As the fourth wave of COVID-19 surges through Israel, the country remains the world’s laboratory for grappling with the pandemic. In an August 26 webinar, hosted by Hadassah International, Hadassah Medical Organization Acting Director General Prof. Yoram Weiss, Prof. Yoseph Caraco, head of Hadassah’s Clinical Pharmacology Unit, and Prof. Dror Mevorach, director of Hadassah’s COVID-10 Outbreak Units, tackled the topic "What the Delta Is Going On?"
Prof. Weiss explained that while 64 percent of the Israeli population has received two doses of the COVID-19 vaccine, the "completely dominant" Delta variant is 60 percent more contagious than the earlier Alpha variant. Though in May, Israel had only a few new cases daily, currently, he reported, over 100,00 people are in "active isolation" because they tested positive for COVID-19. In addition, Prof. Weiss said, the efficacy of our current vaccines has proven to decrease with time, which is why Israel has decided that a third vaccine, a booster dose, should be given five to six months following an individual’s second dose.
Israel is leading the world in providing the booster. To date, over 1,600,000 people have been vaccinated with the booster, and Prof. Weiss reports that it is providing people with much better protection than two doses.
In any case, Prof. Weiss emphasized, "What is very clear is that most of those who have severe disease are those who are not vaccinated."
Referring to both the initial vaccine and the booster as "game-changers," Prof. Caraco cautioned, "Don’t wait for a new formulation. Get the current vaccine now. It provides about 88 percent protection against the Delta variant." He noted, too, that herd immunity will be elusive in a world that is really a "small village," where so many unvaccinated people travel.
The aim of the booster, Prof. Mevorach explained, is to prevent severe disease and death. It is not to achieve herd immunity. He suggested that an official from Israel’s Health Ministry be authorized to identify the localities where people are "vaccine hesitant" and go to speak with them to convey the truth about the vaccine's risks versus benefits. Prof. Caraco pointed out that you can’t change the minds of the anti-vaccination people, but you can explain to those who are fearful of getting the vaccine that the risk of disease is greater than the minor risk of serious side effects from the vaccine.
Prof. Caraco believes it is time for us to shift our treatment paradigm to focus on those individuals who become mildly or moderately ill from COVID-19 and to develop antiviral drugs for them. Though antibody therapy has proven to be an effective treatment, he said, it was logistically complex because it had to be administered by infusion. Recently, an injectable form was created. However, Prof. Caraco still believes the way to go is to develop an oral drug and give it to people in the early stages of the disease so that hospitalization does not become necessary. Hadassah is working with global partners toward that goal.
One of the key factors pandemic strategists must grapple with, the presenters said, is whether to lock down the country once again—and when. As Prof. Mevorach explained, there are several strategies: institute a complete lockdown as soon as there are just a few cases in the country, like New Zealand; completely open the country despite rising cases, like Sweden and the United Kingdom; or hold off with imposing restrictions like mask mandates until either the number of infected individuals or the number of severely ill patients reaches a certain level. “We don’t know yet what the best strategy is,” he said, but Israel is choosing the middle road, basing restrictions mostly on the number of severe cases. As he explained, Israel is trying to live with the disease and control the severity of illness with the booster vaccine.
How long will immunity last with this third dose? Prof. Weiss believes that while we can’t yet know the answer to that question, it could be that a booster will be needed every five to six months.
Further complicating our effectiveness in fighting the pandemic is the level of compliance among a country’s citizens. Prof. Caraco pointed out that compliance with the mask mandate and other recommendations like social distancing influences the level of success.
The pandemic is clearly a moving target, and, as the presenters all pointed out, no one can prophesize what will happen next. Each day, Prof. Mevorach reported, Hadassah’s top-level administrators and COVID-19 experts re-assess their strategies, deciding, for example, whether to move more staff to COVID-19 units and how many resources must be shifted without endangering patients who have been hospitalized for other illnesses.
"Hadassah is a role model for common sense and anticipating problems," Prof. Mevorach said. He adds, "Our doctors and nurses are tired, but they embody the spirit of mission to work together to save our patients."