Israel is not the same without her tourists. Yes, relatives can come, oftentimes struggling with dizzying regulation changes that are making even adaptive Israelis nauseous, and we can now have limited small tourist groups come in. This summer, Christian and Jewish groups and even camps came in with restrictions, testing and hassles. At least they came. We are grateful that vaccinated students can enter the country.
But a regular tourist with no first degree relative who wants to come with their family because they love Israel, want to see friends, want to have a falafel has been unable to visit for the last 18 months. And that is no longer OK. Here is the epidemiological argument and solution for allowing safe tourism to restart.
Epidemiological justification: Looking back at the peak of the Delta wave we see a different pattern than other waves, but which is among the typical types of viral mutations or variants that we can see with a pandemic.
The Delta onset was the most rapid with a 620% rise between July and August. There was a more prolonged, higher peak of daily cases as seen in the epidemiological curve, or daily case rates. This wave statistically affected and continues to affect unvaccinated or partially vaccinated people exponentially compared to the fully vaccinated population.
Based on Tuesday’s new cases, there is a 61.8:1 ratio of an unvaccinated person contracting coronavirus compared to the post-booster (or post recovery and one shot) population. People without vaccines or immunity are 5.4 times as likely to catch COVID compared to someone with two vaccines.
The Delta wave worldwide affected younger people – who are also more likely to be unvaccinated – with 95% of ICU beds full of unvaccinated patients whose average age is approximately 58 (down from 70). We know that contrary to other holiday periods during this pandemic, our numbers improved with no lockdowns, which is directly related to our third vaccine rollout. Israel’s booster model and data are being studied worldwide in the effort of offering boosters to wide populations in the future.
The world is adapting to this pandemic, and with improved transparency of data we know our cases are not being primarily imported as feared. In recent months, of the 50,807 people who arrived from the US (by far the highest importer of tourists to Israel) 0.45% – 228 people – were found to be positive. During that same period, Israel was averaging five to 10 times the positivity rate.
Yes, our variants were imported, but since tourists were extremely regulated and restricted most imported mutations came from returning Israelis, such as Israelis returning from Uman. Citizens are not restricted from returning to Israel, do not need medical insurance or vaccines and are culturally less likely to strictly quarantine. Recall the third lockdown failure for details. I am proud to be Israeli, but we are culturally rule-breakers, which works for start-ups and innovation but not as well for pandemic safety.
Throughout this period – now going on 19 months – our tourism and hospitality industries have been decimated. The OECD pre-coronavirus statistics include 230,000 tourism-related jobs (2020) and national income of $5.8 billion in Israel. And personally, walking around Jerusalem, the Old City, Tel Aviv, Galilee this holiday period – the absence of tourists echoes in the alleys and woods.
The impact of the dearth of tourists affects olim disproportionately, as do many of the pandemic related policies. Thanks to political activists such as Michal Cotler-Wunsh and Dov Lipman, the immigrant voice is being heard, but the lack of consideration for the hundreds of thousands of immigrants in the country is shocking in most policy development. There is a disconnect for olim. Our non-first-degree relatives cannot enter, neither can our friends and contacts. Policymakers who have Israeli relatives abroad do not have to apply for permission to enter their country.
It remains unclear if a tourist fully vaccinated according to current FDA vaccine approvals (usually without boosters) can enter without isolation. They can from Europe, but the Health Ministry’s vague language makes it an ongoing issue that requires further clarity.
What does this mean? We need to let tourists back into Israel. Memo to the government: No one wants to come to Israel to quarantine.
THIS IS my suggested policy for re-opening tourism during the pandemic:
APPLICATION
Tourists will apply for a streamlined entry permit, which should have an automated system with approval turnaround time of one to two days with no consulate involvement.
This should include:
- Proof of vaccine(s) or recovery as currently designated
- Receipt for prepaid antigen/rapid testing for every other day of the first SEVEN days in country (with a registered service). Antigen/rapid testing, which are finally being used more widely, are the key to ending entry quarantine.
- Medical insurance to include COVID
- Local contact, home email, cell phone
ELECTRONICALLY SIGNED CONSENT INCLUDING
- Responsibility for payment of quarantine facility (can be private), if needed
- Attestation to true documents
- Possessors of forged documents will be subject to legal action including significant fines, prosecution and banishment from entering Israel. Civil actions should be permitted from people they exposed/quarantined or gave COVID to. Hey, money talks.
- Agreement to maintain all regulations with link to current regulations
ENTERING ISRAEL
- PCR tests within 72 hours of departure to Israel.
- Upon arrival PCR, serology AND antigen/rapid testing at the airport.
- Negative antigen/rapid test AND positive serology test = no quarantine. This was among my springtime suggestion to former Health Ministry director-general Prof. Chezy Levi and ministry public health official Dr. Sharon Alroy-Preis.
- Temporary Green Pass (for the duration of their trip) automatically issued to tourists with negative PCR test or within 24 hours, whichever comes first. EU Green Passes will automatically provide Israeli Green Passes.
- No need to repeat serology test within six months, but PCR and antigen tests always required upon arrival.
Tourists required to take antigen tests every two days during their first week in Israel. This will mitigate cases that fall between the cracks. Official companies that do testing will provide written report of results as proof.
Antigen positive tourists require PCR testing and 10-day quarantine. Quarantine allowed in a private residence, (short-term rental) or COVID hotels available. The state must have an option for an upgraded COVID hotel, partially subsidized for those who want a higher level of service (good food, balcony, comfortable setting). Tourists may not quarantine at a regular hotel or with high-risk family members.
DEPARTING TOURISTS
PCR or antigen test pre-departure from Israel within 72 hours according to airline regulations. I believe this will change to an antigen rapid test within 24 hours (easier and affordable)
WHAT ABOUT CHILDREN?
Children under 12 years old is a challenge for pandemic-era tourism, but with pediatric vaccines about to be approved by the FDA, we hope this will not be a problem for long. Recovered children should have the same entry rights as vaccinated or recovered adults, although adults will need a booster. Yes, people are getting COVID more than once, but rarely and with all the other testing, the risk is mitigated.
This plan is sound, will work, easily implementable and enforceable. The benefits to Israel’s economy, public image as the world leader in pandemic management, and to the lovers of Israel, Jew and non-Jew alike, are innumerable. Israel needs her tourists back.
The writer, director of EMA Care, specializes in pandemic planning, epidemiology, public health (clinical and policy), and is an expert in health access for non-residents and immigrants. She established the first 24/7 English-language telemedicine hotline in Israel. Her website is www.emacare.com.