Israel's COOVID vaccination campaign is showing the country's positive aspects in a prestigious light worldwide. The ability to respond quickly to emergency situations, the healthcare providers' unique infrastructure that is showing both logistics and planning capabilities as well as operational flexibility; the medical teams that have jumped on the mission and are devoting themselves to it day and night; and an overwhelming majority of the public who are listening to science and not following fake news and scare scenarios – all of these have led to extraordinary success and the vaccination of half of the country's residents in under two months.

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The data from the research we at Clalit Health Service's research institute conducted in conjunction with Harvard University, which were published a few days ago in the New England Journal of Medicine, indicate that it is very likely that we in Israel are seeing the beginning of the end of the COVID pandemic as an event that interferes with our lives and something that determines our regular routines. I say this even though the study did not show that those who have received the vaccine are invulnerable – it demonstrated that that vaccine is not "armor" and does not provide 100% protection against a serious disease.

Given that the vaccine provides partial but very significant protection (12 times as much) against a serious illness and even death in every age group and for people with pre-existing conditions, the vaccination campaign is reducing the pandemic's potential to cause harm. This gradual process will conclude when enough members of at-risk groups have been vaccinated, and the number of serious cases, as well as the prospect of another outbreak, are low enough to ensure that the healthcare system is not overwhelmed.

But that having been said, it is important to stress that we're not there yet. It would be a painful mistake to lose control at this point and allow a fourth wave of infection. We need to remember that the vaccination campaign has already reduced the potential for serious illness, but not enough. We need to accept the fact that given the British variant, which is more contagious and more violent than the varieties we knew earlier, only a combination of oversight to ensure that the virus does not spread and continuing the vaccination campaign in the next few weeks can lead us to a new status quo in which we live with the virus – and "gradual" is the name of the game.

It's easy to see how complicated the current situation is right now. If at the peak of the third outbreak we found it difficult to cope with 1,000 new serious cases per week, now – even with most of the adult population already vaccinated – we are still seeing 500 new serious cases per week, half of whom are people under 60. From here, we can easily extrapolate that if there were twice as many new cases, we'd be seeing 1,000 serious new cases per week no, as well, and the situation in our hospitals would still be difficult despite the achievements of the vaccination campaign. Vaccinating a few hundred thousand more adults will have a significant effect on the percentage of the population that is vaccinated, something that can happen and is happening.

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Alongside efforts to complete the vaccination of people in high-risk groups and protect children, who cannot yet be vaccinated, I understand that there is a need to conduct open dialogue about how the new social contract will look, as we gradually transition. There will have to be an emphasis on personal responsibility. We will need to make sure that safe frameworks are available to everybody but decide when it is time to instate "risky" frameworks that will be open those who choose to participate, based on when decision-makers deem the danger of an overwhelmed healthcare system is low enough to do so. The debate about when that will be and what the proper balance is has already been abandoned, but it's important to understand that we are still in the danger zone, and we need to behave with moderation in the next few weeks to prevent a disaster in the last few kilometers before the goal.

In the next few weeks, especially, it is important to adhere to the Health Ministry guidelines. It's important to keep wearing masks in public, maintain social distancing, and ventilate closed spaces. It's also important to keep promoting more and more "green passport" plans that are low-risk, if not risk-free for people who have been vaccinated or recovered from COVID.

Despite what happened during Purim, I want to believe and hope that we can make it through the next few weeks wisely, thus preventing a painful, preventable fourth outbreak while also allowing us to reopen and rehabilitate the economy.

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For me, like for many of my friends, today is a day to celebrate. Today we will start the clock and the countdown to the end of the coronavirus pandemic. If nothing unexpected happens, as it has a number of times with viral diseases, the disease could be gone in four to six months if most of Israel's population is vaccinated against it. But we can't fall victim to complacence and risk an accident in the final stretch of a long and exhausting journey riddled with obstacles.

Vaccines are without a doubt the medical technology that has had the most impact on life expectancy in the past 100 years. Every year, vaccines save the lives of 3 million people and help many millions of others avoid illness and disability. From the start of the current pandemic, it was clear that only a vaccine would provide a total answer to the outbreak. But the development of a vaccine is a complicated, lengthy, and expensive process. No one, not doctors or scientists, dared to dream that we would have millions of doses of a vaccine that would prevent 95% of serious cases ready this year.

