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Two weeks of closure will suffice?

In Australia it took almost two months

In Israel, there are hopes for a closure to reduce morbidity, but the current measures will not prevent the increase in the number of patients, which crossed the 6,000 per day, and the hospitals' dealing with 800 patients in a difficult situation.

One can look at what has happened in Australia and understand that to see results it takes a plan and patience to wait a long time

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Two Ashkenazi

Thursday, 24 September 2020, 06:01

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In the video: Restrictions on prayers during the holiday closure (Photo: Reuters)

The Australian state of Victoria entered another closure on August 2, announcing a "state of disaster".

This is after a daily record of 671 new infections, which symbolized for the Prime Minister, Daniel Andrews, the satisfactory signal that led to the closure of 6.2 million locals, without further delay.

Leaving the house during the closure was allowed only for buying food, receiving or providing medical care, leaving for work that could not be performed from the house and physical activity, for a period of six weeks.

A little less than two months after it went into effect, the closure led to a reduction in corona cases in the country from 670 at the height of the second outbreak to just 11 this week.

But the decline, as stated, did not occur all at once, and required very close cooperation of the citizens, supervision and setting clear goals by the authorities, and perhaps more importantly: great patience.

In the city of Melbourne, Victoria, the closure was repeated even earlier;

On July 7, for a month and a half, after the discovery of 191 infected for 24 hours.

The closure was extended but only after seven weeks, morbidity levels began to decline.

To ease the closure measures starting Sept. 28, the state has announced targets: a drop to an average daily incidence rate of 50-30 new contaminants consecutively, over the two weeks prior to the target date.

Currently, the daily average of new cases in Melbourne is 34 more patients a day.

Like other countries in the world, more than two weeks have passed in Victoria - from the moment the closure was announced until the morbidity trend slowed down.

This week, after she managed to flatten the curve, Victoria has already moved on to the third stage of her regular plan to deal with the corona.

And here in Israel?

While the Corona Cabinet has stated that the holiday period in Israel alone will be defined as a closure period, the question arises as to whether we can really return to routine, or a limited launch, in such a short period of time that it is not enough to "flatten the curve."

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It took a long time to flatten the curve.

Garbage collections in Australia this month (Photo: Reuters)

Record turnover in the near future

"No one in the world thinks that within two weeks there will be a decrease in morbidity, but rather an increase - people carry earlier infections and infect the family. In Israel, too, on March 15, they began with closure measures, and on April 2 we reached a record number of verified patients." Says Prof. Ronit Calderon-Margalit, an epidemiologist from the School of Public Health at the Hebrew University and Hadassah.

"On Passover, a week later, we reached a record number of patients in critical condition. We actually expect the increase in the rate of illness to reach a peak in the near future, depending on the closure measures."

"It probably will not be enough. We will not be able to open the economy at the stage when we are at the peak of morbidity, because the disease will spread more in this way. We will have to wait for the morbidity to start declining, in terms of number of infected and positive percentages in tests. Will not give anything away.

”Our real concern is the health care system and the hospitalization system.

The community system is collapsing, and the hospitalization system is measured by the number of patients in moderate and severe condition, who represent an infection that was about ten days ago.

We must get to a point where the hospital system goes down to a situation that can be dealt with.

If we expect the number of patients in a moderate and difficult situation to rise even more, we need to define a decrease in the value that the system can handle. "

" That in a week we will pass the 800 hospitalized in critical condition.

At this time, there are many staff members who are completely worn out, or who are in isolation (more than 4,000 medical staff members are currently disabled from their jobs, SA) ".

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The health system warns against reaching 800 patients in critical condition, symbolizing a threshold of inadequacy for the system.

According to Calderon, "These are soft parameters that are difficult to anticipate. This is a bit of a historical and not entirely well-founded number. The situation right now, with a lower number of patients in a difficult situation, is very serious. It is a very significant warning sign for us. "And at the moment everyone feels that there is another power group that is profiting at his expense, and that he is losing out, when it comes to the health of us all. When you lose trust, you have a hard time believing and realizing that you have a responsibility.

How complex is the situation?

Israel reaches the closure on Friday, or the tightening measures that took effect on Friday, with almost 7,000 new corona sites a day, with a verified percentage of the total number of tests - 11.7%.

