The epidemiology of the coronavirus in Israel and across the globe should teach the decision-makers a lesson in humility. Politicians issued baseless promises, only to realize shortly after that infection rates were again on the rise, forcing them to explain why they are imposing another lockdown after vowing the previous one would be the last.

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Today the situation is different, as most of the at-risk population has already been fully vaccinated. Has the time come to open the economy and return to real life, without the need for safety precautions?

The truth is that caution is imperative. We are still in the midst of a global pandemic.  From a public health perspective, the probability of a dramatic spike in the number of serious cases beyond the health system's capacity is exceedingly low. On the individual level, however, each and every one of us is at risk of contracting a disease that could be damaging, even in the young and healthy.  In accordance with Aaron Antonovsky's salutogenic approach, it's better to avoid a black and white approach to disease, and rather focus on finding solutions conducive to a healthier life, in the broader sense.

Decisions about reopening the economy must be based on epidemiological considerations, not political ones, even during an election season. The risk of infection is high in closed spaces, in areas with high infection rates, in large gatherings with numerous personal interactions, and in activities involving singing, kissing, speaking and eating. The risk of serious illness is greater in the elderly, those with chronic conditions and the unvaccinated.

To identify the appearance of new variants in time, we must methodically perform full genetic sequencing on those returning from abroad, in outbreak zones and in cases of infection among vaccinated individuals. We cannot allow the failed political management of preventing the spread of the coronavirus at Ben Gurion Airport and the borders, which led to Israelis being stripped of their basic civil right to return home, to be replaced by total neglect. We still need an e epidemiological unit at Ben Gurion Airport, along with effective testing and quarantine measures for at-risk people re-entering the country, based on professional criteria. We should also stop our addiction to news reports about the calculated reproduction rate, which is neither accurate nor relevant in the vaccine era. Instead, we need to track actual infection measurements: hospitalization and serious cases, based on distributions of risk levels, population and region.

There is a misconception that people are selfish by nature and that therefore only forceful means will prevent people from putting themselves and others at risk during a crisis. Research and experience tell us that most people are fundamentally decent and care for others. Hence, if we give them logical and consistent recommendations and set a personal example, the public, for the most part, will quickly abide by health guidelines. If people aren't given clear directives now, we could see a complete breakdown, the first signs of which we saw on Purim. The recommendations need to be simple and easy to implement, so as not to create a disconnect between the stated policy and reality on the ground.

Our test is to learn to live with the virus and restore our control over our lives and health. It is time for kids of all ages to return to school, for adults to return to work in all sectors, and to reinstate leisure, sports and cultural activities. But, even if we are vaccinated, we must continue practicing caution on the individual level and observing public health guidelines.

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Public health is defined as the science and art of disease prevention, life extension, the improvement of quality of life and promotion of good health facilitated through organized initiatives and informed decisions made by society, public and private groups, communities and individuals. We all need to exhibit responsibility for our health in general, and during the corona pandemic in particular, especially our elected officials in the government and Knesset. We must all understand now that this is an emergency situation that necessitates a drastic lifestyle change. We all need to adhere to public health professionals' safety guidelines for preventing infection. But public health is not just a matter of preventing the coronavirus. Public health obligates a broad spectrum of considerations pertaining to health, economy and society and empowers the public so that its motivation for protecting its own health becomes internalized.

Thus far, management of the corona crisis has been a failure and irresponsible and has brought us to the point of widespread infection across the country. It has also broken the public's trust. Hospitals have raised a red flag due to severe exhaustion and overcapacity amid a significant spike in infections. Now, stringent measures must be implemented countrywide for a limited period of time to reduce the rate of infection and to stabilize the healthcare system. Simultaneously, an organized plan of action is needed to facilitate daily routine life after this period and strengthen the public health system, clinics and hospitals.

The government, however, needs be responsible, meaning not shutting down the entire country in a manner that causes an unnecessary and devastating economic-social-health disaster. Today, our ministers must not opt for the politically expedient solution of a general lockdown. A lockdown is not a sustainable solution. It severely damages the social fabric and the public's trust, without tangibly helping us cope with the pandemic in the long term. In short, the first stage of the lockdown will be more detrimental than beneficial, hence the need to skip immediately to the second phase ("tightened restraint"), in accordance with the original recommendation presented by the corona commissioner's professional task force.