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But the unbelievable came to pass, and we are witnessing a truly wonderful leap forward. Until a few years ago, it took an average of 10 years to develop a new vaccines. But the SARS, avian flu, and swine flu of the previous decade, as well as the fear of a lethal flu pandemic, brought the risks of the new virus to the forefront of our collective consciousness and science, and many resources were diverted into making it possible to rapidly develop a vaccine against a new threat.

These capabilities were honed and improved over the past decade, and they – as well as unprecedented investment in processes of development, trials, and manufacturing in 2020 – allowed for the international effort that resulted in a vaccine that is now accessible to the Israeli public. It is important to stress that this expedited process did not skip the accepted procedures of oversight, but they were conducted simultaneously at a massive financial risk, especially for those manufacturers who weren't able to complete work on their vaccines.

I read the scientific reports about the clinical trials conducted by Pfizer and Moderna; I listened to the public hearing by the FDA; and I am confident that the vaccines are effective. Thus far, there is no indication about any safety issues for the populations on whom the vaccine has been tested (it still hasn't been tried on children or pregnant women, and therefore will not be administered to them). The theoretical risk of a new side effect that could appear months or years after the vaccine is given pales in my mind against the visible danger of the virus that is now once again spreading in Israel and the world. Therefore, I will be getting vaccinated today, and I will do all I can to ensure that those of my family in high-risk groups opt to be vaccinated as soon as possible. I believe that most Israelis will do the same in the next few months, allowing us to hope we can get back to life without restrictions and without the spread of disease.

There is immense hope, but we can't fall into complacency. The virus is now spreading in Europe and in the US, both of which are seeing mortality that is 10 to 20 times that of Israel's. Belgium, a country with a population the size of Israel's, saw 200 or more COVID deaths a day this month. Here, the virus is spreading rapidly, and could cause a deadly winter wave like the ones other western countries are seeing.

We need to stop the outbreak, take personal responsibility for wearing masks, maintaining social distancing, and airing out closed spaces, and implement medical experts' recommendations more readily and determinedly. It will be complicated to stem the tide of the virus, and the next few months will test us. We cannot give in to tiredness or fall asleep at the wheel just when we are almost home.

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A small part of that increase can be attributed to the increase in the number of corona tests being carried out, but the vast majority is the result of community spread. It is happening in every community in all sectors of the population, especially among young people. Many factors might be involved in the spread, but public gatherings, including weddings and other celebrations, are a key element in community spread, and we must not wait a single day longer to restrict them.

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Currently, Israel is seeing a higher number of people test positive per day than any European country, including nations much larger than us that were badly hit by the virus. Britain, for example, a country of 66 million that is running over 100,000 tests per day, saw fewer new cases on Saturday than Israel. In terms of confirmed cases per 1 million people, Israel is second only to the United States.

Some might ask what, exactly, the problem is, since the rise in the number of cases does not go along with a corresponding number of serious cases, right? Sadly, that is incorrect. Among the older citizens who contract the virus, the rate of serious cases has not changed, and one out of every seven people age 60 and over who contract coronavirus will become seriously ill. The older population follows public health regulations more carefully, and older people make up a smaller percentage of new cases than they did in the first wave, but the virus continues to worm its way through, infecting many dozens of elderly each day.

The math for the numbers of seriously ill corona patients we can expect to see in the next few weeks is very clear. If nothing changes unexpectedly, 2% of new cases in the past two weeks, or 10-20 individuals, will become seriously ill within two weeks, and require two to three weeks of hospitalization. Within a few weeks, therefore, we could see 200 corona patients hospitalized in serious condition, in intensive care that requires close care by a large staff wearing clumsy protective gear that must be changed frequently. That isn't a number that will bring down the healthcare system, but it certainly comprises a major burden on the system, which is already stretched to the limit.

When the infection rate reaches thousands per day, or if the virus makes its way to the elderly population, it will bring us closer to the limits of what the nation's health care system can provide. Given the current rate of spread, these are extremely viable scenarios. If we don't make significant changes to how we handle it, and even if the number of seriously ill remains under what I mentioned above, we could find ourselves maxed out by the end of August.

If that happens, what options do we have? The system of epidemiological research and quarantine cannot cope with such a high rate of infection, even if there were enough personnel.

At the end of the day, we must not wait for the authorities to declare restrictions. We all need to safeguard our lives. The keep to stopping the spread of the virus requires all of us – young and old – to keep our distance from anyone outside our nuclear families. Wearing masks in public, washing and sanitizing our hand, and staying at home if any symptom appears will also help check the rate of infection.

