【Editor's Note】
As the pandemic caused by the coronavirus variant Omiljung recedes in most countries around the world, attitudes and strategies towards COVID-19 are changing in these countries. How to restore and maintain normal life to the greatest extent possible while containing the spread of the virus as much as possible is a major choice that all countries will face in 2022.
Since January 2022, the www.thepaper.cn has selected a series of the most representative countries around the world based on factors such as population, economic level, vaccination rates and social openness policies. Through continuous interviews and investigations, the experiences, experiences and lessons of how these countries have emerged from the Opichron pandemic and gradually restored social openness will be presented to Chinese readers through a series of reports.
In the eyes of Israeli physician Neta Petersiel, the past two years often feel like a strange dream – our real world has been forever changed by the coronavirus, and people have become accustomed to wearing masks, maintaining social distancing and embracing wave after wave of COVID-19. The pandemic has affected everyone around the world, but each country has taken a different approach to how it has responded.
Netta is a clinician at the Rambam Health Care Campus in Israel. For a year and a half after the outbreak began, he worked as an attending physician in the COVID-19 ward. Now, two years after Israel closed its borders for the first time, the country has announced it will be open to all, with a full return to "normal life."
If you want to sum up the battle between humanity and the new crown virus, there is one country that has to be carefully studied - it is Israel. The country of more than 9 million people is ahead of almost every initiative: the first to close borders, the first to start vaccinations, the first to receive boosters (third doses) and a fourth dose. Israel's every move is closely watched globally.
Since 1 March, Israel has lifted almost all health restrictions, opening its doors to the world. How israel's future outbreak will develop remains to be seen, but it certainly provides an observable sample for the international community: what has Israel done, from lockdown to flexible control to full opening-up?
Step out of the shadows of Omikeron
After more than two months of "wrestling" with Aomi Kerong, since March 1, Israel's epidemic prevention and control and social management measures have undergone obvious changes.
It is also the first time since the beginning of the COVID-19 pandemic that Israel's doors have been fully opened to foreigners. The only requirement for all entrants is to submit a positive polymerase chain reaction (PCR) test report before boarding and after landing. All non-positive travellers are admitted, regardless of whether they have been vaccinated or not.
"After more than two years of pandemic, it's time to return to a more normal reality – to live with this virus and take appropriate steps to protect public health." Israeli Prime Minister Bennett said in a statement that the basis for this was that "all the data on the outbreak are steadily declining.". So, as one of the first countries in the world to close their borders, it's time to reopen.
Two months ago, Omi Kerong brought Israel its worst wave since the outbreak began. At one point, the number of newly confirmed cases (seven-day average) exceeded 100,000, nearly 1,300 severe cases, and more than 200 deaths. These numbers have now dropped sharply to more than 6,000, more than 200 and more than 20 respectively. In Israel, the R value (the number of people infected per infected person), which measures the spread of the new coronavirus, has dropped below 0.7.
"We estimate that 20 to 30 percent of Israelis were infected with Omi kerong during this wave, and as the outbreak subsides, there is now a lot of immunity in the population – a combination of long-term vaccination and natural immunity after large-scale infection." Asher Yeshaihu Salmon, director of the Department of International Relations at the Israeli Ministry of Health, told The Paper.
Currently, of Israel's 9.2 million people, 3.7 million – more than 40% of the population has been confirmed– while the number of people actually infected is certainly higher. More than 10,000 people have died of illness. On a per million population basis, Israel has a higher number of deaths per million than Singapore and the United Kingdom and a lower number of deaths than the United States.
Escher said that under this wave of the Omicron outbreak, most people have only mild illness or asymptomatic after infection. Unfortunately, there are still severe and fatal cases due to the sheer number of infections being too high. Fortunately, hospitalizations, severe illnesses, and mortality rates have remained low, and Israel's health system, while always operating at full capacity, has never been broken.
Israel's experience shows that high rates of complete vaccination (including third doses) or protection against infection and transmission in Amiquerong can be effective in reducing severe illness and mortality, keeping the bottom line of the health system from collapsing.
"Based on this experience, we believe that we will enter a phase of continuous living with the virus. We will continue to monitor symptomatic cases and test everyone who enters Israel. Protect children and the elderly. At the same time, we have to get back to our normal lifestyle. I mean, major events can be re-held and schools can resume normal operations. Whoever it is, welcome them to Israel. Escher said.
It is interesting to note that, during the op-Mikharong pandemic, the Israeli government has insisted on not returning to the strict lockdown of the past, but has made appropriate adjustments based on maintaining the original measures.
