have not been taken off the roads or factories forced to cease operating because of their impact on the environment.
“If we saw the numbers of people who died every day, then we would do something about it,” Miron-Shatz asserted. “No one is saying, ‘Let us do good by our health.’ This is a golden opportunity, and we are missing out.”
Zimlichman said the crisis highlighted the significance of scientific collaboration, and he believes that going forward, this will be something that remains.
“Having a vaccine within a year is a huge achievement,” he said.
He said he believes that if the world would encounter a pandemic in the future, this process could be even quicker, perhaps taking weeks, because the pandemic has exposed how essential it is to invest in science, with more young minds now likely to join the field.
“More young people will turn to careers in medical science, because these are the heroes of our age,” Zimilichman hypothesized.
“We can do amazing things when we pull our resources together and put aside our political or commercial interests,” Miron-Shatz added. “Think how we could solve world hunger, if we would just say, ‘Let’s pool our resources together and get this done!’”
She agreed that the coronavirus crisis is a war but said it is different from traditional battles where people take sides and some are against others.
The pandemic broke down barriers and reminded the people of the world that we are all in this together, Afek said.
“One thing we have learned from corona is that people are alike,” he said. “Everyone can get coronavirus – Jew, Muslim, Christian. It does not distinguish.”
This leveling of the playing field could be the greatest gift to the world in 2021, Miron-Shatz said, if world leaders want it bad enough.
“If governments around the world united and said, ‘Wow, that was really bad,’” but used the pain and suffering to determine a game plan for how to collectively solve more crises, Miron-Shatz said, “then corona could ultimately make the world a better place.” 