The entire population has to follow the rules, but the at-risk population – the elderly and those who suffer from chronic or serious illnesses – must do so even more stringently. The danger of contracting the virus is now at its apex, and people who spread it might be completely asymptomatic. This is the time to avoid any risk, limit social contact, and totally avoid crowded placed. As for the younger folks – if not for your own sake, then at least think about your parents and grandparents, and do everything possible to behave responsibly and avoid infection. Keep your distance, wash your hands, wear masks, and stay healthy.

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But in addition to the warning signs, last week brought us a few positive developments in terms of our national handling of the coronavirus challenge, and we should take note of them. The first was the health and education ministers deciding on a new policy of "jumping" on every incidence of coronavirus in schools that entails sending all students and staff home and testing them. The policy was made to allow most of the nation's schools to continue operating as usual, while preventing more cases of mass infection like the one we saw at Jerusalem's Gymnasia high school – an event that is still ongoing and looks like it might include the second-tier spread.

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As a result of the Jerusalem incident, in at least one case last week (in Hadera), a suspected coronavirus hotspot was shut down by testing the patient, quarantine, and testing all the students at the school, all in the space of 36 hours. This was proof that the system, when it coordinates, can handle the main challenge of the coronavirus crisis, which is to prevent a mass outbreak.

But the system's ability to handle a number of incidents like these simultaneously is still limited. As other cases appear and more schools join the infection-and-quarantine cycle, the healthcare system faces an unprecedented challenge. Although a month ago or more, there were days that saw over 10,000 tests run, at that time routine health care was still operating on an emergency basis only, and medical laboratory workers could devote all their resources to corona testing. Now that the labs are needed full time for regular medical testing procedures (and even more, to deal with the backlog), there is a limit to what workers can accomplish, even working three shifts and under immense pressure.

There is an immediate need to add staff to the HMO labs and continue with the plan to expand our national ability to conduct more tests if the virus continues to spread. It's not an easy goal – it requires equipment, kits, and more than anything, manpower. But the additional staff is vital if we are going to avoid shutting down all schools and community sites. After more employees are brought in, it will be possible to run more tests on the asymptomatic carriers five days after the initial results are in.

Another positive development is that the plan to protect the elderly is still in place by re-testing a few outbreak sites in retirement homes after initial tests were negative. This has certainly prevented additional infection among patients at the highest risk for complications.

We have to remember that the corona crisis won't be leaving us in the next few months, not by natural immunity and not thanks to a vaccine. The challenge we are facing now are a sort of dry run to improve our capabilities ahead of the challenges the winter will bring. The methods I have mentioned are important but even more important is responsibility on the part of the public – social distancing, masks, hygiene measures, and self-quarantine when symptoms appear. Let us hope that we can maintain all these practices and avoid a major outbreak like the ones other countries are currently seeing. Only through personal responsibility can we live as normal a public life as possible.

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Thanks to the disease's lesser impact, Israel has had the privilege of acting otherwise. In light of the rapid, exponential decrease in the number of cases, it swiftly – some say too swiftly – began to lift restrictions to restore the country's economic productivity and social stability. One of the recent decisions taken as part of these steps – reopening the education system – is almost unparalleled in other countries struck by the disease. We thus have no point of comparison or way of knowing whether the number of cases can be contained in crowded classes of over 30 pupils, in "real life" conditions wherein masks are not consistently worn.

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The last few days have thus provided troubling evidence. At least two clusters of over 10 new cases of infected pupils and teachers (one cluster involving many dozens) are a major warning sign reminding us that high outside temperatures and hypotheses regarding low infection rates in children cannot deter the spread of the virus.

The decision to reopen schools was a calculated risk, assuming we should implement a trial-and-error strategy. Errors are permissible, and risks should indeed be taken, as long as we have a broad and significant "safety margin" between the present rate of infection and one that threatens the health system with overload. This safety margin allows for significant maneuvering and risk-taking, yet still requires good judgment to reduce the danger of overflow.

It is therefore unnecessary at this stage to close down all the elementary and secondary schools, excluding those that are in imminent danger or where new cases have been found. The Health Ministry should ensure that swift contact tracing and widespread testing be performed for every new cluster to effectively break the chain of infection. However, if in the next few days outbreaks continue to occur in educational facilities, we will have no choice but to revoke the schools' "purple badge" and shift to a different mode of activity less conducive to mass infection.

