Depressing: Highly vaccinated Israel considers new lockdown as COVID cases surge

(Abir Sultan, Pool Photo via AP, File)

They’re stuck in the same perfect storm we are. Delta is super-contagious, vaccine immunity is beginning to wane in people who had their shots many months ago, and a meaningful share of the population remains unvaccinated.

Although that share is bigger here than it is there.

On June 9, Israel recorded 10 cases nationally. Two months and one day later:

Average daily deaths currently stand at 13, which is still just a fifth of the winter peak but that number is on its way up too. For almost the entirety of May, June, and July, Israel never averaged more than two COVID deaths per day.

Two months ago it was unimaginable that Israel would ever again feel strain on its hospitals from SARS-CoV-2. But severe cases are rising so quickly that the cabinet is scrambling to boost capacity in anticipation that the current surge will get worse. “At this rate, health officials predicted at least 5,000 people would need hospital beds by early September, half of them with serious medical needs, twice as many as Israel is equipped to handle,” an Israeli reporter wrote today at the Financial Times. If things don’t turn around within the next three weeks, they’re in trouble:

Hospitals in Israel could be close to capacity within 20 days based on the current trajectory of the virus outbreak, prompting the public as well as the experts to wonder whether the country is sliding toward its fourth lockdown, but the country’s new weapon against the Delta variant has just been locked and loaded…

“Currently, there are 350 people in serious condition and 3,500 new daily cases on average. The number of serious patients is doubling in a space of ten days, which means that after two doublings, we could be over the critical limit for hospitals,” he said Sunday.

“In the last wave we hit 1,200 serious patients and that seems to be the critical limit. That’s scary. And if this does happen, or seem to be happening, we should go to lockdown.”

The country is desperate to avert a lockdown during next month’s holiday season so they’re ordering new restrictions short of that in the interim. They’ve tightened masking requirements for certain gatherings, encouraged more working from home, imposed new limits on travel, and, most importantly, have encouraged everyone over 50 to get a booster shot. Whether the boosters will meaningfully reduce cases of serious illness is anyone’s guess at the moment. In case not, the country is also scrambling to boost hospital capacity by increasing the number of beds and nurses while outsourcing the care of very sick but not critical patients to HMOs and even home treatment.

Will the extra staff help much? Some Israeli health professionals are skeptical. “What are they thinking? That they can just push a button and out comes a trained physician who can begin to work? Experienced nurses also need to be trained before they can enter coronavirus wards,” said one to Haaretz.

They’re so desperate to slow the spread of Delta that the cabinet reportedly considered locking down all citizens 60 and over. They gave up on the idea, fearing that it wouldn’t be legal, but the data on who’s getting sick justifies their cause for concern. Of more than 400 seriously ill patients, 85 percent are over 60 and 90 percent are over 50. And more than half of the 400 have been vaccinated. That isn’t surprising given that the great majority of Israelis have been vaccinated, but it’s a reminder that Delta plus waning vaccine immunity is a bad combination.

It’s sobering to take all of that in and realize that we’re doing worse than they are. More than twice as bad, in fact, if you measure by hospitalizations per capita:

The trend in cases is revealing too:

What do we see in those two graphs? The U.S. is still deteriorating in both cases and hospitalizations; Israel is seeing cases soar but may have leveled off in hospitalizations; the UK may have plateaued in both metrics after a big surge; and Canada is doing superbly. What might explain that array of results?

There’s no silver bullet, obviously, but I can’t help noticing that the UK and Canada each followed the “first doses first” strategy that I wrote about yesterday. That means Brits and Canadians had a much longer delay between their first and second shots than Americans and Israelis did — and there’s scientific evidence that a longer delay makes for a more robust immune response. On top of that, by delaying second doses the UK and Canada unwittingly assured that many citizens got that dose shortly before Delta began sweeping across the planet, eliciting strong immunity at a fortuitous moment. Many Americans and Israelis were already several months past their second dose when Delta arrived, by contrast, and may have been more susceptible due to waning immunity.

Beyond the “first doses first” distinction, though, Americans are more likely than Brits, Canadians, or Israelis to have a major COVID comorbidity, namely, obesity. In the U.S. 42 percent are obese compared to 28 percent in the UK, 27 percent in Canada, and 23 percent in Israel. Israel also has a younger population than we do with 28 percent aged 14 or younger versus 18 percent here.

And of course we have a smaller share of our population fully vaccinated (50 percent) than the other three countries do, all of whom are around 60 percent or better. Combine that with our relative risk factors of weight and age plus the unfortunate fact that we didn’t follow the “first doses first” approach and that may explain why we’re the worst-performing nation in this group of four.