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Day 209:

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Day 209 (September 16th 2020) cumulative COVID cases in Israel 171,413 (+4,560) of which 73% have recovered. Deaths 1,162 (+10) or 0.68% of all cases (case fatality rate). Criitical patients 549 (+15) of which 24.7% or 136 are ventilated (+1).

 
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Although numbers are climbing steadily, all over the world treatments are improving and survival rates are better. Our death rate is less than half from our peak, and we were already among the lowest fatality rates in the world.

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We have already exceeded new cases for July and August with 2 weeks left in September. Looking at the last month 8/18-9/18 we can see significant trend changes in looking at the cases per age group.

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Teen rates have risen by 50%, but more worrying are the older adult rates which have risen by 34-40%. Elderly women are more common, as women live an average of 4 years more than men, so higher rates in women persist in 80+ age groups. Interestingly, infected women aged 30-59 now exceed men per age their group, which is different than international trends. Why this is happening is a good question for the epidemiologists. Are these the ages of teachers (more likely to be women)?

 


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Day 208:

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Day 208 (9/15/2020) Cumulative COVID cases in Israel 166,795 (+5,510) deaths 1,152 (+13) critical cases 534 (+10) of which 135 (-3) are ventilated.

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73.6% of cases have recovered. Our case fatality rate is 0.69% (diluted even more because of increased case load not currently impacting death rate).

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Of the record 56,240 tests performed yesterday, 9.8% tested positive. Although we want this positivity rate to be lower, it does indicate that 90.2% or people with exposures and/or symptoms do not have COVID. For the wonderful gap year parents on this group – remember that colds, infections, and viruses can happen but even with symptoms -most people do not have COVID.

 


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Day 207:

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Day 207 (September 14th) cumulative Israel cases 161,213 (+4,913); deaths 1,139 (+14), critical cases 524 of which 138 are ventilated.

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Testing rates rebounded post-weekend to 46k but our positivity rate is 10.6%, which mid-week is the highest level we have seen. More testing capacity is needed as this increase is at critical levels. 5,000 cases a day is equal to 1 in 1,840 residents of Israel, or .05% of the population, catching COVID daily.

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This chart reflects the percentage of change in new cases daily based on the cumulative amount. As the cumulative number goes up, a stable outbreak would decrease percentage wise, as the new cases are diluted in the total, growing number. For example. 1.000 new cases when the cumulative cases are 10,000 = 10%. 1,000 new cases when total case count is 50,000 = 2%. Maintaining the same increase would require 5,000 new cases in this example. Considering our rising cumulative number, the significance of an increasing percentage is significant.

 


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Day 206:

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Day 206 (Sept 13th 2020) cumulative cases 156,376 (+3,274) with 1,125 deaths (+14), 519 (+24) critical patients of which 27% or 142 (+5) are ventilated. Note how dwarfed our first wave appears in this graph.

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Our new cases are outnumbering our recovered cases, although recovered cases are also a delayed factor as there is a mandatory 13+ day post-infection period before recovery is official (3 days must be symptom-free). If symptoms persist, recovery is delayed until symptom-free period or a negative test is obtained.

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As a result of this disparity, the active case count is rapidly growing.

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In the last week, we have maintained an exponential growth factor

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Of the cities with 200 or more active cases, here is a chart showing active cases per 10,000 population and the percentage of cumulative cases that are active.

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This is a logarithmic chart, which shows trends over time in large numbers, but for those who are not math-geeks, it is not a linear chart. The red line is Israel. In a linear scale, which all of the other charts we send out are based on, is easiest for the lay person to understand. Every interval between lines is equal. Dates are 1 day or 1 week at a time. Cases are based on total numbers with scales evenly spaced. The values between points stays the same. A logarithmic scale is based on exponents, so each line is exponentially higher (but in a specific pattern). In the above chart the confirm case number jumps from 10 to 100 to 1000 to 10000 – so each major interval is 10x the previous one. Same thing for the vertical line of confirmed weekly new cases. Logarithmic scales are used to measure and understand large numbers (in a wide range of numbers) over long periods of time, gaining long term perspectives on trends. These scales also help show the rate of change over time. The angle of Israel’s current “uptick” is concerning, as it indicates a significant case load increase over time.