Mass outbreaks are not extraordinary with coronavirus. According to mounting evidence in studies from Israel and abroad, the disease tends to spread in particular events of mass infection in unprotected groups, rather than steadily progressing from one person to another. In a famous outbreak, 53 (out of 61) singers present at a single choir gathering in Washington State were infected by one "super-spreader." Two have since died of the disease.

The evidence shows that with coronavirus, any large gathering is like a barrel of gunpowder waiting for a match. We've been lucky so far, but at some point a super-spreader with no mask will enter a crowd, setting off an outbreak that will force us to implement social distancing restrictions more stringent than we would like. Such events can be easily prevented: everyone should take personal responsibility, avoiding crowds, wearing masks, and staying at home when feeling any suspicious symptom, especially a fever, coughing, or impaired smell or taste – a typical sign of coronavirus. Symptomatic individuals should contact their HMO to be tested.

The rise in infections – assuming this trend will continue – will again increase the risk to the elderly and the chronically ill, who should again exercise good judgment to prevent infection by avoiding large groups and close contact. However, a combination of a national effort to break chains of infection and the assumption of minimal personal responsibility for reasonable behavior will allow Israel to get back to normal without disturbances or delay. At the moment Israel enjoys relatively optimal conditions to succeed – and success is entirely in our hands.

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The fact that only 30 new cases were discovered on Tuesday is a sign that as of 10 days ago, community transmission was at near zero, and that the virus is exponentially, and rapidly, being suppressed in Israel.

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The assumption that we can expect this trend to continue gave decision-makers the confidence to ease restrictions starting after Passover and continue with additional ones the week after, as more information became available. The goal is to allow a return to "routine, with restrictions," with the remaining regulations to be re-evaluated and adjusted at predefined stages.

The process of risk management that has taken place since Passover is based on the working assumption that the eased restrictions will lead to a higher rate of infectious conditions, causing renewed spread of the virus in the next few weeks and months.

The expectation and hope is that the bugger zone created thus far allows us at withstand at least two weeks of uncertainly about the effects of each stage of easements. If we can reach a steady average of new cases per day, the economy could be rehabilitated gradually by the time winter comes.

Other countries that took the necessary steps relatively late and saw a dramatic rise in infection now face a situation in which the daily infection and death numbers require them to choose between bad and terrible options -- continuing with stringent restrictions for many weeks to come, wrecking their economies, or lifting the shutdowns, which will keep the daily death toll at its current rate for weeks or months to come.

For Israel, it would be excellent news if the current number of new cases remains steady. For the US and some of Europe, as well as more and more countries in South America, the numbers could lead to ongoing catastrophes for their society, economy, and humanity.

But as we are hitting "restart" for our economy and our social ties, we must not take things too lightly. It's important that we constantly remind ourselves that it's not over yet. Countries more disciplined than we are like Japan (particularly its northern island, Hokkaido) and Singapore, which eased its shutdown too soon, have found themselves seeing another exponential outbreak and have reinstated restrictions. Their economies and societies will have difficulty handling another blow.

So we must use the next few weeks for three main purposes: The first, to put the economy back on track as far as the global recession allows.

The second, to adjust the economy and people's behavior in public to the conditions that will prevent the spread of the virus -- including the Purple Tag for businesses and people taking responsibility for maintaining social distancing, washing their hands, and wearing masks.  

The third, and most critical, to prepare for the next corona outbreak.

These preparations must include strengthening medical institutions through additional personnel and equipment while at the same time outfitting ourselves for and drilling national systems that will be tested in the next outbreak: a system of epidemiological tracing, from the moment the virus is suspected until potential carriers can be quarantined; a system of support for at-risk populations, including the elderly who live at home and younger people who are in danger according to models; and a system that meets the differential needs of "red areas," which see concentrated outbreaks.

We don't necessarily have the time to finish all the preparations. We cannot become complacent, not as individuals, whether it has to do with cautious behavior in public or quarantining ourselves at the first suspicion of infection, and not as a nation, when it comes to taking advantage of the precious time we have to get ready for the next stage of this unfolding event. The first part might be over, but the real battle lies ahead. 

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The country's leadership is busy formulating an exit plan from the quarantine, set to begin after the Passover holiday. Everyone understands that these reduced restrictions don't mean a return to normalcy, rather a return to "routine amid the presence of the coronavirus," a routine that still combines physical social distancing, wearing masks in public places, avoiding large gatherings and meticulous personal and environmental hygiene. Yet still – routine, a modicum of normalcy in the global storm.

