Despite a much reduced rate of new coronavirus infections in Israel, the elderly and others with specific health issues remain vulnerable to serious infection and death. This is decidedly the case because much more crowding is being permitted as efforts to promote economic recovery proceed apace. Some special steps, particularly in the realm of public transportation, with social distancing maintained and masks mandatory, are greatly needed; otherwise, many of those who are highly vulnerable may be forced to remain largely isolated for what could be a long period of time until either the virus disappears or an effective vaccine becomes widely available.
Israel has had a much reduced daily rate of measured new infections during May and has been steadily relaxing lockdown regulations during the last few weeks, with more to come in the weeks ahead. This policy is being driven by urgent pressures to promote economic recovery, given the large number of Israelis who have lost their jobs in prior months and the many businesses whose revenues have collapsed.
Though much lower than in March and April, the number of new infections remains positive, which means that the virus is still active in the population. The numbers are widely expected to rise as a result of reopening. Not only is it likely that the actual number of new infections per day is above the measured number, given the low incidence of testing being undertaken, but some patients may be both asymptomatic and infectious.
The data for the last few months have unambiguously shown that the risk of a severe cononavirus infection or death is much higher for those over age 70 than for those under age 70. Therefore, the elderly should continue to be particularly mindful of these risks as the steps to promote reopening are multiplying the instances of crowding.
Revised public transportation rules and their risks
While many of the relaxed regulations concerning masks, social distancing, cleaning, etc, still explicitly aspire to protect both workers, shoppers, and others, this is not the case with the new rules regarding buses, taxis and minibuses. As of May 28 the following rules apply, according to the Ministry of Health website:
Increasing Bus and Taxi Capacity
- Intercity buses: 46 passengers max. (except the first row behind the driver, all seats can be used).
- City buses: 49 passengers max.
- Minibuses and shared taxis: 75 percent of the max. capacity permitted in the vehicle license.
- No passengers allowed to remain standing.
- Taxis: Up to 2 passengers in the back.
It is understandable that facilitating workers and shoppers to reach reopened stores, restaurants, markets, offices and other places of work requires parallel steps to increase public transit. Unfortunately, in this case necessity and much heightened risk of infection go together.
Why does crowding on public transit especially raise the risk being infected by the virus? In “These Coronavirus Exposures Might Be the Most Dangerous,” by Joshua Rabinowitz and Caroline Bartman, an April 1, 2020 article in the New York Times, it was explained that “…viruses are usually more dangerous in larger amounts. Small initial exposures tend to lead to mild or asymptomatic infections, while larger doses can be lethal.” They give two examples: “Stepping into an office building that once had someone with the coronavirus in it is not as dangerous as sitting next to that infected person for an hour long train commute.” Close proximity to someone who is ill and long duration of exposure are key determinants of the risk of becoming seriously ill. And this risk is most severe for the elderly and others who are medically vulnerable.
The new rules for buses and minibuses mean there will be many crowded buses where all passengers will be in close proximity to others, and such proximity will be of long duration on intercity trips and on many intracity journeys. For the general population this may be too much, too soon; for the elderly and those otherwise vulnerable it is certainly dangerous.
What are their options?
For those without their own car, one option is just to stay at home or within a radius comfortable for walking. This means more prolonged isolation, with all the downsides of ongoing loneliness and the elevated risk of mental distress and mental illness.
A second option is to suggest that they should only take taxis. This might be okay for some, but it might come across as a kind of “let them eat cake” response for others, since many of the elderly have limited incomes and would find taxi fares prohibitive.
The best option: reserve every third or fourth bus for seniors, with the number of passengers at any one time limited to about 20 persons per bus, to enable adequate spacing between passengers. These numbers could be fine-tined over time based on experience. For example, some hours would have more reserved buses and some hours fewer. The reserved buses would be clearly marked. It may be advisable, at least initially or on a random basis, to employ a second person on the bus to maintain distancing. In similar fashion, some light rail trains in Jerusalem could be reserved for seniors to provide a safer travel option for them. These steps would not only benefit the elderly; making it safer for them to go to markets and malls where social distancing is observed would support the economic recovery.
Why one in three or four buses? Ten percent of the Israeli population are 65 or older. However, casual observation suggests that the elderly percentage of those who use public transportation is well above 10%, particularly in non-rush hour parts of the day. Transit system data may clarify the actual percentages.
The setting of public policies in the face of multiple risks is challenging and it should be a work in progress. The new policies regarding public transportation are clearly out of step with the imperative of social distancing. It is hoped that the Minister and Director-General of the Ministry of Transport will take note: Some modifications for the elderly, such as those suggested here, are very much needed.