 

 


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Day 205:

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Day 205 (reporting for September 10th,11th & 12th) cumulative cases 153,098 (+4,156; +3,949; +2,704) with total deaths 1,111 (+9; +16; +18). 74% of our total cases have recovered, but this is being reduced daily as our daily growth of new cases is once again exponentially growing. During this wave we hit 82% recovery rate, while after the first wave we attained an 87% recovered case record.

 
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Our delayed indicators: Critical care patients (495) and ventilated patients (137) will not begin to see the significant impact of the new wave or increase in cases for another 4-10 days, assuming the delay to critical care and ventilation remains 10-14 days average from diagnosis.

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Because of increased testing, we are capturing more patients earlier (as many people are tested when exposed yet pre-symptomatic) which continues the anticipated delay of these critical numbers, and may even prolong them. The deaths almost always involve ventilated patients or, at least, critical care patients. As the threshold for critical care patients has decreased, the treatment for patients has improved causing a much lower percentage of people to require ventilation, thereby decreasing our mortality rate significantly.

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Significance of these rankings: Although Israeli public has been unable and unwilling at times to follow the 3 regulations of hygiene, masks, & distancing, the increasing scope of testing, truly among the best in the world, is likely maintaining our low death rates and is a government-only managed factor. Increasing testing capacity and scope, which we had a slow start in as did many countries in the world, has thrown a wider net, diagnosing people earlier, helped identify exposed people faster, and has improved statistical outcomes despite the terrible increases of numbers.

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Among the cities we have been monitoring, here are current weekly updates and growth rates.

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(Note that even these European countries have the weekend effect with lower infection numbers over the weekends).

 

 

 


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Day 202:

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Day 202 – (reporting for September 7th-9th) cumulative cases 142,267 (+3,393; +3,568; +3,955). Deaths 1,068 (+10; +13; +25) with Case Fatality Rate of 0.75%.

 
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Of the 477 critical cases, 141 people are on ventilators (see chart for daily fluctuations). 77% of all cases have recovered (109,744) with approximately (approximate because the numbers are adjusted several times a day for weeks) 31,455 active cases as of last night.

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Testing rates have gone up to 44,000+ daily but our positivity rate has also risen to >8%. So we are testing more, but more cases are likely undetected despite casting a wider net. Over 3,000 health care workers are in quarantine (most since July 26th), putting even more pressure on the health care system.

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We can all see the charts, we all understand the impact of the increased numbers. The concern, as It is in all countries, is to prevent the health system from getting swamped. Recall the “flattening the curve” chart – spreading the cases out so the health care system doesn’t collapse. Nearly every country in the world had this issue already, including many US states. Action is required to reduce the rapidly rising case numbers, which we know statistically will lead to the delayed critical cases and deaths. Timing of diagnosis to critical care averages 1-2 weeks. Deaths average 2-4 weeks post diagnosis. The surge in critical cases we are seeing now relates to cases diagnosed 1-2 weeks

 


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Day 199:

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 Day 199 (Sept 6th) cumulative cases 131,395 (25th worldwide) with 2,249 new cases Sunday. There are 1,020 deaths (+4), 453 critical patients (+14) with 134 ventilator patients (+17).

The testing rates 

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The closest country population with more cases: Chile with 19 million citizens. So among our “cohort” countries with similar population sizes – we have the most cases. Israel has conducted a total of 2.5 million tests to date. Israel is ranked 16th worldwide in tests per million population; 5th when eliminating countries with less than a million people (i.e. Falkland Islands have 3500 population).

 
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As predicted, we continue to have the weekend effect of low test rates and high positivity rates, although this Sunday we had the highest positivity rate ever of 12.2%. What is the significance? High positive test rates indicate that we are unable to capture most cases, that we are not casting a wide enough net of testing. As our cases increase, the number of tests must increase commensurately. Israel’s testing is slowly inching past 30,000 daily, but the lack of weekend testing could be related to lack of public desire to be tested on weekends/shabbat or lack of resources available (limited testing hours, no availability of MOH hotline etc.). What we do know is the trend is increasing and Israel is not adapting fast enough to the new increase in cases.

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Our 1-week average chart, which eliminates the daily ups and downs and helps us see trends more clearly indicates a sharp upturn this past week. We have not had such a dramatic uptrend since the beginning of the second wave.

 


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Day 198:

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Day 198 (reporting on September 4th and 5th) total COVID cases in Israel 129,149 (+2,613; +1,506 new cases respectively) of which 79.3% are recovered. Total deaths 1,016 (+7; +21 respectively). Critical cases 439 (increase of 22 net over 2 days) with 117 on ventilator (unchanged).

