Compared to China, Iran or Italy, Israel – with no deaths and 17 confirmed coronavirus cases to date – has hardly been affected by the epidemic. But Health Ministry officials here have taken the toughest action worldwide to prevent the spread of the contagion, including the decision on Wednesday to ban the entry of foreign nationals from five additional European countries.Currently, two weeks of self-quarantine are required for all Israeli citizens returning from China, Hong Kong, Thailand, Singapore, Macau, South Korea, Japan, Austria, Germany, Spain, France, Switzerland and Italy. Almost 70,000 Israelis have now been ordered into a 14-day period of self-isolation. Introducing the expanded measures on Wednesday, Prime Minister Benjamin Netanyahu emphasized that Israel is in a “good situation” due to a policy of “over-preparation and not under-preparation.”“We had to take strict steps, even very strict steps, to slow the spread of the disease in Israel, and that is what happened,” he said.While “better safe than sorry” has been the guiding principle for public health authorities since the start of the outbreak, some citizens and business leaders have questioned the restrictions, which are almost unparalleled in their severity. In a letter sent to employees on Wednesday, El Al CEO Gonen Usishkin lamented the damage caused by the strict measures to the airline, which has announced plans to lay off 1,000 permanent and temporary staff.Dr. Hagai Levine, an associate professor at the Hebrew University of Jerusalem’s Braun School of Public Health and Community Medicine and chairman of the Association of Public Health Physicians, told The Jerusalem Post experienced public health professionals “always consider the economic, social and legal implications” of their decisions.“Of course, there could still be measures that are first of all, inaccurate; second, exaggerated; third, ineffective; and fourth, damaging,” he said. “The decision must be proportional, must be realistic, must be evidence-based and must be transparent to the public. If all these conditions are met, then it is also feasible, and it is the social norm, and people respond with trust.”The current lack of a government and “unprecedented” absence of trust in elected officials makes it “very difficult” for health professionals to do their best work, Levine said.“Especially at the beginning of an outbreak, it is necessary to take extreme measures – especially in the coronavirus outbreak. At every point of time, we have to be flexible and reconsider our steps,” he said, adding that “aggressive instructions” for home quarantine are justified when trying to prevent the disease from penetrating the country.“When you already have a pandemic, and the virus has already spread in some communities in Israel, you have to change the policy and focus on preventing close contact with sick people who have tested positive for corona,” Levine said.Current measures requiring large groups of people to enter isolation after simply being nearby sick individuals “cannot last over time,” he said. “I hope the prime minister will decide to adjust the situation very soon to be more proportional and adequate to the current situation.”Prof. Nadav Davidovitch, director of the School of Public Health at Ben-Gurion University of the Negev, said the implementation of strict measures to be appropriately prepared and alert are very different from accusations of hysteria and panic.“As we continue to move ahead, we know more about this disease,” he told the Post. “We understand that it is worse than the regular influenza, but less so than SARS. We want to take the right measures, and we can now see that other countries are taking similar measures related to containment.”While several citizens have tested positive and “imported” the virus after returning from abroad, Israel is “still in the early containment stage,” Davidovitch said. Once there is greater local transmission, then other measures are likely to be implemented, including wider testing for the coronavirus at community-based sentinel sites, he said.“These sentinels will be very effective to know if there is high transmission within the community,” Davidovitch said. “But we are not there yet. We are still quite successful in the very early stage of containment, as we don’t have widespread community transmission.”While measures including preventing entry to visitors from certain countries are justified when still in the early stages of containment, the economic impact of such decisions means that they “can only be taken for a certain amount of time,” he said.Ultimately, the main idea of the measures is to “earn time to continue and prepare for the next stage,” Davidovitch said. Once Israel enters into the stage of widespread community transmission, which is “likely to arrive,” the burden will increasingly fall upon the healthcare system and the hospitals.