For more than two years now, the coronavirus has dictated the global agenda while influencing economies and societies in an unprecedented fashion.

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On one hand, we've made progress in our understanding of the virus and have developed coping mechanisms – mainly through vaccines, medicines, and safe behavior, such as wearing masks. On the other hand, the coronavirus keeps surprising us and changing shape – from the original virus to the virulent Delta variant, to the highly contagious Omicron variant, and now the Omicron mutation known as BA.2, which is even more contagious than its parent. The response from governments and healthcare systems across the globe is far slower and hesitant than the virus, and the steps being taken in their war on new variants – are outdated and no longer relevant.

The first response component should be to strengthen the healthcare system. The Israeli government must define the potential future scenarios for the healthcare system. If the government decides preparations must be made to treat 4,000 seriously ill patients, as per the national training exercise in November, it must give the healthcare system the necessary beds and manpower.

The second component is vaccines, which need to be accessible to all. Additionally, an Israeli-licensed vaccine production plant must be built, which will allow us to precede the world in the development and manufacturing of adapted vaccines.

A third component is making rapid antigen tests and PCR tests free of charge and completely accessible, which will help people to stay healthy and prevent contagion; and to continue encouraging safe behavior – mask-wearing as a protective measure for the population in general, and for the elderly and immunosuppressed in particular.

A fourth and no-less important component in dealing with the coronavirus in the future is establishing a national information center that will communicate with the public honestly and frankly.

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The State of Israel is currently contending with the fifth, Omicron wave of the coronavirus. The Omicron variant is characterized by a high reproduction rate. Every person who contracts the virus variant infects another two to three people.

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Under such conditions, the number of infections in Israel will double in days, and at the height of the wave is expected to reach tens of thousands of infections a day. On the other hand, research findings point to Omicron causing more mild illness, particularly among those who received a booster dose of the vaccine. A booster shot has been proven to be 88% effective at preventing hospitalization with the virus.

The question is how many people will be hospitalized in serious condition at the peak of the wave. Will this many patients overwhelm hospitals, or will they be able to contend with the situation? This number will be derived from the reproduction rate of the various variants, the rate of vaccination with a third dose of the vaccine that prevents serious illness, and the distribution of morbidity across various age groups. Experts believe that at the peak of the wave, 2,750 Israelis will be simultaneously hospitalized with the virus.

To this assessment, we must add the fact that unlike last year, when there were barely any cases of the flu, this year, the internal medicine departments are filled with flu patients. If a lot of people are hospitalized with the coronavirus as well as the flu, then this will significantly impair hospitals' ability to provide medical treatment.

The new medicines arriving in Israel can change this scenario and bring down the number of hospitalizations of people in serious condition by up to 90%. The public can also enlist in the effort to lower morbidity in general and severe morbidity in particular by getting their third dose of the vaccine and vaccinating children.  

Sheba Medical Center at Tel Hashomer is currently leading a first-of-its-kind study on the efficacy and safety of a fourth dose of the vaccine. Initial finds are encouraging. When Health Ministry Director-General Nachman Ash authorized the fourth dose for medical workers and those aged 60 and over, I rushed to get the jab. I see it as an important step in protecting my health and the health of those around me, as well as a matter of mutual responsibility.

Alongside the understandable sense of uncertainty, there is in a pandemic, it is important to present an optimistic scenario for the future. The Omicron variant multiplies mainly in the upper respiratory tract, in the nose and the sinuses, which is why it is so contagious. On the other hand, to the best of researchers' and doctors' knowledge, it causes less damage to our health. As a result, we have seen an eight- to nine-fold decrease in severe morbidity from Omicron in comparison to the Delta variant.

The spread of a highly contagious variant, which certainly causes mild illness among the vaccinated, and as a result, serves to lessen the load on hospitals and the number of those in critical condition who require intensive care, is an important step in the path to our being able to live with the disease. We can cautiously assume that the infection of hundreds of thousands will lead to an increase in herd immunity that will allow us to begin to see the light at the end of the tunnel.  