 
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As usual, the “weekend effect” can be seen with lower numbers of new cases, lower testing numbers, and a higher percentage of positivity in testing (9.8% on Shabbat – the highest ever). The rebound is normally on Monday.

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Analysis of selected cities

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The overall trend as discussed last week, is a significant increase of activity, initially related to the beginning of “Elul Zman” but already now diffuse among the nation are increased cases related to the beginning of the school year on September 1st. Although it is very early, less than a week after school began, there are widely reported outbreaks and quarantines in school with thousands of students and families affected across the religious and geographic spectrum.

 


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Day 195:

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Day 195 (reporting on September 2nd) as many of you know, Wednesday was a terrible day of discovery as the case count per day increased by 42% overnight. Total cases 122,336 (+3,192) with 976 deaths (+15), 423 critical cases (+9) and 117 (+5) ventilated.

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The crossing of the blue new case line above the critical case orange line has been shown to precede new trends.

 

 


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Day 194:

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Day 194 (Sept 1st) cumulative cases 119,078 (+2,190) with 961 deaths (+16), 414 critical patients (-23 related to deaths yesterday and today) with 112 (-4) ventilator patients.

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The government issued a major adjustment of the recovered cases today, with many hundreds removed as “recovered” likely due to reporting errors over the last month. 81.56% of all cases have recovered, but our active case rate, which was stagnating, is now teetering on a real increase.

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More concerning is that we have not been able to maintain a low positivity rate or an increasing testing rate. We tested only 27,000 people yesterday with an 8% positivity rate.

 


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Day 193:

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Day 194 (August 31st) total cases 116,893 (+2,183) deaths 945 (+20 – cumulative number adjusted since yesterday). 437 Critical cases (-7) with 116 (-10) on ventilators.

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Despite the ongoing lab technician strike, testing bounced back to over 30,000 tests daily with a positivity rate of 7.2% (higher than we were last week and the week before, and this is more concerning than the actual new case number). Let us remember that 92.8% of tests are negative and results are taking less time than in the past. For private testing, Magen David Adom claims to require 2-5 days for results, but we have received results consistently within 1-2 days.

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The new cases by month. We can see that August was very slightly better than July, but again indicates what we have seen: an overall flattening of our case rates.

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In the last 2 weeks here is the case increase in selected cities.

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Israel now ranks the 27th country of most COVID cases. We are ranked 18th for cases per million population (13th if you eliminate countries with less than a million people). We dipped to 50th before the second wave began. Better news: In total deaths we are the 50th country. We are ranked 17th for tests per million population (6th if you eliminate countries with less than a million people and among the 5 countries with more testing, only one has a larger population: Russia) – only one place better than the US in terms of testing per population!

 


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Day 192:

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 Day 192 (August 30th) cumulative cases 114,704 (+1,102) of which 81.1% are recovered. Deaths 919 (+8) with a case fatality rate of 0.8%. Critical cases 444 (+6) of which 126 are on ventilators. In this graph we expect the blue line (total cases) to start flattening (see how our April first wave appears miniature compared to the second wave). They grey line representing the recovered cases will continue rising until it is close to the blue. We can already see our active cases are flatlining, but we want this line to be reduced as the recovered cases continues rising.

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Our recovered cases outnumber our new cases, with a steady, slow reduction of active cases over the last 5 weeks.

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Our 1-week averages chart, however, reflect a pattern we don’t like to see. Our case count went up last week, which we attribute to the high testing rates and low positivity rates, indicating that more previously undiagnosed or sub-clinical cases are now being diagnosed. The weekends always reflect poor testing rates and fewer new cases, but this is the “weekend effect” discussed before. The weekly average is a more accurate trend catcher.

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The percentage of new cases per day has been decreasing, with some stagnation in the last week. The waves reflect the weekend effect.

 


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Day 191:

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Day 191 (reporting for 2 days Aug 28-29th) total cases 113,591 (+1,832; +897 respectively – Shabbat/weekend decline noted). Total deaths 911 (+11; +7) with 438 critical cases (increase of 29 over 2 days) and 116 on ventilators (+5).