So how did Israel survive this wave of the Opmikhayan outbreak?
Soon after South Africa first spotted the Ami kerong variant last November, Israel quickly closed its borders. Now Escher recalls that this bought some time for follow-up preparations.
"The first phase of our response to Theomilon was containment, delaying local spread as long as possible." Escher explained. These measures have bought Israel precious weeks to prepare for the inevitable surge in cases that will follow.
At the beginning of the outbreak of the Omiljung outbreak, the experiences of South Africa and the United Kingdom showed that Omiljung had super transmission, caused mild symptoms and had a certain escape from the vaccine. The Israeli government and public health experts have thus formed a scientific consensus and judgment: even the most severe lockdown measures cannot completely stop the spread of Omi kerong, and a large number of people are bound to be infected. The focus should be on protecting the most vulnerable, reducing severe and mortality, and ensuring that health systems do not collapse.
The Israeli government has laid out three principles that guide the response to the Opmikharong pandemic – keeping the economy as open as possible, protecting the most vulnerable groups in society, and keeping the education system functioning.
As a result, Israel has rapidly changed its approach to detecting and tracing infected people. "Because the Omicron is so contagious that we expect up to 20% of the population to be infected, it is necessary to change the testing and screening system, and past PCR (nucleic acid) tests often required long queues of hours outdoors, which was inefficient, expensive, and unhealthy." Therefore, young people and other low-risk groups are advised to adopt rapid antigen detection at home.
Escher said that although the antigen fast screening method is less accurate than nucleic acid testing, it can be performed at home and results can be produced in just a few tens of minutes, which is still preferable under the epidemic conditions at that time. It also means that most people (if asymptomatic or mildly ill who test positive) need to take responsibility for self-testing and self-isolation at home.
At the same time, the Israeli government has purchased a large number of antiviral drugs. These drugs have a very good effect on the treatment of early patients. "We have some time to adjust the health system a little bit to be more prepared for the coming wave." We haven't been able to stop the arrival of the Aomi Kerong outbreak, and when it came, there was a spike in cases, but at least we had some time to prepare. He said.
Israel began 31 December 2021 and was the first to provide the 4th dose of Pfizer to people over the age of 60. A 4th dose is later recommended for all adults. Preliminary data from Israel indicate that antibodies in the human body are significantly enhanced after the injection of the fourth dose of the vaccine.
"The reason for starting the fourth dose (without a general consensus in the medical community) is simple, because past data and studies have shown that vaccines are less effective, so we must protect the most vulnerable people." The large number of vaccination boosters has indeed played a key role in saving our lives. Escher said.
Israel's journey through the Opmi-Kerong outbreak has not been easy. "Despite everything we did, we lost thousands of lives. Perhaps the only consolation is that the Opmi-Kerong variant causes milder symptoms of the disease. Our entire hospital system is still operating at full capacity, but it is not collapsing. He said.
What has kept Israel's health system under pressure in this wave of the pandemic without collapsing?
Escher further explains: First of all, Israel has a very strong community health system. The government requires all mildly ill and asymptomatic infected people not to go to the hospital, but to isolate themselves at home for treatment; only requires patients who really need hospitalization according to objective criteria.
"The best way to reduce mortality requires good equipment and good knowledge, but also if the health care system is not overwhelmed." When hospitals are packed with patients, you can't provide the best treatment for each patient. So our goal has always been to take whatever action is necessary to avoid the hospital being squeezed out. Escher said.
How Israel has transformed
To understand the choices Israel is making now, we need to look back at the process of changing Israel's epidemic prevention and control policies over the past two years.
Since the COVID-19 pandemic, Israel has experienced five outbreaks. In December 2020, Israel was the first country in the world to implement mass vaccination, which also became a watershed in Israel's response to the epidemic.
In the first year of the outbreak, Israel was one of the first countries in the world to impose lockdown and strict control measures. In the absence of a vaccine, after the first relaxation of controls in May 2020, the epidemic rebounded rapidly, becoming the country with the highest infection rate per million people in the world.
Dr Netta recalled to The Paper that during that time, The Resources of Israel's medical system were once pushed to the limit.
"By then, we had exhausted all the spare rooms in the hospital and were understaffed. So it was decided to move all the COVID-19 wards to a temporary ward converted from an underground parking lot. You heard that right – parking lot. Imagine being a patient being cared for by paramedics dressed like astronauts in a makeshift ward in a parking lot. He recalled.
Dr Netta Hospital converted the car park into a ward
The introduction of vaccines became a turning point. On 20 December 2020, Israel became the first country to launch a nationwide mass vaccine program. The Israeli government has since continued to expand the age range of vaccine coverage and has been the first in the world to approve the injection of booster injections (third) and fourth doses. These measures have played an important role in responding to the Delta and Aumequeron outbreaks.
