Concerns, Questions and COVID-19 in Israel, the Middle East and the World

As I sit in Ben Gurion Airport on my way to Baku, Azerbaijan, the same refrain runs through my head: “Don’t touch your face, don’t touch your face, don’t touch your face, don’t touch your face!”

Now is a time of heightened global awareness, both of the weaknesses in our overburdened healthcare systems and of the vulnerability of our fragile human bodies. The novel coronavirus, or nCOVID-19, has exposed many of the cracks in our hyper-globalized economy, travel systems and disease prevention methods.

Countries are starting to take notice; last week Israel banned entries from 3 Asian nations, established mandatory quarantines for a suite of other countries, and threatened to close the borders entirely, prompting El Al Airlines to issue a statement of impending collapse should this ban take effect. Although a noble gesture (or a bailout tactic), it is doubtless that in the face of such a potentially serious public health crisis, Israel will choose security over a few local airlines, even El Al.

But with misinformation flying around the globe at breakneck speed thanks to the Internet, what should we really be concerned about when it comes to nCOVID-19? Before going further, I should note that I have no specific training in public health or epidemiology – I am a scientist, so my perspectives are based on the same news articles and books everyone else has access to, just with a bit of scientific skepticism added to the mix.

How much disruption could nCOVID-19 actually cause? The answer really depends on how well we limit or slow its spread. nCOVID-19 spreads really fast, and health officials are rightly worried. If a significant percentage of the population (even as low as 0.5% or 1%) gets infected all at the same time, the healthcare systems in developed countries will stop treating patients effectively. This will cause death rates to increase significantly, especially amongst vulnerable populations like older folks and immune-compromised folks (even though at present the death rate is around 2%, lower than other recent coronavirus epidemics like MERS or SARS). An overwhelm of the healthcare system would be similar to what happened during the 1917 Spanish Flu pandemic, which killed 200 million people worldwide, many dying in giant emergency hospitals with overworked nursing staff, and a repeat of this pandemic is what the World Health Organization is trying to avoid.

The other issue we are quickly becoming aware of is what happens to our tightly wound global economy, when people don’t go to work and produce goods to feed our razor-thin supply-chain margins. Wall Street just had its worst week since the 2008 recession, El Al is preparing to lay off 1000 employees, and central banks have started rolling out interest rate cuts as the US stock market enters correction territory.

Will nCOVID-19 actually cause a recession? At this point, it’s still too early to guess. Stock market investors are people too, and they are just as vulnerable to group panic and herd mentality as the rest of us. As we buy up paper masks from our local pharmacy, knowing that this has little to no effect in preventing nCOVID-19 transmission, investors flock to US Treasury Bonds and other safe-haven investments. The real question that will determine overall health of the global economy, as most pundits have noted, is the degree to which the virus spreads in the US and shuts workers out of their jobs. Already an estimated 3.6 to 5 trillion USD have been wiped off the markets, but if the virus peters out soon this short-term crunch will be easy to rebound from as pent-up demand will fuel growth in the next quarter. Longer-term economic damage, centered outside of Asia in the financial hubs in America and Europe would be harder to recover from as easily.

How is nCOVID-19 different than the seasonal flu? This virus spreads faster than the seasonal flu (influenza viruses) because we don’t have any immunity to it. Most of us are too lazy to get the flu shot every year, but we don’t get flu-like symptoms. This is because the influenza virus only mutates, or changes shape, a little bit every year. With some pieces of the virus still recognizable by our body’s immune system, we may be exposed to the flu and not even show symptoms. This is due to our immune system’s built-in pattern-recognition systems (like how if you train a computer to recognize car license plates, it will probably be able to point out other car license plates even if the make of the car or the numbers on the plate have changed). nCOVID-19 evades our immune system by looking completely different – like a fire hydrant instead of a license plate (for an accurate picture of the virus, click here). nCOVID-19 looks so different because the virus is almost certainly zoonotic (this means it came from an animal host, and has never spread amongst humans before – and no, nCOVID-19 was absolutely not made in a lab).

Could nCOVID-19 reshape the map of the Middle East? Likely not, but it is certainly revealing some of the weaknesses in Middle-Eastern countries and their international relationships. With the highest fraction of non-Asian cases, Iran looks increasingly isolated, and its broken healthcare system will not be able to cope with a severe outbreak, which could put more pressure on an already-weak government. In Baku, Azerbaijan, the streets and hotels were empty as the government closed the border with Iran for two weeks. Saudi Arabia, the caretakers of many Muslim holy sites including Mecca and Medina, closed the annual pilgrimage to all foreigners this year. While actively working towards a vaccine, Israel has taken one of the most aggressive responses of any democratic country by banning flights from South Korea and China, and imposing 14-day mandatory quarantines on a number of other hotspot countries.

Will these travel bans work? Most research shows that internal travel bans (those within countries) are too porous to be effective, although the draconian restrictions in China may be having some impact – it is still too early to tell, and many cases are likely still going undetected.

Travel bans to other countries may be more effective, however they open countries up to another set of risks. Economically, they halt the inflow of cash from tourism, strangle small businesses and impede innovation. Globally, these types of bans erode trust and the freedom of movement that our rules-based international world order is built upon. Most research still suggests travel bans don’t work, and although closing borders before an outbreak might work, widespread use of them has never been tested in the modern era and the economic consequences would be severe to say the least, especially for a small country like Israel with a big tourism industry.

What can we do to protect ourselves? Masks aren’t effective in preventing transmission unless worn correctly (N95 respirator, sealed fit, changed every 4 hours), and these specialized masks are essential for healthcare workers right now, not the general public. Also when people wear masks they are less likely to be careful about other behaviors, like touching their face or washing hands. Mask wearing is relevant only if you are sick, or are taking care of someone who is sick. The best advice we have: wash your hands with soap for 20+ seconds, avoid air travel unless absolutely necessary, and don’t touch your face in public. For a good, balanced info-video about precautions for nCOVID-19, check out this UNICEF video series.

If you feel sick, staying home is actually a good idea (unless your symptoms are severe and require hospitalization, in which case go to the ER in a face-mask and alert the triage nurse immediately). Staying home is better for three reasons; if your symptoms are mild and you self-isolate, you reduce the chance of catching a secondary infection at the hospital, you decrease the burden on the healthcare system in this difficult time, and you make room for more serious cases in-hospital. If you actually have the seasonal flu, staying home is better because you won’t spread it to others, and you have less chance of catching another virus (like nCOVID2019) from someone else. On the rare chance you actually have nCOVID2019 (remember only ~5000 people outside of China have the disease, so you have about a 1 in 1.4 million chance of contracting the disease), staying home with mild symptoms will keep others safe. As with many flu-like diseases, it is often those who show mild symptoms that end up spreading the disease more than those who present with severe symptoms.

Overall, there is still a lot that scientists, public health officials and healthcare practitioners don’t know about nCOVID-19. Scientists are trained to be cautious with information, which can seem close-mouthed but is intended to stop the flow of misinformation or inaccurate information. So in this time of fear and uncertainty, the most important things we can do are to keep communicating, preserve global trust and work together to combat the virus. And remember: don’t touch your face!