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Our concern is that critical cases continue to rise. Last month, the threshold was lowered for categorizing critical cases, but nonetheless, we expected numbers to stabilize, and they have not. The good news is that the ventilator rate is closer to 25% of critical cases instead of the 33% they were in July, and the >50% they were in the first wave. So, we are keeping people off ventilators, but more people are getting critically ill. Since our numbers have been stable for more than 4 weeks, we would expect to see a slowdown.

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Our case resolutions are showing increasing recovered cases. Our recoveries are consistently more than our new cases, so our active case rates have been steadily but slowly decreasing Since July 21st.

 

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The weekly analysis of cities shows some increasing trends in Modiin, Tiveria, and Ashdod. Some cities are (as reported by officials within the communities) “playing with their numbers” by testing thousands of school children to dilute their actual positive rates and decrease their status to orange from red.

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The active case rate of over 200 include many Arab cities/towns. There were many regulation violations over the July 31st – August 2nd Eid Al Adha holiday, and many illegal, large weddings and other gatherings have happened over the last month have likely been the cause of these spikes. Remember that Jerusalem is over 30% Arab, and over 30% Haredi, which is reflected in the continuous high active numbers we have seen since the beginning of this wave.

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When we look at the same cities in terms of what percent of the total cases are active, we see significant differences in the Arab communities. Topping the list is Daliat-Al-Carmel, with 88% of all their cases active, most of which were diagnosed this last week. The sharp increases in the last 1-2 weeks if perfectly timed with the violations in large holiday gatherings.  With the addition of new COVID units in 3 Arab hospitals, Jerusalem hospitals are now averaging 66.3% COVID Unit occupancy.

 


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Day 188:

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 Day 188 (August 26th - reporting on 2 days) - total cases 108,799 (+1,942; 1,952), deaths 875 (+8; +18 – an all-time high daily death rate). 80% of all cases have recovered. Critical patients 404 (-23; +11) with 119 ventilator cases for the last 3 days.

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Our recovered cases are outstripping our new cases, reducing our overall active case rate – but slowly. The crazy-looking ups and downs show how disruptive shabbat/weekend patterns are to our overall trend.

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Our testing has increased to record numbers – 33k and 32k in the last 2 days, with the national program to increase testing coming together. The positive test rate remain significantly lower than previous weeks, which means we are testing large enough sample sizes to find more cases, yet still diluted to only 5.9-6% positivity rates (we were over 9% which was critical level. So our higher numbers in recent days may be reflecting the wider testing policy and availability. On this graph we want to see the blue lines go up and the orange line go down, indicating less positive tests but more widespread testing.

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Two more corona units opened up today, according to the MOH daily report. These hospitals, Al Maqasad Hospital in Jerusalem and Holy Family Hospital in Nazareth have 34.8% and 50% occupancy in their respective COVID units. Both service the Arab community in Israel, who have been deeply affected by COVID during his wave.

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Odds of Catching COVID – by location, action, precautions

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Please see the graph of selected countries. This is a logarithmic graph which shows trends over long period of time but is not a linear scale. Each major graph line is 10x the line before. Examples of logarithmic chart is a growth chart. This shows that several countries are starting second waves, but that Israel seems to have stagnated in growth, which is good and the first sign before the “flattening of the curve” begins, appearing here as a downward turn of the trend line.

 


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Day 186:

The daily case resolution.

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Day 186 total cumulative cases 104,887 (+1,889) of which 79% have recovered, deaths 849 (+12). Our case fatality rate is 0.8%. Critical cases continue to rise with 416 (+18) of which 119 are ventilated.

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Day 185:

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 Day 185 August 23rd (for 2 weekend days of Shabbat/ Sunday which we see every week as their own pattern) cumulative cases 103,001 (+720; +964) with 837 total COVID deaths (+13 each day). Critical cases number 398 for both days, of which 29% are ventilated.

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As in last weeks, the newly recovered and newly infected are similar which leads to a stable active case count.

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We can see that our active case count has remained stable, which is a good sign, but shows that we have stagnated in our fight against COVID.

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Our weekly average of new cases, which incorporates the daily and weekly fluctuations, shows a slow but steady decline. Unless drastic action is taken we will only be in moderately better shape for the holidays (read: with tighter restrictions), and that is not including the likelihood of an increase in cases in the weeks following when schools start next week.

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The city analysis is much more stable. Interventions have helped reduce case counts in Modiin Ilit, Beit Shemesh, even Jerusalem. The most crowded COVID unit is currently Poriya hospital in Tiveria at 160% capacity. The average COVID unit occupancy rate is 68.4% of the 26 units in the country.

