What we don't know about the next COVID-19 wave

HEALTH AFFAIRS: Major guidelines, such as masks on planes or testing to travel, may have been canceled, but we wonder when the government – here or elsewhere – will grasp at these guidelines again.

 BACK TO THE lines? Magen David worker take a COVID-19 rapid antigen test at a Magen David Adom drive-thru site in Jerusalem on Monday.  (photo credit: OLIVIER FITOUSSI/FLASH90)
BACK TO THE lines? Magen David worker take a COVID-19 rapid antigen test at a Magen David Adom drive-thru site in Jerusalem on Monday.
(photo credit: OLIVIER FITOUSSI/FLASH90)

I recently went into an Aroma coffee shop in Modi’in. Attached to the end of the counter was a small cone-shaped device with a screen.

During the beginning of the pandemic, such machines were rolled out so people could check their own temperatures when entering. If the device showed red numbers, then you were too hot and were expected to leave, because you might have had COVID.

That was before tests were readily available. Now you can buy COVID tests at the gas station, next to the rolling papers and small bottles of alcohol. The days of a person checking each customer’s temperature, or asking for a Green Pass and demanding masks be worn correctly seem in the distant past. Some are wondering whether those mandates will come back in some form or another.

The relics of COVID past are all around us. At the mall in Jerusalem, the white squares for social distancing are still visible, as they are at the zoo. And many places still have signs asking patrons to wear a mask and distance, even though the rules have been relaxed.

A HEALTH worker administers a COVID test to a child at a Maccabi HMO clinic.  (credit: MICHAEL GILADI/FLASH90)A HEALTH worker administers a COVID test to a child at a Maccabi HMO clinic. (credit: MICHAEL GILADI/FLASH90)

Will the mask mandate return?

Israel is now weighing a return of an indoor mask mandate, as the number of new cases rises above 10,000 a day, and there are almost 200 people in serious condition in hospitals. There are dozens of patients in critical condition, and the “R” rate of the spread of the virus is more than one. That is bad news, from a public health standpoint. Israel’s experts say the BA.5 sub-variant of Omicron is to blame.

AS ISRAEL prepares for possible new chaos of mask mandates, maybe more mass testing or travel chaos, and the country goes through another chaotic election cycle, it is a reminder of the uncertainty of the past.

In the early days of the pandemic, the country prepared for the worst. It used the army to bolster the police to help impose lockdowns. By December 2020, though, it was also the first country to roll out widespread vaccination. Today, some 6.7 million people have been vaccinated. Israel offered a booster to people over 60 in July 2021 and to people under 60 in August of that year. By January 2022 it was offering the fourth shot to those over 60.

Israel's Green Pass program

Over the past year Israel’s changing regulations have seen many pandemic policies come and go. For instance, in February Israel dropped its Green Pass program.

This program included an app on the phone where you could download the pass to be scanned to enter restaurants.

For kids who were not vaccinated, a different set of rules prevailed, at least until November 2021, when those over five could get vaccinated. To enter a public pool children had to be tested within 24 hours, and parents got a QR code they could scan at the entrance. I have some of those still in my phone from October 9, October 2, September 5, August 28 and September 12. Those were the days where, if you wanted to take a few days of vacation, you’d have to get the kids tested every day. Each day was like a roll of the dice. If the kid had COVID, you’d have to isolate.

Along with the need to test every day, if one wanted to take kids to the pool or some other activities, came widespread testing for kids at schools. When one kid was positive, sometimes the whole class would have to go home. For us that was the case on January 17 and January 3 of 2022, when 10 kids were positive, and December 29 of 2021.

Shifting regulations

Then, of course, there were the changing test requirements for flights. It used to be, in 2020, that they’d test sometimes before leaving and then also on arrival at the country of destination, and there would be quarantines. Then they’d change the quarantine time from 14 to 10 days, to just waiting for results. When Omicron arrived, the US, which had decided travelers had to be fully vaccinated, also demanded tests within 24 hours of a flight, rather than 72 hours.

The changing test requirements at airports also came with airlines’ differing approaches to working with customers. In one case, I’d purchased tickets to fly on vacation in early 2021, after having been vaccinated. The airline then arbitrarily changed the dates of the flight, not only making it so we couldn’t travel but also coinciding with new restrictions in Israel. The ticket was nonrefundable, and the airline refused to respond to inquiries, because companies during the pandemic could do what they wanted.

The second time a family trip was canceled during the pandemic, at least the airline agreed to refund the ticket price.

That was in late 2021, when Israel suddenly decided to close its airport to foreign travelers and reinstate quarantines during the Omicron wave. Israel had also suddenly closed its international airport in January 2021.

During the Omicron wave, regulations also changed every few days at large shopping centers. One day would find the food court closed, the next day checks for Green Passes.

Other shifting regulations were confusing. In the beginning they would restrict the number of people in some stores. For instance, small stores could have only one or two customers inside at a time. I remember the frustration of watching the snail’s pace line at an ice cream shop, as patrons were allowed in one after the other.

Then there were changing regulations at the gym. First it was closed. Then you had to have a Green Pass but couldn’t use the pool. Then the public could use the pool, but the weight room was open only to those who had a Green Pass and got a special bracelet. Then the Jacuzzi was closed, but then it was open; and the pool was open, but closed to kids under 12; and then it was open to such kids if they were tested; and then it was open.

Public eating was also banned at some point, and in malls you could walk around but not eat or drink. Then they let you drink, but tables were closed to eating; and then they would let every other table be open to “distanced” eating. Eating on public transit wasn’t allowed until they got rid of the mask indoor mandate, but it was allowed on flights.

For the vast majority of the public, the regulations are at best an advisory, because most people can’t keep up anyway, and follow them only to the bare minimum. For instance, many businesses had to put up signs saying only one or two people could be in elevators, but most people didn’t follow this guideline.

The future of COVID guidelines is uncertain

THE MAJOR guidelines, such as masks on planes or testing to travel, may have been canceled, but we wonder when the government – here or elsewhere – will grasp at these guidelines again.

Many people have now had COVID, or even had it twice. Some who may have had it never tested and won’t know if they had it once or not at all.

All of these realities and fatigue with the guidelines may help inform policy-makers during the “sixth wave.”

There are lasting questions about the past two years of the pandemic, and most can never be answered, because we don’t have enough information about what underpinned the constantly shifting regulations and mandates.