This Passover, Israelis are celebrating their freedom from COVID-19. But as they leave the confinements of isolation, health experts warn that it is still too preliminary for the country to believe it has reached the Promised Land of health.
That is true even as the Health Ministry calculated Israel’s coronavirus reproduction rate – also known as the “R” – to only 0.55; a rate under one means the virus is on the decline.
“It cannot be determined at this point that the pandemic is behind us and therefore complacency should be avoided,” a report published by the Coronavirus Knowledge & Information Center warned on Monday. “Carefully keep the guidelines and be cautious while continuing to ease economic restrictions.”
These are four of the coronavirus questions that remain:
1) Could variants undo Israel’s mass vaccination campaign?
Viruses mutate – this is part of their biology.
The rate of mutation is dependent on the number of times the virus replicates. When infection rates decrease, so do the number of new mutations. That is good news for Israel, where only around 1.2% of people screened for coronavirus are testing positive.
However, there is still a concern that there may be a mutation that occurs with a trait that gives it an advantage over the vaccine, rendering it what is called “vaccine resistant.”
While such a mutation could occur in Israel, it is more likely that a vaccine-resistant variant would be imported to Israel from abroad.
“A major issue these days is risk management in Israel in relation to the arrival of problematic variants,” the Knowledge Center explained, noting that this is especially concerning over the Passover holiday when citizens are traveling in and out of the country.
In recent months, strains have been identified that significantly increase the risk for infection – such as the British variant that before vaccination constituted as much as 99% of all infections in Israel. Others, such as the South African, Brazilian and New York strains, have been found to increase the risk of reinfection by people who had already recovered from the virus.
The Brazilian coronavirus strain traveled quickly to neighboring Paraguay, Peru and Uruguay, launching new waves of COVID-19 in those countries.
“In light of this, there is an increased risk of incoming flights from South and Central America, as well as from the United States and European countries, where the South African variant is spreading,” the center warned.
The way to stop these mutations from entering Israel is to secure the country’s borders and to follow practices that limit unregulated entry, said Prof. Jonathan Gershoni of the Shmunis School of Biomedicine and Cancer Research at Tel Aviv University.
“People should only be coming from abroad hopefully after they have been vaccinated,” he said. Otherwise, he recommended a combination effort of effective testing and quarantine to limit risk.
Until now, the government has struggled to secure Israel’s airport. The Health Ministry said nearly two-thirds of all returnees failed to properly quarantine.
2) Will we need a booster shot?
Health experts have said that it is still too early to know for how long the Pfizer-BioNTech coronavirus vaccine will last. It is possible that in as little as six months or a year, people who have already completed the normal two-dose regimen will require a third dose.
“We don’t know how robust the protection will be,” Gershoni said, but he noted that “the need for a booster shot months or even years after initial vaccination is quite normal to fortify and enhance the protection developed from a first vaccination.”
It could also be that the coronavirus is altered so much each year that a new vaccination is required, such as is the case with influenza; flu vaccines are adjusted each year to keep up with what is known as “antigenic drift.”
However, most research to date has indicated that SARS-CoV-2 evolves slower than the flu or HIV – and that’s a good sign.
Finally, vaccine-resistant variants that could impact the effectiveness of the vaccines could make a booster required. Messenger RNA vaccines, such as those developed by Pfizer and Moderna, are faster to modify than traditional vaccines, and hence the companies should be able to craft new versions to combat individual variants if needed.
In fact, Pfizer, Moderna, AstraZeneca and Johnson & Johnson have already started working on boosters to be more effective against variants.
But, Gershoni noted, that even if some variants render the vaccines less effective, it is unlikely that they will become totally ineffective, meaning they would still likely prevent severe cases of the virus.
“From what we can see, the vaccines are doing a pretty good job,” he said, “and there is no real reason to expect we will need a booster in the coming months.”
3) When can we take off our masks?
The Centers for Disease Control ruled earlier this month that people who are fully vaccinated can gather together – including indoors – without wearing masks. But Israelis are still wearing their masks – even outside, where air circulation reduces the chances of infection.
“We still do not take off the masks, neither outside nor inside,” Prof. Nachman Ash stressed last week in an interview with Ynet. But he has said that masks are much more important in crowded areas or inside.
Ash said that the Health Ministry will soon convene on the subject and that officials are considering allowing Israelis to unmask in open areas.
“I estimate we will do it in the near future,” he told Ynet.
Mask wearing has been scientifically shown to stop the spread of coronavirus. Because it is still unclear whether vaccination halts asymptomatic infection and resulting transmission, health officials in most countries have not removed the mask requirement to protect the unvaccinated – including children – from catching corona.
So far, more than 50% of Israeli citizens have received two shots of the Pfizer vaccine, including 87% of people over the age of 60. Children are less likely to develop severe cases of COVID-19.
“As the burden of virus is reduced in the country, one can begin to consider relaxation of some of the rules and regulations, and so one of these could be to relax policies of when one has to wear a mask,” Gershoni told The Jerusalem Post.
4) Why have we still not achieved herd immunity?
Israel has not achieved herd immunity despite the stunning roll out of its COVID-19 vaccination campaign, and it probably never will.
That’s because experts believe that between 70% and 80% of the population would need to be vaccinated to reach such a goal, and that would require the bulk of the country’s nearly three million children to get the jab.
Pfizer and Moderna are both in the midst of trials on children under the age of 16, but no results are expected until at least the summer.
Moreover, not everyone is getting vaccinated.
While the majority of older adults have been inoculated, only 54% of students between 16 and 19 have been vaccinated, the Health Ministry showed. Similarly, only 71% of people 20-29 have gotten their shots.
“There are a number of factors that affect herd immunity,” Gershoni explained, including “the total number of people who are vaccinated or recovered and the efficacy by which the virus can spread.”
The British variant was as much as 70% more infectious than the original strain, for example, which meant that more people had to be protected to achieve herd immunity when that variant was circulating.
Meanwhile, Israel is vaccinated but the Palestinians are not. Neither are Israel’s other neighbors in Jordan, Egypt, Syria or Lebanon.
“Viruses know no borders or boundaries, and obviously it is in Israel’s best interest to have neighbors who are protected as well,” Gershoni said. “Have we reached herd immunity? Definitely not. Can we reach herd immunity? Also, probably not. But that’s just through numbers. We have already accomplished coverage with an emphasis on the protection of those over the age of 60. That means that with or without herd immunity, the danger of developing serious disease that requires hospitalization or could even lead to death is markedly reduced.”