Will Israel lead the way?

Is it accurate to predict that those who recover from COVID-19 will all become immune?

By YITZHAK SOKOLOFF
The IDF holds a blood drive in light of the coronavirus crisis (photo credit: IDF SPOKESPERSON'S UNIT)
The IDF holds a blood drive in light of the coronavirus crisis
(photo credit: IDF SPOKESPERSON'S UNIT)
Earlier this week a tiny local newspaper in a small city on the Mediterranean coast published an article that may contain a very big idea for anyone concerned about the coronavirus, which is pretty much everyone.
Dr. Shalom Reich is a doctor in the Emergency Department of the Assuta Medical Center in Ashdod. He proposes that Israel and perhaps other governments recruit volunteers from among young, 20-40-year-old, non-smoking and healthy doctors and nurses as well as other vital personnel such as police, ambulance drivers and other critical sectors, intentionally infect them with the coronavirus, provide 24/7 quarantined medical supervision while they recover and then, just as the crisis may reach its peak, release them back to their jobs to save the rest of us.
His assumption is that having recovered from the virus, the volunteers will develop natural immunity and then be able to move freely throughout the infected population with little or no risk of infection. Reich believes that this taskforce, numbering approximately 25% of the vital workforce, will be the deciding factor in the fight for a functioning healthcare infrastructure, because the other doctors and emergency staff are likely to fall ill or be forced into quarantine at the same time that patients are flooding emergency rooms.
 
For those of us who have ever had the experience of waiting in an emergency room filled well past its capacity, Reich’s idea intuitively makes a lot of sense. In the “World of Coronavirus” the greatest fear is that health services will be overwhelmed by demands they have never faced before and will no longer be able to provide minimal care to the population, not only for COVID-19 patients, but for all the other “normal” occurrences for which we depend on modern medicine.
Victims of heart attacks, strokes, cancer and trauma - most of whom are treated and released by hospitals operating normally, will need to be triaged in ways that will come at a great cost to patients' health and sorely test the resilience and solidarity of our societies. This is what happened in the Hunan province of China in January and February and what is happening today in much of Italy, a country with one of the most advanced medical systems in the world.
 
Reich argues that the writing is on the wall. In the proposal he submitted to the Health Ministry, which led to the publication in the Ashdod local paper, he wrote that “we are dealing with a global crisis that is taking a devastating toll on our economies and our healthcare systems and that presents a clear and present danger to our populations and the orderly function of our governments.” Although the mortality rate for those 80 and above may be as high as 14%, for young and healthy individuals in their 20s and 30s infection by COVID-19 is generally mild and often not even noticed.
According to his plan, after a closely supervised incubation period of two to three weeks from their deliberate infection, volunteers from the health community and others who are critical to our day-to-day life in emergencies would be released back into the workforce, immune to COVID-19 and ready to play critical roles as the virus peaks.
 
Unfortunately, wrote Reich, “there are no definitive ways to prevent the eventual infection of the wider population. Current strategies are simply buying us time in order to taper the rate of infection and to allow time for inoculation production.”
In other words, give or take, we are all on the way to becoming Italians. The question is, when we get there will there be enough doctors, nurses, X-ray technicians, ambulance drivers, firemen, police and a host of other trained professionals whom we have accustomed ourselves to depend on in times of need.
 
Is it accurate to predict that those who recover from COVID-19 will all become immune?
According to Dr. Stephen Gluckman, an infectious diseases physician at Penn Medicine and the medical director of Penn Global Medicine, who was quoted recently in The Independent, “it seems likely that having the disease once results in immunity in most individuals - as is seen with other coronaviruses… Coronaviruses aren’t new, they’ve been around for a long, long time and many species – not just humans – get them, he explained. So we know a fair amount about coronaviruses in general. For the most part, the feeling is once you’ve had a specific coronavirus, you are immune. We don’t have enough data to say that with this coronavirus, but it is likely.”
Likely is not definite, and the possibility that the virus would mutate and leave individuals susceptible to reacquiring the infection certainly exists. We will probably not know the definitive answer until after the crisis has passed. For Reich the nature of the threat of a massive breakdown of medical and emergency services justifies the risk. He recognizes an ethical dilemma with his proposal and believes that intentional exposure to the virus should be administered only to volunteers and even then, only to those whose medical profile puts them in the very lowest of risk categories. He does not believe that there would be a shortage of volunteers in the current reality.
“We should remember,” he writes in his proposal, “that most of this population will be infected by the virus in any case, but now it is still possible to treat them in a controlled way that gives them the best medical care before the crisis reaches its peak. We should measure the risks involved against the many lives we can expect to save because our health and emergency service providers will be able to function when we need them the most.”
Reading this, images of D-Day and 9/11 flashed through my head. The danger then was clear and present, and still the soldiers and the firefighters threw themselves into infernos. In contrast, “for young and healthy people,” said Reich, the mortality rate of coronavirus is virtually zero.” When asked if he himself would agree to volunteer, he answered that he intended to be first in line.
Full disclosure, I knew Shalom Reich when he was himself a combat intelligence officer in the IDF and this did not surprise me. Neither did the fact that his proposal was based on the volunteering ethic that is so ingrained in Israeli society.
Will the intentional infection plan be adopted by Israel? Tonight, when I tried to reach Reich, he was working full time in the emergency room and unable to comment any further. But his modest proposal to the Health Ministry and the article published in an obscure local newspaper in its wake may have set off a process that could revolutionize the way we fight the coronavirus worldwide. If so then the next step might be a full appraisal together with the National Security Council, which is now coordinating Israel’s response to the crisis together with other government agencies.
No other country in the world has taken such a bold approach to the coronavirus challenge. Yet this would not be the first time Israel has stepped out of the box with a novel approach to a universal problem. “If the idea is adopted”, says Reich, it can serve other countries who are at the beginning of the outbreak.”