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However, amid all the discussions about the exit strategy, it seems one vital aspect has been brushed to the side of the public's interest: routine medical care. This critical apparatus was one of the first "victims" of the transition to the emergency national footing, with a series of directives to dramatically reduce activity in hospitals, with an emphasis on surgeries and elective (non-urgent) procedures, out-patient clinics and "reserving" beds for corona patients. Even among the public, despite a dramatic increase in online activity there has been a general decrease in physical visits for treatment. 

To be clear: The scenario the Health Ministry is preparing for is realistic if the disease spirals out of control, and it's crucial to use this valuable time to prepare for the flood experienced by many countries in Europe and the United States. 

This is the time, therefore, to increase the healthcare system's emergency capacity – to do everything possible to expedite the admission of new workers into the field and train them, invest resources in creating new hospitalization options similar to Germany, which doubled the number of beds in intensive care units and is building new hospitals, and also establishing generous incentive benefits packages for those medical workers risking their own welfare on the front lines on behalf of us all.

But the wait for this menacing situation to materialize (or not), could last for months of "routine in the presence of the coronavirus." Already now, on the verge of the initial steps to lift restrictions, we must go back and create "routine medical care in the presence of the coronavirus." In this new routine, we must provide a worthy response for the millions of patients who, due to the stoppage of elective healthcare, postponed procedures, surgeries, and other necessary treatments. 

Now, we must gradually restore these services to partial activity in a calculated and measured fashion. If we keep the healthcare system paralyzed for a period of months, patients will pay the price with their health.

And some of these patients, sadly, are already paying the price. Due to their natural fear of contracting the coronavirus, people have also postponed receiving urgent care and have died as a result. It's important to note: Chest pain, exacerbated depression and other acute ailments should frighten us much more than the coronavirus. 

Any sign of severe deterioration necessitates, even now, an urgent visit to your personal health fund or hospital, in accordance with the severity of the situation. The staff there, for their part, are ready and are implementing the proper separation measures to prevent infection. The risk of contracting the coronavirus during a visit to the hospital or local clinic is miniscule in comparison to the disability and irreversible damage that other diseases can cause. If you are feeling ill – don't hesitate, go get checked, and don't die from fear.

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All they can do now is hold on tightly and wait for impact. Almost 5,000 people have already died in Italy, and the numbers keep rising. The situation in Spain is also dire, with nearly 1,500 dead. France decided to implement a general shutdown only a few days ago, and the French president instructed his people to stay at home and to only leave if absolutely necessary. But the heads of the healthcare systems in these countries know the disease will only start to subside in another three or four weeks.

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Israel's situation is different. The correct decisions were made in a timely fashion; borders were closed, sick people were identified and quarantine protocols were issued. All these bought us an extremely valuable few weeks of time. If we now follow the quarantine directives to the letter, there's a reasonable chance we can escape the fate of Italy and Spain. In this assumption, the morbidity rate in the coming weeks will fall just a hair within the healthcare system's absolute limits, and every critically ill person will receive the best care possible. The mortality rate will be similarly low to the situation in Germany, as opposed to what we're seeing in Italy.

The important question, however, is until when? How long will we have to live in such extreme quarantine conditions? The answer is complicated and depends on several factors. First, we will have to examine the morbidity rate in the coming weeks and determine whether the spread is fast or slow, and whether it's possible to start taking calculated risks.

We should not expect life to return to the way it was a month ago. Social distancing, on-line school and medical appointments will just be a part of our lives in the months ahead. But significantly expanding the scope of testing for the virus, including blood tests to determine morbidity or recovery, will provide us an "exit window" from complete quarantine.

This strategy will be predicated on the timely detection of as many infected people as possible in their early stages and putting them in quarantine. And on releasing those who have recovered from quarantine. All this will happen gradually, and it all depends on the public's ability to sufficiently heed the quarantine instructions.

To this end, what is required now is the complete and total separation of family units, to prevent chain infection and stop the spread of the virus in its tracks. This is the duty of each and every one of us, and this is the meaning of mutual responsibility at this time – if even just a few people engage in risky behavior the collateral damage will be immense.

We must not make light of the safety instructions handed down, not even a little. If the entire public adheres to them, we will traverse these coming weeks in one piece.

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