There are challenging days ahead in which we are expected to see 50,000 infections a day. But we can defeat this wave the same way we overcame the ones that preceded it. To do so, management of the pandemic must be based on three components: vaccines, with an emphasis on third and fourth booster doses; the provision of medicine to those at risk; and the bolstering of the health system. Beyond all that, we must all decide to exhibit personal responsibility by masking and avoiding large gatherings and events.

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There is an incredible discrepancy between the situation in Israel today, in which we are living almost normal lives alongside COVID, and the messages from experts in the healthcare system and academic, which are telling us that "the fifth wave" is already here.

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There are a few factors that explain this difference. First, the more time passes, the less effective the vaccine becomes, a process taking place at the same time that the Omicron variant is spreading. We can already say that it is much more contagious than previous strains, and the number of people who contract it doubles every three days.

A clinical study conducted at Sheba Medical Center at Tel Hashomer teaches us that the immune response in people who received both vaccine doses and a booster shot is somewhat less effective in neutralizing the Omicron variant, and that the immune response to this variant in people who received only two doses or who received the second dose six months ago or more is near zero.

Paradoxically, if we find that this strain is highly contagious but does not cause serious cases of COVID-19, it's possible that it could push out other mutations and turn COVID into a minor illness.

Secondly, the question that concerns Israel more than any other is the high number of people who still have to be vaccinated – over 2 million residents if we count the unvaccinated, children who have yet to be vaccinated, and adults who haven't gotten booster shots.

Europe, which is in much worse shape than Israel due to its higher numbers of unvaccinated residents, is currently putting a series of restrictions in place, with an emphasis on those who haven't been vaccinated or haven't gotten booster shots. These measures include selective lockdowns.

The challenge Israel faces to vaccinate over 2 million residents is an even bigger one than the fourth wave of the virus. When the Delta variant began to spread, healthcare authorities decided to begin administering booster shots, even though the FDA hadn't approved them. But the moment the decision was made, about 4 million Israelis responded and rolled up their sleeves, causing the fourth wave to die down. Now we need to convince the anti-vaxxers and the vaccine-hesitant to do the same. This is a much bigger challenge.

To succeed, we need to continue targeted outreach. For example, Sheba and the director general of the Health Ministry recently hosted a conference for the country's prominent rabbis, in which we answered their questions and enlisted them to help the campaign to persuade their communities to get vaccinated.

At the same time, preference should be given to those who got vaccinated and acted on the principle of responsibility for one another, as well as protecting themselves and their families. It's not right to compel all those who return from abroad to quarantine, even if they were exposed to the Omicron variant. This policy is fundamentally wrong for vaccinated citizens.

As for those who still haven't gotten vaccinated, it's time the gloves came off and harsher steps were taken. For a start, restrictions should be put on entry to non-essential public places, and we could go as far as increasing their health tax. Still, making vaccines mandatory is impractical.

No less important is the need to strengthen the healthcare system and add beds to ICU units to avoid any need for a general lockdown should the number of seriously ill patients exceed the few spaces currently available in ICU. During the fourth COVID wave, we found ourselves in extremity, in which there was no room for another patient on an ECMO machine anywhere in the country. So we need to start implementing a plan by the Union of Hospital Directors to add 321 ICU beds to the country's hospitals – a plan that was the result of lessons learned in the second wave.

The bottom line is that the solution is in our hands. If we all enlist, we can live safe lives alongside COVID.

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Having just exited the Delta coronavirus wave, Israel finds itself facing a new challenge. The Omicron variant, recently identified in South Africa, is cause for alarm. From what we know so far, it has 50 different mutations, 30 of which are in the spike protein, enhancing the virus' ability to infect the body.

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The most troubling of all is Omicron's transmission rate. South Africa has reported a sharp increase in coronavirus hospitalizations, and if Omicron is indeed responsible for this, Israel must prepare for the challenge.

While the world's greatest minds are trying to learn more about the new strain, Israel and the rest of the world must take a series of immediate measures, some of which lawmakers had already approved last week.

For example, because Omicron can be brought into the country through the Ben-Gurion International Airport, officials imposed a two-week travel ban on foreigners as well as mandatory self-isolation for Israelis who return from abroad.

Those who claim these measures are hasty must remember that we have a duty to exhibit caution, given that we do not possess all the information about the new strain.