We know today that the majority of coronavirus infections occur in closed spaces. The order of the day, therefore, is to radically avoid contact with people in closed spaces. The plan the government is expected to discuss on Sunday does not allow prayer services in the open air, even though that's where it's safest. This decision contradicts epidemiological logic and the experts' recommendations.

The plan would impose a 500-yard boundary outside the home, contrary to the recommendations put forth by the corona commissioner's professional task force. This is a negligent proposal that will cause tremendous damage, without justification, to the public's health and we, public health physicians, hope the ministers act responsibly and remove this clause from the plan. A balanced plan, based on epidemiological logic, will receive the public's trust and can be implemented successfully. A draconian plan consisting of a general lockdown will not receive the public's trust and could lead us to the abyss.

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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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Life: First of all, we need to protect life itself and prevent mortality and morbidity from corona through physical distance and wearing masks. At the same time we prevent and treat the virus, we must prevent morbidity and mortality from other serious conditions, such as strokes or chronic illnesses like cancer. But life isn't about just surviving. Life means being active, not only physically, but also socially. Coronavirus will be with us for some time, and we Israelis must not become passive. We need to find a way to continue our lives while the virus is present. We, the doctors in the public health care system, are encouraging physical activity outdoors, where there is less chance of infection. It would be a mistake to close public pools and beaches. We need to allow and encourage safe outdoor activities.

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Society: Public health care takes a social approach to strengthen people in their own communities. We are all part of one society that is comprised of many smaller societies. Every decision has to take people into account and adjust solutions for different populations, according to their needs, and working with them. We are under orders to maintain physical distance, but not distance from society. There are people in Israel who are going hungry, and we need to take care of them. Israeli society is only as strong as its weakest link.

Strength: Society in Israel, along with each and every one of us, is being tested. We have already been through tougher times, and this pandemic will also pass. If we work correctly, we can even come out of it stronger. The more we support one another, stay strong, and keep thinking positively, the greater success we will have. The Israeli public is used to emergency situations and knows how to pull together and deal with crises successfully. The more decision-makers work with the public and try to reach a consensus, the stronger the public's faith in them will be.

The public needs stability, so it is vital that decisions be made in an orderly and transparent fashion, with foresight.

Emotional strength is equally important, and we need to address this dimension and provide hope and optimism, rather than scaring people. Strength is also solidarity and economic robustness, which is why we need a safety net for people and businesses, especially those that have been forced to shut down to prevent the spread of the virus. Our strength hinges on the people who work in health care, welfare, education, and the police, who are all on the front lines, and we need to bolster them with tangible resources as well as support.

Wisdom: In a pandemic, like every disease, we need to operate wisely and in accordance with our knowledge and epidemiological reasoning. Therefore, it is vital to invest more in epidemiological research, in collecting and analyzing data about the virus and its spread. Epidemiological research plays a crucial role not only in locating contacts, but in providing information that can help the leadership make decisions about the effectiveness of various measures. For us to work wisely, based on facts, we need the data to be fully transparent as well as professionalism in analyzing the data.

Wisdom also means being modest and understanding that even though we know quite a lot, there is still much about the virus we have to learn. We must not depend on projections, but constantly update ourselves based on the latest figures. Widespread steps like a full shutdown are not wise, because they are only effective for a very short period, but do long-term damage. To maintain strength and life, the actions we take to prevent infection need to be precise and proportional, wise and evidence-based, and come at a reasonable cost to society, public health, and the economy.

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For example, we don't see the nurses in community clinics for newborns or in schools. It is thanks to them that our children have vaccines and we don't have outbreaks of measles and polio.

Because no one sees them, the easiest place to cut budgets is in health care.

Because they are invisible, we have had a lack of enough public health workers in this pandemic. Despite the fact that they are our first line of defense against a pandemic, their numbers have not increased. There are only 27 epidemiological nurses nationwide.