The descent may be steep, certainly when gatherings have ceased, and not all the public obeys the existing provisions.

In order to return to routine, Israel must not only rely on new socio-economic rules of the 'corona routine' that we did not see upon leaving the first quarantine, but also rely on a system of truncating adhesion chains that works properly.

The same array will not be fully operational before the beginning of November, but either way - it is unable to operate efficiently with more than 400 new patients a day.

According to the Information and Knowledge Center, an artist's research body, at the current morbidity rate it will take more than 90 days to reduce the morbidity up to only 400 infected per day.

The numbers of the dead are rising

Calderon, along with other experts from the Hebrew University and Hadassah, monitors the morbidity situation in Israel every week, and last week the team presented the cabinet with a gloomy forecast regarding the development of the morbidity, which included expecting another 1,000 to 2,500 deaths by the first week of November.

According to sources present in the cabinet, these figures have caused a great deal of unease - to say the least - among the ministers, signaling the need to tighten restrictions at this time.

The debate over mortality over the past few weeks is wide.

Throughout the first months of the struggle, mortality in Israel was very low compared to the rest of the world, and so it was until August.

About a month ago, the Central Bureau of Statistics examined excess mortality in Israel until July, and determined that except for three weeks in which there was an excess mortality of about 300 deaths, there is no excess mortality in Israel.

But in a Ministry of Health document presented over the weekend to the Cabinet of Ministers, there is a change of trend;

In August, an excess mortality rate of 10% was recorded in Israel, with a death rate that is consistently above the multi-year average.

The increase in mortality is mainly due to an increase in mortality among those aged 65 and over, and especially among those aged 75 and over.

Prof. Eli Waxman of the Weizmann Institute, head of the advisory team to the National Medical Association that attended the last Corona Cabinet meeting, is not optimistic.

its unstoppable.

They will be very difficult to deal with, "he explains." The holes must be closed immediately in closures - markets, synagogues and also outside (demonstrations) according to strict rules - masks and distances). "Waxman expresses his displeasure with the government's conduct and warns again against dealing with" day after Day, "without a long-term plan." The government is once again dealing with the measures for tomorrow, and avoids discussing the coping policy - what are the goals?

What is the long-term plan? ", He says." In order to harness the public, a clear plan, which does not exist, and professional information must not be provided by the Prime Minister or the Minister of Health or Gamzo, which also cannot be carried out without a plan, because what can we explain?

Because we did not take timely steps, we allowed the disease to run rampant, and now we are forced to take drastic steps for a long time.

We pay a heavy price for the delay. "

According to Waxman, 2.5% of the verified come to a critical condition after a week." We will soon reach a severe patient rate of 120 per day, which means an accumulation of about 1,200 hospitalized in critical condition about 10 days later.

The health care system in Lombardy collapsed when it reached 1,000 patients in critical condition.

The number of hospitalized stabilizes at 1000, because it is the number of beds, while the number of dead jumps, simply because all the patients who reach a difficult situation die from lack of treatment.

The population of Lombardy is similar to Israel, and the health care system in northern Italy is strong.

Our growth is slower, so we will not reach a catastrophe like there, but we are in trouble. "

The amount of infections will only increase.

The parking lot of Rambam Hospital in Haifa, which was converted to treat Corona patients (Photo: Reuven Castro)

The efficiency threshold of the system, 800 patients in severe condition only, is not low and requires the allocation of resources and spot treatment to increase it?

"The severity of severe patients in the country is not low at all, and higher than most OECD countries. This is not the problem. It is impossible to treat the epidemic by increasing the severity - when the number of patients is large it is impossible to control the epidemic, as happens to us. "It will give us a few more days before we fill the magnification and then have to take serious steps for a longer time because it will take longer to go down. The only way to lead a normal life is with low morbidity - 100 per day or less, and suppressing outbreaks by cutting chains."

Spain, one of the European countries hardest hit healthily and economically since the "first wave", is now facing the most severe re-eruption on the continent.

On Tuesday, authorities reported 241 victims a day, and last week about 900 victims were registered.

The head of the Madrid district has announced a "voluntary closure" from last Monday, which encompasses 850,000 residents.

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