To date, 80 per cent of adults in Israel have been vaccinated with two doses, more than 50 per cent with a third dose and a fourth dose with a further 8 per cent. (The vast majority of people are vaccinated with the Pfizer vaccine.) Because some people are still not vaccinated. Israel's vaccination rate in the second half of 2021 will gradually be overtaken by Singapore, South Korea and other countries.
After vaccination, although Israel once again recorded a new record number of new cases in the fourth round of the Delta outbreak in September 2021, both the rate of severe illness and the death rate have dropped significantly, and the economic recovery has become more resilient due to the reduced rigor of social control measures.
Dr. Diane Levin-Zamir, chairman of the National Health Promotion Council of the Israeli Ministry of Health, told The Paper that vaccines play a vital role in keeping Israeli society open.
"Without a vaccine, we wouldn't have been able to get out of it all. Vaccines are game changers. Without vaccines, we cannot survive the delta and Omicron outbreaks. Vaccines do not necessarily prevent infection. There are many breakthrough infections in the Opmi kerong wave, but they are mild and mostly mild symptoms. That's what vaccines do. Zamir said.
According to the Israeli Ministry of Health, more than 75% of positive cases in this past wave have not been vaccinated. This is more pronounced in hospitalized patients.
Commenting on why Israel's attitudes and measures have changed, Dr. Ella Sklan, a virus and immunology specialist at tel Aviv University's Center for Fighting Epidemics, told The Paper, "After 2 years of the COVID-19 pandemic, a lot of things have changed. We have now learned how to treat patients better, and we have effective vaccines and medications that can prevent infections and diseases from worsening to some extent. Although the pandemic does not know when it will end, normal life must continue under conditions that can protect vulnerable groups. ”
With the introduction of vaccines, Israeli society is gradually moving towards flexible control.
In early 2021, Israel introduced the "GreenPass" system as an important mechanism to avoid economic blockades and incentivize residents to vaccinate. Obtaining a "green pass" must meet strict conditions and have a certain degree of validity, which is related to vaccination and medical testing, and second, flexibility to specify which specific occasions must be presented to participate, depending on the severity of the outbreak. In addition, according to the outbreak of the epidemic, the upper limit of people gathering on specific occasions is limited, and the requirements for mask wearing are adjusted.
The Green Pass was implemented for about four months from February 21 to June 1, 2021. In mid-May, the system was suspended due to rising vaccination rates and a continued decline in morbidity and mortality. However, on 21 July, Due to the outbreak of the Delta outbreak, Israel reintroduced the "Green Pass". On March 1, 2022, with Israel's full opening up, the regime was terminated again.
As one of the important test indicators of social openness, entry and exit. Since the outbreak of the epidemic in 2020, Israel first liberalized individual cross-border travel in November 2021, allowing fully vaccinated individual travelers to enter the country. After entry, it must be tested and quarantined and included in the administration of the "Green Pass". It is worth noting that the quarantine period for eligible foreign travelers can be drastically reduced to no more than 24 hours.
However, in this process, it is not without twists and turns. For example, in terms of school opening. On several occasions, Israel has changed plans and requirements for students to return to school face-to-face classes. Isolation requirements for children and students who test positive have also been changed several times, causing confusion and dissatisfaction among parents, schools and society.
The aforementioned series of policies have been described by Israeli experts as "soft inhibition." Nadav Davidovitch, dean of the School of Public Health at Ben Gurion University in Israel, described it as a "golden path" between a massive easing of restrictions in the UK and a tightly controlled route by countries like Australia and New Zealand. Implementing such a strategy requires taking certain risks, but considering the overall consideration, including economic factors, the Israeli government and most experts believe that this is a necessary balance.
Why make such a shift?
First, in the long run, more and more scientists and policymakers are realizing that it is impossible to completely contain the spread of COVID-19. The only thing that can be done is to control the scale of the outbreak as much as possible and ensure that those at highest risk of adverse outcomes are protected.
Earlier this year, Nature surveyed more than 100 virologists and infectious disease experts about their views on whether the coronavirus could be completely eradicated – more than 80 percent of scientists believe that the virus cannot be eliminated and will continue to spread as an epidemic in the community for a long time to come. Many countries are preparing or have begun to explore how to find a new balance in the face of the normalization of the epidemic and return the order of social production and life to the right track.