Although preliminary data from South Africa shows that there is no evidence that Omicron is more contagious than previous strains, we will only know for sure in a few weeks.

Another matter that will become clear soon is whether the vaccine is effective against the new mutation. Doses respond to each new strain differently, but it does not necessarily mean that they will be unable to protect us against Omicron, especially when it comes to reducing the risk of serious illness.

As such, the Health Ministry must continue vaccinating the population, with an emphasis on booster shots and doses for children ages 5-11 who have not yet gotten inoculated. It must also impose restrictions on the 600,000 Israelis who outright refuse to be vaccinated.

Another complex matter is Hanukkah. Nobody wants to disturb festivities, but neither do we want another morbidity outbreak. To reduce transmission we must follow the "green pass" guidelines and test children who have not yet been vaccinated, or who are in the process of building immunity.

Omicron is another opportunity to remind policymakers of the importance and necessity of strengthening the healthcare system, increasing the number of beds in intensive care units, and more.

It seems that the coronavirus is here to stay, especially since many developing countries have not begun to immunize their population at all. In this respect, Israel has a great advantage, both due to a high number of vaccinated citizens and the advanced healthcare system.

We have the tools to minimize the impact of Omicron. And we will if we make sure to follow health guidelines, get vaccinated and wear masks. By doing so, we will show that we are responsible for one another.

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An advisory committee has recommended the Health Ministry begin a coronavirus vaccination campaign for children aged five-11. This recommendation was given after the US Food and Drug Administration approved the vaccine for children in that age group.

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Now the ministry's most important task is to dispel the understandable fear and doubt of parents about whether to vaccinate their children. It must do so with transparency, parental involvement, and willingness to answer questions.

One such question being asked is: Why vaccinate children if in most cases they recover from the coronavirus without developing severe illness? The reality is, the virus is not gone and the emergence of new strains is just a matter of time, and therefore it is essential for parents to vaccinate their children.

It is not only difficult but also immoral to rob children of the opportunity to socialize with peers. Moreover, the damage isolating kids does to social ties by far exceeds the small risk of vaccines.

Those who claim that most children recover from the virus easily must bear in mind that some children do become seriously ill. The fact that it is rare is no consolation for the parents whose child is going through this.

To date, approximately 500 children between the ages of five-11 have developed serious cases after contracting  coronavirus. Over 100 suffered from a post-COVID syndrome that causes great damage to the body.

As parents, we manage risk all the time. The decision to let our child go on a trip without us being nearby is not easy, yet we do not deny them that opportunity. When our child passes a driving test, it is not easy for us to hand them the car keys, but we understand that we cannot hold them back from driving.

Intelligent risk management means making the most correct decision under the current circumstances. We know that being infected with the coronavirus carries far more risks than getting vaccinated, and that inoculated children are less likely to get infected and infect others.

Above all, vaccinating our children is an educational step that expresses responsibility towards all Israeli children – especially those at risk – and toward our elderly parents and the society at large.

Only when children are also vaccinated will we be able to live a safe life alongside coronavirus, with minimal harm to society, education, and the economy.

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We are now hearing some good news on the coronavirus front, according to which the number of seriously ill is on the decline, as is the number of daily new infections and the reproduction rate. Should this trend continue, the fourth wave of the outbreak will soon be behind us.

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The waning of the fourth wave stems unequivocally from the correct if complex and pioneering decision the State of Israel made to encourage Israelis to receive a third dose of the coronavirus vaccine prior to FDA approval for the booster shot. The decision has been adopted by additional countries around the world and is supported by groundbreaking research carried out in Israel that points to the efficacy of the third vaccine dose and the minimal side effects compared to the short- and long-term damage some of those who recover from the virus suffer from.

Despite the optimism, we must not rush to celebrate, as we did at the conclusion of the previous waves. As long as the virus continues to run rampant around the world, and there are countries where people have yet to receive a single vaccine dose, there is a chance mutations can develop. In addition, evidence of the damage the coronavirus causes is on display in hospital inpatient wards that treat seriously ill patients who recovered from the virus yet remain hooked up to ECMO machines and wait for lung transplants. At Sheba Medical Center at Tel Hashomer, three recovered patients have received lung transplants, and unfortunately, many more continue to wait in line for their turn.

