Ministry of Health policy successful? Really not sure
Prof. Udi Kimron, Dr. Uri Gavish Posted: 13.04.20, 15:45
The State of Israel has been under far-reaching movement restrictions for more than a month, with no near term expectations for the reopening of schools and with widespread economic and health damage. And the question being asked - what facts support the continuation of these steps?
Experience from other countries suggests that closure is not always mandatory
The atmosphere is harsh. These are days of war. But do we fight a brutal virus that threatens to consume humanity and kill most of us?
Is it right to compare this virus to the Spanish flu and the Black Death, as officials have done?
Or has the war against the virus been inflated to enormous proportions, and has actually been forced upon us by a global panic based on erroneous mathematical models? What is clear is that this war is shattering the world economy which has been laboriously built, and that its price will be paid for many years.
Relying on incorrect mathematical models
Is the virus as deadly as feared in the first place?
To our delight, we have stopped hearing from officials about the alarming figure on the 4% mortality rate, perhaps because they have internalized that this number is exaggerated. Even Professor Neil Ferguson, who frightened Britain and the world at large with mathematical predictions of mass death and caused a change in British policy, returned from high mortality estimates and accordingly changed apocalyptic forecasts.
This is the same Ferguson, who used mathematical models that predicted about 150,000 deaths from the mad cow disease. To date, 177 people have died from this disease. This is the same Ferguson, who recommended mathematical models to Her Majesty's government in winter 2009, when swine flu was diagnosed, to restrict travel and flights in the kingdom, close all schools and kindergartens, and start preventive drug therapy in the kingdom to "buy time until finding a vaccine" in order to prevent an unprecedented disaster (This is not a writer's mistake - this is his 2009 recommendation).
It is also the same Ferguson, who in mid-February this year predicted, again on the basis of mathematical models, that the peak of the plague in Wuhan would occur within a few weeks, but that peak was reached after two days. And, if you haven't guessed, the mathematical models used by Ferguson is being relied on, in part, for the crisis management policy in Israel.
One must therefore ask whether policymakers are basing their decisions on true data or predictive models? Are they doing enough to get this data as soon as possible? Have enough random samples already been made to get a true picture of the spread of the virus in the country?
Self-congratulation and sowing fear
We have recently heard statements that the State of Israel ranks number two in the world in terms of number of tests per capita, and that Israel is the world's safest country in terms of the Corona virus. We also continue to hear that we are in the midst of one of the most difficult epidemics humanity has experienced in the last century.
Is Israel, as it is argued, ranked second in the amount of corona testing per capita? In fact, Israel ranked 18th in the world, on the day it was declared second place. Since then, its position has dropped to 29th place in the world. Ahead of her are countries like Bahrain, the UAE, Qatar, Estonia, Slovenia, Malta, Iceland, Luxembourg, Switzerland, and more.
And is Israel the safest country in the world in terms of the Corona? An analysis of an objective index such as a death rate for one million people shows that while the State of Israel is in a reasonable place, it is not even close to leading in this index. Sample countries where the death rate per million people are less significant are: South Korea, Hungary, Bahrain, Australia, New Zealand, Argentina, Brazil, Thailand, Japan, Qatar and more. It should be noted that some of these countries did not impose a total closure on their population.
And can it be determined that the policies recommended by health ministry experts have succeeded? Unfortunately, this claim does not have a scientific basis, and the results on the ground show that it is not succeeding. An observation published by Prof. Yitzhak Ben-Israel shows that even after taking a policy that includes closure, as well as after taking a non-closure policy, the rapid spread of the virus stops after a similar time (perhaps due to natural immunity? - we'll get to that later). What is perfectly clear is that the policy adopted in Israel has brought about an unprecedented crushing of the economony. However, the self-congratulation of the unproven successes, ignoring the damage done, continues as propaganda which seems far more important than the substance.
And if we are, in fact, given incorrect data about Israel's position on various indices in the world, and so we are sailing with baseless praise, what about the scientific judgments we are given? Is this really the terrible global epidemic of the last century or is it also a case of factually defunct statements?
Various samples suggest broad natural immunity to the virus
Published virus test samples suggest, in our estimation, that natural immunity already exists for the virus, and may reach around 80% of the population. This estimate is based on four independent samples, each with a maximum adherence rate of 13% to 19%. The fact that none of these samples exceed the 20% threshold and no other representative samples (of at least one hundred samples) have passed, raises the hypothesis that the rest of the population (about 80%) is immune to the virus and in fact the infection rates measured in these samples represent the maximum infection in the population.
