This week, the idea of volunteering to bring disaster to Israel by shutting down the economy for two to three weeks was floated again. What supporters of the idea have in common is a lack of knowledge or experience in public health or management of infectious disease outbreaks, and tunnel vision that does not address the need to handle the virus long-term. Historian Barbara Tuchman lists three conditions necessary for policy to be defined as foolish: that its negative results be seen in real time; that an alternative exists; and that the policy is proposed by a specific group.
Reinstating a full shutdown now will do enormous damage to Israel, which should be assessed before a step like this is taken. We learned about the harm shutdowns do, and their questionable effectiveness, in the first wave. Especially an extreme, disproportionate shutdown like the one Israel declared, which limited people's freedom of movement to a 100-meter [yard] radius from their homes. A shutdown of this type would certainly lead to hundreds of people dying because they did not seek medical treatment for chronic or emergency conditions, and indirect deaths resulting from the huge social and economic harm that especially afflict the weaker and poorer sectors of society.
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Any discussion of a shutdown must assess this damage ahead of time and take them into account, as well as decide on a plan to minimize the harm.
There is still massive community spread in Israel. However, in the past two weeks there are signs that this trend is reversing, and possibly that the spread of the virus is starting to slow, since the attack rate (the number of people infected by a single confirmed carrier) has dropped below 1. This is a situation that demands we all be on alert and act responsibly to further reduce the spread of the virus, but no one disputes that we are far from seeing the public health care system unable to cope. It also looks like the number of fatalities and seriously ill is staying relatively low. As long as we remain stable, with an attack rate of around 1, even if the number of confirmed cases is high, a full shutdown is not a legitimate option.
Supporters of a shutdown present examples from the world today and from history, but get confused when it comes to their understanding of a shutdown. In epidemiology, a shutdown means people are barred from entering or leaving a defined area to spreading a disease from an area where there is an outbreak to an area where there are few or no cases. It doesn't mean bringing the life of an entire country to a standstill, thereby possibly causing an increase in spread within the home, in addition to the other harm it creates.
And we haven't even discussed the unfeasibility of enforcing a shutdown, because the public has lost faith in the authorities. It is clear as day that there are other methods that haven't been fully attempted, and we should work according to the framework set down by coronavirus coordinator Professor Gamzu, the corona cabinet, and the Health Ministry. They should now be working with the public to instill the principles of how to behave during the epidemic.
Supporters of a shutdown argue that morbidity is so high that we cannot open the school year in September. Even if the number of cases drops after a shutdown, it would be an illusion, just like it was in the first wave. As long as we still don't have systems for safe schools in place, such as small groups, outside classes, or effective online school, there will be a risk of infection in middle schools and high schools. As long as we are unable to promote health and change the population's behavior, and make them understand the immense importance of personal responsibility and responsibility toward each other, we can expect another outbreak.
As long as we fail to strengthen the public health care system, including contact tracing, we will be without an initial line of defense. As long as we do not allocate the necessary resources and do not bolster medical care in communities and in hospitals, we will be without a second line of defense. These are the conditions that must be met for us to start the school year for middle and high schools, not some artificial condition about a specific number of cases that represents only the tip of the iceberg of the total morbidity.
The events of this past week have proven that the "shutdown cult" is being countered by a much bigger group that includes a majority of the public in Israel, public health experts, ministers and MKs, journalists, and local leaders. They make up a front that will stand strong against foolishness, and insist on wise decisions that are based on epidemiological reasoning and latitude of judgment.
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