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Exit strategy

Based on China, S. Korea, and Italy, Israel will see more COVID-19 over the next few weeks; then, if we've done successful social distancing, we can hope for the other side of this
Illustrative. Amid fears of coronavirus, senior citizens in Tel Aviv sit two meters apart on March 15, 2020. (Simona Weinglass/Times of Israel)
Illustrative. Amid fears of coronavirus, senior citizens in Tel Aviv sit two meters apart on March 15, 2020. (Simona Weinglass/Times of Israel)

So we’re in light lockdown. That’s good. But what now? For how long will this go on and what is the plan when we all emerge?

It’s a worthy question that no one has the answer to yet, but let us look at how the pandemic has played out in countries which saw their first case earlier than Israel, and therefore can help us model our coming days.

China – Though the data out of China cannot be fully trusted for a variety of reasons (ranging from less testing/detection in rural areas to deliberate government dishonesty), there are signs that the economy is starting to come back online.  Greenhouse gas emission is up signaling more power and automobile use. Healthcare workers are returning to their posts after field hospitals have been dismantled. How did they do it? We are not sure, but here are some possible contributing factors:

  1. Aggressive social distancing. The ruthless totalitarian social distancing implemented by the country, where people in Wuhan were boarded and nailed into their homes, stopped the viral spread.  It cost many people their lives and even more their freedom, and I am not endorsing it, but it worked to curb the outbreak.
  2. Natural immunity. While we are not sure about the coronavirus immunity established after having had the infection, the graphs might indicate that the population is gaining some level of protection from natural immunity.

South Korea – Though they contracted the virus early, South Korea stands as an example of excellent pandemic response through good governance.

  1. Early and aggressive voluntary social distancing. As soon as the threat was discovered, early in January, they took immediate and drastic social distancing precautions.  They went into isolation regardless of exposure, wore masks if they needed to appear in public, and stopped going to clinics with symptoms.
  2. Resources dedicated to mass testing and treatment. The government set up thousands of drive-through testing sites where they were able to quickly ascertain the extent of the spread, and hospitals strictly dedicated to treating COVID19. Healthcare workers were provided proper protection (this was easier as cases were not appearing in all hospitals and clinics but rather to dedicated sites) and so the system continued to function.
  3. Natural Immunity may be part of this picture as well.

Italy – COVID19 has been a nightmare for Italy, which has been the hardest hit. Reports suggest they are finally starting to pass the peak with tens of thousands dead. It is notable that the healthcare system in the area is considered well-equipped and first-class. Why it has been the worst there is likely due to a few factors.

  1. First, the virus arrived before the global community recognized the importance of social distancing, and since they did not stop it early, it multiplied exponentially.
  2. Second, social behavior and demographics played a role; there are more older adults in northern Italy than children, and this, combined with cultural practices of hugging/kissing, may have contributed to the spread and mortality.
  3. As with the previous, the country seems to be flattening the curve with their social distancing +/- possible natural immunity

Israel – Now to us. We began social distancing in earnest on March 15 with school closures. Restrictions have been increasing, but best case scenario will be to see the impact of social distancing around two to three weeks from that date. That means that best case scenario, the peak will be projected to be somewhere between Sunday, March 29 – April 5 (with God’s help!). The rise in cases we are seeing still reflect pre-social distancing, as well as improved testing ability.

Yesterday, there were 1,800 cases in Israel, and if it doubles every three days or so, this Sunday, we would expect 4,000, the following Sunday 18,000.  If it peaks the following week, that will be 80,000. Not to belabor the point, but that is why early, aggressive social distancing is our only weapon against this virus.

Though we are still on the rise, the next few weeks will be very telling in how successful we have been flattening the curve, and are likely to be quite intense in the healthcare system. If we work together to separate, and are blessed, we can hope to see the other side of the wave and easing of restrictions around the end of April or beginning of May.

The Long Term

How society will reconvene after COVID19 is still an unknown, since we are not there as a global society. Perhaps there will be a vaccine, a cure, natural immunity, or something else to save us. Will it be back to life as previous, or will there be a new normal for human society?

Until then, please know that each of you individually in your homes, by not going to work, managing your children without playdates, and zooming with your older parents or grandchildren, are contributing to the survival or the country, and saving lives.

About the Author
Dr Roth is a US-trained family physician with specialties in research and global health. She made aliyah five years ago to Ra'anana, and is mother to four young children. Dr Roth currently practices both in Israel and to the US via telemedicine, and directs the Clinical Reasoning Course at Sackler Medical School (Tel Aviv University).
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