 


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Day 183:

Here are the new daily casesOur new daily cases rate has been consistently decreasing in the last 6 weeks. This means that we are not exponentially increasing cases. The health professionals in quarantine has been on a down trend for the last month – we are currently at 1,845 professionals in quarantine, 44% lower than the peak. 46% of those are hospital employees. Less quarantined health professionals improve the overall delivery of health services and availability of staff.

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Day 183 (covering August 19th-21st) in the last few days we have had 1,492-1,647 new cases with a total of 101,318 cumulative COVID cases in Israel. With last week’s adjustment of the missed deaths in nursing home facilities, we are currently at 811 with 11-15 deaths per day in the last few days.

 
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Our testing average of positive cases is lower with the exception of weekends. Calculating weekdays alone (which pattern-wise is Monday through Friday), we average 24,000-26,600 tests a day with a decreasing positive test rate. 5 weeks ago we averaged 7.58% positive test rate, and this pas week we averaged 5.98% positive test rate. This indicates that we are capturing more tests, that the overall infected population is decreasing, and our tests per day remains stable. Weekends is another story, but this is an international phenomenon found in most countries.

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Our ventilator patient rates have not yet reduced, which is a late indicator of a declining trend, but it is more delayed than the last wave. Our critical patient numbers are not declining either, with 390-399 total critical patients in the last week. Is this because our survival rate is better but it is taking patients longer to be discharged from the ICU? Is it because cases are lingering? We do not know, but these are important things to monitor as we seek a more optimistic outlook approaching the holiday season. What we do know is this second wave has different patterns from the first wave, and we do not yet know how this will play out.

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This graph is for cities with 200+ active cases as of today (Shabbat). Please note that Beitar Ilit with 2,199 cumulative case, who struggled with shut downs, quarantines, and poor case management earlier in this wave, has the same number of active cases (144) as Ra’anana, which has 680 cumulative cases. This shows that with active intervention, assisting Haredi communities through “corona hotels” and lock downs of hot spots for 1-2 weeks can have a tremendous impact on managing population outbreaks. We hope that the government will use similar methods to help communities such as Modiin Ilit, who are struggling to contain their outbreaks.

 


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Day 180:

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Day 180 Total cumulative cases 96,671 (+1,644) with 771 deaths (+11 – see notes below for an explanation about the jump). There are 399 critical patients with 117 on ventilators.

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This is an analysis of the cases by age range in the last 5 weeks.

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is a comparison of where we were pre-second wave to now. 51.46% of all cases are male. 60.9% of the national total cases have occurred in the last 5 weeks (58,677 new cases).

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The Ministry of Health announced today, that at least 53 residents of senior living centers, were unaccounted for in the number of casualties from COVID-19 in July-August. The mistake is believed to be because the numbers were simply not inputted into the central system. The Ministry of Health is taking the matter very seriously, and conducting an investigation, and whether there are similar miscalculations that have occurred elsewhere. The addition of these casualties will spike the number of casualties up to this point. This explains the jump since yesterday, but in fact the 53 cases that had not been reported have been dispersed to the relevant day of death, so our daily new death graph is similar. Source: MOH

 


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Day 179:

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Day 179 (August 17th) 95,029 (+1,659) total cases (23% are active cases), with 699 deaths (+11), 399 (+11) critical cases and 112 (+1) ventilator cases. Our overall second wave ventilator percentile has been lower – less than 30% of critical cases, lowered from the 80-90% during the first wave. This is a trend we are seeing around the world, whereby there are better treatments and alternatives for critical cases, which reduces mortality and morbidity.

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Our testing rates are stable, so not increasing yet, and our positivity testing rate is overall somewhat lower, with the exception of Shabbat trends (we have discussed) that biases the overall numbers.

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The active case graph shows a slow but consistent reduction since our peak. At this rate it will take many months to go back to pre-second wave figures. How the end of the Haredi yeshiva vacation period will impact our trends (Rosh Chodesh this week), and how return to school will impact us. We also await the full impact the planned increased testing, opening tourism, opening the skies, and rapid testing.

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The active case graph shows a slow but consistent reduction since our peak. At this rate it will take many months to go back to pre-second wave figures. How the end of the Haredi yeshiva vacation period will impact our trends (Rosh Chodesh this week), and how return to school will impact us. We also await the full impact the planned increased testing, opening tourism, opening the skies, and rapid testing.