This is reinforced by simple statistical analysis. When talking about the exponential spread of a virus in the population, the probability of sampling at a specific point in time when there is exponential spread is relatively smaller than the probability of sampling at the time when the virus has exhausted itself and reached saturation. The reason is that the exponential expansion is rapid and limited in time, whereas the stage at which the infection is exhausted is not limited in time and in fact lasts from the end of the exponential expansion over a long time. Therefore, we see a large number of independent samples showing similar high infection rates, which can be assumed to reflect the maximum infection of the population, rather than similar infection rates taken at the same stage of exponential expansion.
The first sample to show a maximum adhesion of 19% is from the Diamond Princess. (This ship had about 3,700 passengers and crew, of whom 712 were diagnosed with the virus.) The second sample was conducted on the U.S. Navy ship "Theodore Roosevelt," which showed a 13% infection rate. (Of 4,223 subjects, 550 were found to be carriers of the virus.) The third sample was conducted in Germany, in the Heisenberg district, which contained a (serological) sample in which approximately 15% of the people of Ganglet were exposed to the virus and developed antibodies against it. A similar number of infected come from a report from a San Carlos hospital director in Madrid that 15% of his team is infected with the virus.
Other samples that are coming soon will establish or refute the hypothesis that a high percentage of the population has a natural immunity to the virus. Therefore, it is worth noting the maximum numbers obtained in these samples, which indicate the degree of general immunity.
How can there be natural immunity to a new virus?
The corona virus began to spread to the world's population only five months ago. But, the virus has six relatives, which have been infecting the population for many years, and which produce very similar molecules. Small parts of these molecules are completely identical between the viruses.
As part of the immune system's defense mechanism, pieces of virus molecules are sampled and displayed to the immune system on infected cells so that they can identify and eliminate these cells. Such identification leaves immune cells in the body that recognize the same parts of molecules and prevents the virus from replicating in the body. Thus, cellular immunity to a new virus is created as a result of exposure to his relatives. It is reasonable to assume that if we do observe natural immunity, this is the way it was acquired.
Because different populations of people have different genetics, and cells that display the parts of the viral molecules a little differently, different populations may also have different immunity to the virus.
This is one of the reasons why it is essential as soon as possible to carry out surveys in Israel, for example, in Bnei Brak which has been hit hard by the virus, to examine the local rate of immunity, and not to rely only on population samples from abroad. It is important to check the maximum infection rate in a population of people who spent time together in close contact in one place and would be expected to infect everyone (a Beit Midrash, for example).
The significance of natural population immunity is that the spread of the virus is much higher than estimated, since with a high natural immunity rate, only very infectious viruses can spread rapidly. The introduction of such a fact into a mathematical modelling system may fundamentally change all predictions of such models.
Another implication of this finding is that the calculated mortality rate is about one fifth of any other estimate so far calculated, as only one fifth of the population is susceptible to the virus and may be exposed to the disease it is causing. This is therefore a finding that requires quick confirmation and if proven correct - a perceptual upheaval in the epidemic will be requested.
Route recalculation required
Sweden has adopted a policy that maintains a functioning economy during the Corona crisis, and has not taken any significant steps to paralyze its economy. We hear interpretations from health ministry experts and journalists echoing their comments that the "experiment" Sweden has conducted "has exploded in its face" because the death rate there is significantly higher than its neighbours.
Although the corona virus mortality rate in Sweden is indeed higher than its neighbors, we disagree that the experiment "exploded". On the contrary, in fact, we have witnessed a recent stabilization in the number of people who are infected with Corona, and we do not foresee the collapse of the Swedish health system. Accordingly, reports of Sweden's "experiment" are also diminishing in the disaster-loving media.
It seems, therefore, that such a policy, which shortens the time required to obtain herd immunity, is precisely justified by current observations in Sweden. The alternative policy adopted by Sweden's neighbours, including Israel, is likely to result in a similar mortality rate, which will simply continue over a longer period, with widespread damage to the economy and without the acquiring of rapid herd immunity.
When we hear the statements of health ministry representatives about only measured easing of the closures, with no near term expectation for the continuing of the school year, and without opening the skies, we are surprised. What facts support these steps? Isn't it time to change the way we deal with the crisis, which is losing millions of people's livelihoods, preventing them from taking care of any problem unrelated to the Corona virus, and severely compromising infrastructure, education and security budgets?
Will health ministry representatives, in the future, be able to justify their recommendations, which rely mainly on questionable mathematical models and disaster-focused media reports? Can they explain why we did not act as Sweden does, which is advised by one of the world's leading epidemiologists? Will the excuse of "most of the world behave that way, and so do we" be acceptable?
Prof. Udi Kimron is Professor of Clinical Microbiology at the Faculty of Medicine, Tel Aviv University
*Dr. Uri Gavish is a physicist, algorithms specialist, and biomedical consultant
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