In medicine, caution is warranted as a worldview, and we must learn to live safely alongside the virus. First and foremost, we must learn the lessons of previous waves and anticipate the future. We must implement the green class model that sees students in a class in which one child is infected must be able to provide a negative PCR test before returning to school. At Sheba Medical Center and around the world, this model has proven effective at bringing down infections and significantly decreasing quarantines. Better to take a calculated risk now to allow our children to live normal lives alongside the virus.

Bolster the healthcare system

Beyond this, as with every ceasefire, this is also the time to prepare for the next round. Medical staff stationed on the frontlines have allowed the market to open. ICU teams continue to treat seriously ill coronavirus patients, patients who recovered but remain in serious condition, as well as patients who require treatment under other circumstances. The State of Israel must bolster the health system now.

Compared to Western states, Israel suffers from a lack of ICU beds. After the second wave, the healthcare system presented the government with a plan for an additional 321 beds. This requires ICU staff to undergo the necessary training. The decision to condition the number of positions to be added to the healthcare system on an illogical number of coronavirus patients, which we were lucky to never reach, was a grave mistake. I hope we won't have to pay a heavy price for this decision down the line.

Another lesson we must internalize is that there is a need to close the loopholes at Ben-Gurion International Airport. It cannot be that two years into a pandemic, no solution has been found to prevent new mutations from entering Israel. At the same time, a campaign must be launched to convince the unvaccinated and those who have not received a third dose of the vaccine to get the shot. There must also be tougher punishments for coronavirus deniers who spread false information.

The waning of the fourth wave is proof of the winning recipe of cooperation between the government, the health system, and Israel's citizens. If we join forces now, we can defeat the coming waves.

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On the eve of Yom Kippur, each one of us is asked to do some soul-searching. Almost two years have passed since the outbreak of the COVID pandemic. The world as a whole and Israel, in particular, have been rocked off their axes, and it looks like this year it is more important and meaningful than usual for us to reflect.

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This is the time to internalize the lessons we have learned since COVID came into our lives, including the humility with which the forces of nature should be confronted. This is also the time to reach new conclusions that will allow us to live safely alongside the virus – especially given the fact that it will likely remain with us for some time.

The healthcare system and medical workers have been on the frontline of the battle against COVID from the beginning and are continuing the national mission, fighting bravely and with devotion for the life of every patient. They are worn out. In addition to the everyday load they handle, they need to treat COVID patients – some of whom are in very serious condition.

This is the time to thank the angels in white for their devotion and hard work. This is also the time to strengthen the public healthcare system and ensure that it receives the necessary tools to offer appropriate care for COVID patients, regular patients, and the patient load expected this coming winter.

Israel is currently at a critical point at which it is trying to learn how to live safely alongside the virus. The two main decisions by the last two governments to be the first in the world to vaccinate the entire population and then to administer booster shots are proving themselves to be correct. The percentage of COVID patients in intensive care who have received booster shots is down significantly, and the vast majority of patients in serious condition have either not been vaccinated or have not gotten booster shots.

On the eve of Yom Kippur, we are also asked to reflect on how we treat each other. In the context of COVID, those who have not been vaccinated and comprise a disproportionally large percentage of the serious cases, and the burden on hospitals force us to divert experienced medical staff to their care at the expense of other patients. They need to change their approach and get vaccinated to help contain the virus.

Responsibility for each other is part of the essence of being accountable to each other. The idea of the grandfather sitting next to us in synagogue, the cancer patient waiting in line at the supermarket, or the immunocompromised child should be enough to prompt us to act responsibly and get vaccinated.

The eyes of the scientific world are on Israel. We are producing groundbreaking studies, including some that have proved that the vaccine is safe, provides 90% protection against serious illness, and reduces both the spread of the virus and infection. The higher the percentage of vaccinated people in Israel and elsewhere, the closer we come to putting COVID behind us.

