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Medical staff at a COVID-19 isolation unit in Ashkelon, Israel, last week. Officials fear that a sharp increase in the number of cases will soon fill Israeli hospitals.
Gil Cohen Magen / Xinhua / Getty Images
By Meredith Wadman
“Now is a critical time,” Israeli Health Minister Nitzan Horowitz said as the 56-year-old received a COVID-19 booster on August 13, the day his country became the first country to offer a third dose of vaccine to the population. from the age of 50. “We are in a race against the pandemic. “
His message was intended for his fellow Israelis, but it is a warning to the world. Israel has one of the highest vaccination levels in the world for COVID-19, with 78% of those aged 12 and over fully vaccinated, the vast majority with the Pfizer vaccine. Yet the country now has one of the highest infection rates in the world, with nearly 650 new cases per day per million population. More than half are fully vaccinated people, which underscores the extraordinary transmissibility of the Delta variant and raises concerns that the benefits of vaccination diminish over time.
The large number of Israelis vaccinated means that some emerging infections were inevitable, and the unvaccinated are still much more likely to end up in hospital or die. But Israel’s experience forces the issue of the recall on the radar of other nations, suggesting that even the best-vaccinated countries will face an increase in the delta.
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“This is a very clear warning sign to the rest of the world,” says Ran Balicer, chief innovation officer at Clalit Health Services (CHS), Israel’s largest health maintenance organization (HMO). . “If it can happen here, it can probably happen anywhere. “
Israel is now under close surveillance as it was one of the first countries to be vaccinated in December 2020 and quickly achieved a level of population coverage that was the envy of other nations, for some time. The nation of 9.3 million people also has a strong public health infrastructure and a fully enrolled population in closely monitoring HMOs, enabling it to produce high-quality real data on health. effectiveness of vaccines.
“I watch [Israeli data] very, very closely because this is some of the best data available in the world, ”says David O’Connor, viral sequencing expert at the University of Wisconsin, Madison. “Israel is the model,” agrees Eric Topol, physician-researcher at Scripps Research. “It’s pure mRNA [messenger RNA] vaccines. It’s out early. It has a very high level population [uptake]. It is a functional experimental laboratory from which we can draw lessons.
Israel’s HMOs, led by CHS and Maccabi Healthcare Services (MHS), track demographics, co-morbidities and a wealth of coronavirus measures on infections, illnesses and deaths. “We have rich data at the individual level that allows us to provide real-world evidence in near real time,” says Balicer. (The UK is also compiling a wealth of data. But its vaccination campaign gained momentum later than Israel’s, making its current situation less representative of what the future may portend; and it used three different vaccines, making its data more difficult to analyze.)
Now, the effects of waning immunity may begin to show in Israelis vaccinated in early winter; a pre-publication released last month by scientists at MHS found that protection against COVID-19 infection in June and July decreased in proportion to the time since an individual was vaccinated. People vaccinated in January had a 2.26 times higher risk of contracting a viral infection than those vaccinated in April. (Potential confounders include the fact that older Israelis, with weaker immune systems, were vaccinated first.)
Israel’s serious setback
Israel, which has led the world in launching vaccinations and collecting data, is facing a spate of COVID-19 cases that authorities say will push hospitals to the brink. Almost 60% of critically ill patients are fully immunized.
K. Franklin /Science
At the same time, cases in the country, which were barely registering in early summer, have doubled every week to 10 days since then, with the Delta variant being responsible for most of them. They are now at their highest level since mid-February, with hospitalizations and intensive care unit admissions starting to follow. How much of the current increase is due to decreased immunity to the power of the Delta variant to spread like wildfire is uncertain.
What is clear is that “breakthrough” cases are not the rare occurrences that the term implies. As of August 15, 514 Israelis were hospitalized with severe or critical COVID-19, a 31% increase from just 4 days earlier. Of the 514, 59% were fully vaccinated. Of those vaccinated, 87% were 60 years or older. “There are so many breakthrough infections that they dominate and most hospital patients are actually vaccinated,” says Uri Shalit, a bioinformatician at the Israel Institute of Technology (Technion) who has consulted on COVID-19 for the government . “One of the great stories of Israel [is]: “The vaccines work, but not well enough. “
“The scariest thing for the government and the health ministry is the burden on hospitals,” says Dror Mevorach, who cares for COVID-19 patients at Hadassah Ein Kerem Hospital and advises the government. In his hospital, he lines up anesthesiologists and surgeons to spell out his medical staff in case they are overwhelmed by a wave like the one in January, when COVID-19 patients filled 200 beds. “The staff are exhausted,” he says, and he’s restarted a weekly support group for them “to prevent some kind of PTSD [post-traumatic stress disorder] effect.”
In an attempt to bring the tide under control, Israel turned to booster shots, starting July 30 with people 60 and older and, last Friday, expanding to people 50 and older. As of Monday, nearly a million Israelis had received a third dose, according to the health ministry. World health leaders, including Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, have pleaded with developed countries not to administer booster shots as most of the world’s population has not even received a boost. single dose. Wealthy countries that are considering or already administering booster vaccines so far are reserving them primarily for special populations such as the immunocompromised and healthcare workers.
Still, studies suggest that boosters may have broader value. Researchers have shown that stimulation induces a rapid rise in antibodies, which are needed in the nose and throat as a crucial first line of defense against infection. The Israeli government’s decision to start stimulating people 50 and over was prompted by preliminary data from the Health Ministry indicating that people over 60 who received a third dose were half as likely as their peers vaccinated twice to be hospitalized in recent days, Mevorach said. The CHS also reported that in a sample of over 4,500 patients who received boosters, 88% said the side effects of the third stroke were no worse, and sometimes milder, than the second stroke.
Still, boosters are unlikely to tame a Delta surge on their own, says Dvir Aran, a biomedical data scientist at the Technion. In Israel, the current surge is so strong that “even if you get two-thirds of those 60 and over [boosted], it’s just going to give us another week, maybe 2 weeks, until our hospitals are flooded. He says it is also essential to vaccinate those who still have not received their first or second dose, and to return to the masking and social distancing that Israel thought it left behind, but has started to reintegrate.
Aran’s message to the US and other wealthier countries considering boosters is clear: “Don’t think boosters are the solution.
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