"I think Israel's approach is to do everything it can to keep the country's economy open," Zamir said. Because we realize that leaving people at home for a long time is very dangerous and there will be a lot of health problems. There will also be huge economic costs for the country as a whole and for society as a whole. So it's important to keep a normal life as much as possible. That's what the government is trying to do. ”
But both Zamir and Escher stressed that Israel's approach is different from that of some countries in the West, represented by the United Kingdom, which are completely lying flat and coexisting with the virus. "We are still working to reduce the spread of the virus. You must always be prepared for the next outbreak. They said.
In addition to public health considerations, Israel's real national situation, the external dependence of economic recovery, also determines the need to maintain contacts with the outside world.
For more than two years, the recurrence of the epidemic has always suppressed the recovery of consumption, especially in the service industry, and strict epidemic prevention policies are an important catalyst for the high bankruptcy of small and medium-sized enterprises. In 2020, Israel's total GDP shrank by 2.2 percent and its per capita GDP shrank by 3.9 percent due to repeated blockades and restrictions on gathering and travel.
Taking tourism, one of Israel's main economic sources, for example, israel's Ministry of Tourism said that israel's visitor arrivals in the year before the pandemic (2019) reached a record high of 4.55 million, generating $7.2 billion for the local economy. Since March 2020, israel's economic losses are estimated to be more than $7.02 billion. Since November 2021, fully vaccinated tourists have been briefly allowed to enter Israel, and now all restrictions have been lifted, which is undoubtedly of great significance for driving the recovery of tourism and related services.
After the implementation of a more flexible epidemic prevention policy, israel's purchasing managers' index (PMI), although affected after each outbreak, has rebounded rapidly; from the perspective of employment, as the vaccination rate has risen, the labor force participation rate has continued to recover, and the unemployment caused by the epidemic has not rebounded from the outbreak of the new epidemic; from the perspective of inflation, the price of the epidemic-sensitive service industry has risen steadily (such as entertainment, education, communication and transportation), and has not been interrupted by the large increase in confirmed cases.
In November 2021, Israel welcomed visitors after resuming individual tours
What are the challenges ahead?
Where will the epidemic in Israel go in the future? Can Israel's experience serve as a reference to the patterns in which humans get along with COVID-19? It is too early to draw conclusions. Experts agree that as long as the epidemic rages around the world, Israel will still face the threat of the virus, which will not disappear completely, but will only temporarily subside.
Experts interviewed by The Paper said everyone must be aware that humans will live with COVID-19 for a long time – months or even years. But coexistence with the virus does not mean ignoring its consequences, and the long-term goal of governments should be both to keep people safe and to ensure economic prosperity. The future scenario is likely to be that the COVID-19 epidemic is at a lower level, and as new outbreaks of virus mutations occur from time to time, the government takes meticulous border control measures to identify and delay the entry of new mutant strains into the country. The ultimate goal of prevention and treatment should be to focus on unvaccinated populations and maintain low levels of severely ill patients and deaths.
Even so, we should not forget the cost of this possible new normal: whether in Israel or elsewhere, we will still lose some lives in the coming years as humanity learns to live with the virus.
Based on the fact that the protection of COVID-19 vaccines is reduced. Are people getting vaccinated every 6 months from now on?
Escher argues that even Israel is not feasible. "Because it's going to be too expensive, too complicated. If we can do it and give the public a shot of covid-19 vaccine mixed flu vaccine every fall, it will be feasible and realistic expectations. If we can do this, COVID-19 will become an endemic disease. He said.
A number of experts interviewed also pointed out that Although Israel's flexible epidemic prevention system around vaccines and passes is worth learning, it should also recognize that its implementation has unique applicability and limitations. For example, Israel's small size and population make it relatively difficult to control, and the impact of aggressive vaccination policies on global vaccine supply is limited, but for large countries, it is necessary to relax epidemic prevention measures in an orderly and cautious manner.
If there is any lesson to be shared from Israel, Professor Zamir believes, it is the importance of solidarity and public trust.
"You have to understand that what you do affects other people, your family, and your community. Public trust is very important and essential. In the face of a crisis like this, you have to make sure of the public's trust, and you can go with the public to face it and guide the public to do something they haven't done before. Like staying home. If the public doesn't trust you, they won't do what you say. If they realize that it is in their best interests, they will do it. Zamir said.
"What I'm satisfied with israel's performance over the past two years is that the health care system has invested a lot of money and there has been a very rapid response. This is partly due to Israel's habit of a flexible way of governing its country, and we often make the right decisions very quickly, especially with the courage to make many pioneering attempts, but also hopefully in a safe way. In that regard, Israel's experience has contributed to the rest of the world. She said.