Other than encouraging vaccination, we need to increase testing – both PCR and rapid antigen. Being careful to be tested and following quarantine regulations should the need arise; wearing masks in closed spaces and during crowded events outdoors; and adhering to the rules of the green pass all demand personal responsibility as well as stiffer enforcement. We need to improve in all these areas, a lot, in the new year.

And on a personal note, I am asking for the forgiveness of the medical staff who have been caring for patients devotedly, without rest, since the start of the pandemic. It took me time to understand that beyond the physical difficulty and the exhausting and endless work, they are also undergoing immense emotional difficulty in dealing with a sense of helplessness when treating COVID patients desperate for oxygen, whom we can't help. We have provided emotional support for staff, even if we were late.

This lesson in humility is one of many we have all learned as we have dealt with COVID. But the most important lesson is that if we all put our backs into it and take action while looking out for each other, we will defeat COVID.

May you all be inscribed in the book of life! 

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Israel and the rest of the world are battling a fourth wave of COVID that erupted due to the Delta variant. Data collected in Britain indicate that vaccines are more than 90% effective in preventing serious cases of COVID-19 and hospitalizations in people who contract either the original or Delta strains of the virus.

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However, Delta is highly contagious and requires Israel to take a number of steps that will cut back on the rate of infection and the number of seriously ill.

The high rate of transmission of the Delta variant arrives when Israel has a relatively high rate of vaccinated citizens – over 65%. However, Israel can't rest on its laurels. As long as the COVID pandemic rages, new variants will appear that will constantly prevent new challenges to the successful vaccination campaign.

Companies like Pfizer are already making an effort to adapt their vaccines to variants, and we can expect to keep vaccination until most of the world is either vaccinated or contracts COVID and recovers. Israel needs to adopt a long-term strategy about how to live safely alongside COVID.

The first part of this strategy is to maintain a high percentage of vaccinated members of the population, including encouraging the million Israelis who have not yet been vaccinated to do so – through both outreach and incentives, along with legitimate restrictions on the non-vaccinated. These would include the government not shouldering the cost of tests or paying for quarantine days for the unvaccinated.

Most of the Israelis who haven't been vaccinated aren't anti-vaxxers. Most of them are afraid, hesitant, or feed off of fake news that irresponsible people put online. This sector should be identified and action taken by their community leaders to encourage them to get vaccinated.

The second part of the strategy is to make sure the elderly, medical workers, and other at-risk populations are vaccinated. Israel pioneered the COVID booster shot. Studies conducted at Sheba Medical Center at Tel Hashomer indicate that a third shot of the vaccine significantly increases a recipient's level of antibodies. Health Ministry statistics show that it has led to a 50% drop in people age 60 and over who contract the virus.

The third element is to strengthen Israel's healthcare system, which launched its war on COVID without reserves and with one of the highest rates of hospital bed occupancy in the world. A recent government decision to establish additional positions in the public healthcare system is a vital step.

These actions need to be accompanied by a nationwide PCR testing apparatus, as well as stepped-up enforcement of public health regulations – especially at Ben-Gurion International Airport – so we are able to retain the success of the vaccination campaign in the long term.

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Ever since the outbreak of the coronavirus pandemic in March 2020, the world and Israel have experienced a number of waves of morbidity. We overcame the first two waves through lockdowns that took a high toll on society and the economy. Israel stopped the third wave first and foremost with the world's fastest and most efficient vaccine campaign.

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Israel is one of the world's leading countries in terms of its vaccination rate and the percentage of people inoculated. It is thanks to this unprecedented achievement that Israel can and must live securely alongside the coronavirus through risk management and minimum harm to its citizens. Living safely with the virus means creating a balance between implementing steps to rein in infection and serious illness and preventing major damage to the economy and society.

It is possible to live alongside the coronavirus thanks to the vaccine's impressive ability to prevent serious illness, even when the delta variant is concerned. Proof of this can be found in data from Israel and around the world. In January 2021, Israel confirmed around 8,000 new cases and 50 deaths every day, to our regret. That same month, Britain recorded 45,000 new cases and over 560 deaths in one day. Now, in July 2021,  Israel is confirming 973 confirmed cases and two deaths in one day, while Britain is recording 31,000 new cases and 96 deaths in one day. In light of these findings, Israel's central mission is to convince around 1 million Israelis who have not been vaccinated to do so.