 


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Day 178:

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 Day 178 (August 16th) cumulative cases 93,357 (+1,060). Deaths 688 (+13) – this metric does not yet reflect the overall reduced cases we have been seeing (it is delayed by 2-4 weeks on average from the impact of lower cases), but overall the death rate as a proportion of cases has been significantly reduced this wave. Critical cases 382 (-5) of which 111 (-5) are ventilated.

This shows Israeli's cases by city. 

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The new cases vs recovered cases have been neck-in-neck for weeks, but our overall active case rate has been in significant decline since the 3rd week of July when we peaked at 31,143 active cases. We now hover at 22-23,000 active cases nationwide. Lots of room for improvement of course but we are in a positive trend.

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At mid-month we can see less than half of the July rate of new cases.

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The weekly trend is showing the slow decline we discussed. This is a more statistically significant chart as it rounds off the daily variances and fluctuations, creating a clearer picture. The increase in cases we went through takes much less time than reducing the spread and cases. Like losing weight, the battle to reduce COVID spread and cases is a challenging one, always balanced by a societal need to have a functional economy, schooling, jobs, commerce while doing the most to protect lives, particularly those who are most fragile.

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Day 177:

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Day 177 (reporting for the weekend August 14th & 15th) total cases 92,297 (+1,386 Friday; +760 Shabbat) with 675 deaths (+11; +8), 387 critical cases (-3; +13), of which 116 are on ventilators (-6; +9). 74.1% of all cases are recovered and our case fatality rate is 0.73%.

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Our weekend trends continue with lower diagnosis rates and higher positivity rates (higher COVID positive percentage on weekends vs weekday but less overall cases on weekends).

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Overall new case trend is reduced based on average daily percentage of new cases (this calculates second wave only).

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As you can see, our case resolution rate is trending favorably with more recovered cases, and as you can see by the very thin yellow bar – this wave our overall death rate is lower.

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Case resolution 

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City by city analysis we can see that Modiin Ilit is still among the highest growth rate of the major cities in Israel with 18% increased cases in the last week. While Jerusalem has the highest number of overall cases, the weekly increase has been reduced to 8% (a few weeks ago we were 20-30%).

 


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Day 174:

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Day 174 (August 12th) 88,489 cumulative cases (+1,614), 640 deaths (+14), critical cases 269 (-6), and 110 ventilator patients (0 change).

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City-by-city analysis shows a 1-week case increase in Modiin Ilit of 25.5%. There are 1,220 active cases in the city, of which 701 (57.5%) have been diagnosed in the last week. Of the 3,868 active cases currently in Jerusalem, 45% were diagnosed this past week.

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The average COVID unit is currently 62.25% occupied. The average hospital in Israel as a 79.5% general occupancy rate.

 


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Day 173:

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Day 173 (August 11th) cumulative cases 86,876 (+1,803) with 626 deaths (+9), 375 critical cases (-13) and 110 ventilator patients (-4). This chart flatlines when there is no growth, it is not a bell curve as it includes cumulative cases only.

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our new daily cases

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Newly recovered vs New cases have been neck-in-neck in the last 3 weeks (as retroactively adjusted) so the active case rate has stagnated.

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Of all the countries in the world with equal or more cases of COVID than Israel, Israel remains on the low end of case fatality rates despite having the first full-blown second wave. Case fatality rates (CFR) is the number of deaths as a proportion of total diagnosed cases. So countries with wiser population testing have lower CFR rates as the deaths are diluted in the asymptomatic, yet diagnosed cases that are often missed by country testing protocols. Israel’s wider testing policy, which now includes asymptomatic contacts of confirmed cases, should help isolate and diagnose more cases, and potentially bring the CFR lower.

 


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Day 172:

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Day 172 (Aug 10th) total cases 85,056 (+1,694) of which 70.4% are recovered. There have been 617 deaths (+14) and there are 388 people in critical conditions (-7) with 114 ventilator patients (+5).

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Whether we are plateauing at this level because of people relaxing their standards or for other reasons, we seem to be stagnant and action must be taken to lower our numbers. Some hospitals with COVID units are being forced to reduce staffing of other units due to staffing shortages. We must get hold of our cases so we can see reduced ICU and ventilator numbers in 2 weeks from now.