The minister of health and the ministry's director general have tried to finally bolster the staff at the district health offices tasked with the tracing of carriers. This is a welcome development, but that is not enough.

Epidemiological tracing is not just about the patient. It also means verifying their diagnosis is correct, guiding them on the way forward, finding anyone who might have been in contact with them, and coordinating the various measures that the economy must take to deal with it.

Pandemics are defeated through data. As epidemiologists says: "We believe only in God, and for everything else, bring us data."

A lot has been said this week about the rise in cases and deaths. But unfortunately, the government has refused to heed the request of epidemiologists who want to look at the raw data in order to understand the trends.

We keep getting reports from the government without a professional entity signing off on them. This means we do not get a clear picture of what is happening.

The rise in infections was expected because there is still no herd immunity and the virus is not being weakened by the summer heat. It is also clear that symptomatic patients are only the tip of the iceberg. That's why we can't just play whack-a-mole by finding the carriers. Rather, we have to find the clusters and take public health measures there based on epidemiological evidence.

This means we have to assume that everyone we meet is a potential carrier. This does not mean we have to be in a constant state of fear, but rather accommodate our behavior.

We have to limit our interaction with people and keep a safe distance, as well as wear masks. If we feel sick, or if we were in contact with a confirmed carrier, we have to go into self-isolation and consider testing for coronavirus. But at the same time, the government must encourage people to adopt such behavior, not just through fear but by explaining.

The coronavirus is here to stay for a long time, even though it clear that it is not an existential threat for Israel or humanity. It is a threat for public health, and this requires a proper and proportional response while planning for the long haul. The more we bolster our public health care apparatus, the better we are.

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We must all understand that overreacting and panic may be more dangerous than the public health risk the coronavirus itself poses – and it is already clear that it does not pose an existential threat to humanity or to Israel. Therefore, decision-makers must act to reduce public panic and encourage an appropriate response to the situation. 

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There is such a thing as a public health doctrine on how to manage a public health crisis and communicate it to the public in such a way that encourages vigilance and proper response while preventing overreaction and panic. For example, dramatic press conferences should be avoided, as should the rollout of media alerts about every case and the posting of alarming videos about the dispersion of saliva droplets.  This only stirs up panic and does nothing to foster a proportionate response in the public. 

In accordance with the principles of public health, the response to a pandemic event should be based on facts while thinking ahead and addressing the needs of the individual and society. There is always uncertainty, but we already have a lot of information about the virus and how to handle it.

At this stage, it is necessary to release a detailed epidemiological report to medical teams, and the public, that will include an epidemiological curve, details about the clinical and epidemiological characteristics of the cases, morbidity rates according to age groups, etc. It is essential to produce a macro view of the situation, not just a micro one. 

It is impossible to know how long this crisis will last, but it is clear that it will not be less than a few months. Therefore, it is essential to maneuver the national and personal levels from an acute immediate stress response phase, which cannot be sustained for a long time, to a  routine suited to the ongoing emergency. Various steps may be necessary to "flatten the curve," but they cannot flatten Israel and its social fabric along the way.

There is a need to devise a sane daily routine alongside the continued operations of essential industries. Social distancing is required to reduce the number of coronavirus cases, making the shuttering of the educational system and the various limitations imposed on the private sector necessary – but such steps must follow an orderly plan or they will lead to complete stagnation.

The public deserves answers about what is being done to ensure its economic security, especially with respect to small businesses and people who have been placed on leave.

Overreacting can also impair necessary preparations. If we come to a situation of widespread morbidity, the healthcare system and its medical personnel will be on the front line and the state must provide them with the support and protection they need. 

The public health system has been neglected for years and that has compromised its readiness. Now is the time – the 11th hour – to invest the necessary resources to ensure it is there to protect us. 

We have to carefully plan how to optimally allocate the valuable resource of advanced care in hospitals and formulate an outline that ensures adequate outpatient care for mild cases.

Even during an emergency, it is worth investing in actions that reinforce the healthcare system in the long run and primarily protect healthcare workers.

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