The different course the coronavirus has taken in the current wave presents a challenge to the medical world. We must understand the significance of infection with the delta variant through medical research. The vaccine is highly effective – around 90%- at preventing serious illness from this variant.

Still, we must not dismiss infections, as some of those infected are liable to deteriorate and become seriously ill. We must therefore decide whether and when to offer a third vaccine dose or booster shot to increase antibody levels and help prevent infection. At this stage, the medical world cannot provide an answer based on medical data.

Today, the Health Ministry and Sheba Medical Center at Tel Hashomer will begin to research families with confirmed coronavirus patients that have been inoculated against the virus and who agreed to take part in the study. Researchers will try to determine the infection rate among vaccinated individuals and the nature of the disease among those infected to help determine policies that will allow Israel to remain open and safe.

At the same time, Sheba Medical Center has already begun to collect data from research into immunocompromised individuals, including the elderly, who received a third vaccine dose.

Israel undoubtedly leads the world when it comes to the coronavirus, and the professional "Torah will go forth from Zion."

A combination of increasing the vaccination rate, mask-wearing, increased testing, enforcement, and research, and avoiding a lockdown as much as possible will allow us to live safely alongside the coronavirus and ensure we manage the pandemic instead of the pandemic managing us.

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Over the past two weeks, we have experienced a new wave of coronavirus infections, which has partly affected those who have been vaccinated. I have no doubt that the last thing the residents of Israel want, especially after finally returning to normal, is another significant infection wave entailing restrictions and economic damage.

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With that, it's important to remember that the morbidity situation isn't at all similar to the situation during the third wave. The fact that Israel is a global leader in terms of vaccinating the population makes the question of handling the current wave fundamentally different than coping with the third wave.

First and foremost, the government and health system's successful campaign to protect the residents of Israel with the Pfizer vaccine safeguards us against the harsh disease caused by the delta variant, similar to the level of protection the vaccine provides against the original alpha variant. Evidence of this can be found in a study conducted by the Health Ministry and Sheba Medical Center, which was published last week, and in other studies recently conducted in Great Britain, which has been facing a delta variant wave as well.

However, due to the fact that protection against delta variant infection is around 80%, the assessment is that we will continue to see a spike in the number of people who have contracted the virus.

Therefore, coping with this wave means we must keep a close eye on the number of seriously ill patients and operate in accordance with hospital stress loads. Yet, at the same time, we must also note the number of infections, as a small percentage will likely develop severe symptoms.

The response to the current wave needs to come on several levels. First, we must close the breaches at Ben Gurion Airport and the land crossings as quickly as possible. The decision to appoint former GOC Central Command Maj. Gen. Roni Numa to handle COVID measures at Ben-Gurion International Airport is an important and necessary step in curbing the flow of the delta variant into the country; and in the long term, in preventing new variants from entering as well. For the first time since the outbreak of the pandemic, we are seeing encouraging measures, such as removing travelers from planes destined for "red" countries in contravention of safety directives, separating those returning from red countries and green countries at the arrivals terminal in Israel, and enhancing the testing apparatus at the airport.

Second, we must increase the vaccination rate, with an emphasis on the coming week. This must be done to allow people to receive their second Pfizer dose before the end of July – when Israel's current supply of vaccines is set to expire. We need to vaccinate more teenagers, and around 10% more people aged 50 and up who still haven't been vaccinated.

Third, we have to consider imposing certain restrictions in a responsible manner, while minimizing economic and social harm. The decision to reinstate the Green Pass or Purple Pass into our lives depends on the number of infections and needs to be implemented cautiously and level-headedly.

If we needed a reminder that the world is a global village, then the gaps between the vaccination rates in Israel to other Western countries is proving it. As long as vaccination rates remain low in Third World countries, the coronavirus will remain a part of our lives. Hence, a joint global effort to eradicate the virus is imperative.

In the meantime, in light of Israel's relatively excellent situation, our ability to live normally alongside the coronavirus mostly depends on us. As long as we continue wearing masks indoors and observing isolation protocols, we can enjoy our summer holidays in Israel and avoid restrictions and other impairments to our quality of life.

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