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This graph shows us the new daily cases

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The city-by-city increases over the last week shows lower percentages of growth compared to previous weeks, except in Modiin Ilit where there was a 23% increase in the last week.

 


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Day 171:

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Day 171 (August 9th) Israel cumulative cases 83,303 (+884) with 603 deaths (+7) with case fatality rate of 0.72%. 70% of all cases are recovered.

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There are 395 critical cases (+7) with 109 people on ventilators (+3).

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This past week’s average cases per day was down for the second week in a row, averaging 1,470 cases per day. Although the decline is small, we are pleased to continue seeing the downward trend, and the averaging of week-long new case numbers is more important that looking at the daily fluctuations. Keep in mind, with the economy not shut down, the decline of cases will likely be slower than the first wave, even keeping in mind that we are starting with many more active cases than the peak of the first wave.

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Here are the numbers of cases (daily and total) of Sweden superimposed on Israel so you can see the patterns as they have developed.

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Here are the numbers of deaths (daily and total) of Sweden superimposed on Israel. Sweden, now in a lull after their first wave, has suffered 10 times the deaths compared to Israel. That is the price Sweden has paid for their decisions. Israel is a nation built on the ashes of lost millions only a few decades ago. Israel was formed 72 years ago with very few elderly, less than 1% of the population in 1948 was over 60 years old because they had not survived the Holocaust. The values of our country, across the cultures (Jewish, Muslim, Christian etc.) includes valuing our vulnerable and older populations. We take pride in our consistent high ranking of life expectancy, our high rate of volunteerism, our health care system, our medical and biomedical breakthroughs and research.

 


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Day 170:

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Day 170 (August 8th) total cumulative cases 82,416 (+763 Shabbat; +1,753 cases Friday). Remember that data from the last day is coming in late and then adjusted, often for days or weeks – so adjustments are always made. The number lagging the most is daily recovered cases, as each kupah processes recoveries at a different rate, and the data is reviewed later for reporting errors. Deaths 596 (+12 shabbat; +8 Friday) with 388 critical cases (+14 Shabbat; +16 Friday) of which 106 are ventilator patients (-1 on Shabbat; +8 on Friday).

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57,436 people, or 69.7% of all cases have recovered officially, with 24,384 active cases. Testing on Shabbat was substantially lower in number (8.596) and higher in positive rate (9.4%) than weekday average, which is consistent with many weekend behaviors in Israel and around the world.

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This second round we have a lower rate of deaths, lower rate of ventilator use (see graph) due to better treatments and more knowledge about this virus, but these are trends we see worldwide as their second waves begin. We will analyze this further this week.

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The percentages of new cases per day as calculated by cumulative cases is dropping weekly. Although the new cases, if they remain stagnant, will naturally dilute in a larger and larger cumulative case count, this drop is significant, as the rise was, as it is well above the natural dilution rate. This means if I have total of 1000 cases with 10 new cases today – that would represent a 1% increase or 10/1000. Tomorrow 10 new cases out of 1010 cases would equal 0.99% increase etc.

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The cases of medical professional in quarantine have decreased substantially in the last 3 weeks. Currently there are 2,032 health professionals in quarantine, down from a peak of 3,252 on July 24th. This is especially important considering the staffing shortages being faced across the board. Nearly every country is suffering from staffing shortages during peak pandemic activity.

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Here is the list of top cities with active cases. The “reddest” city seems to be Modiin Ilit with huge growth of cases in the last 2 weeks. Their active cases will exceed Tel Aviv and are more than half the rate of Bnei Brak. And those 2 cities are much more populous. Modiin Ilit has 128 active cases per 10,000 population, while Bnei Brak has 91, Jerusalem has 40, Tel Aviv has 25.

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New cases this week by city – we can see that Tel Aviv has declining cases as do many other former hot spots (Beitar Ilit, Beit Shemesh, even Jerusalem). Jerusalem is not a safe city (none of these are) but the relative improvements are hopeful for the trend we are trying to keep (downward!).

 


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Day 167:

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 Day 167 (August 5th) Cumulative cases 78,260 (+1,689) with 569 (+7) deaths, 34,5 (+4) critical cases of which 106 (+7) are ventilated patients. Our recovery to new case ratio is equalizing with 5/14 of the last days with close or equal numbers, which means fewer active cases in the country.

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Israel’s case fatality rate (CFR) or deaths as a ratio for total diagnosed cases is 0.73%, or less than half of our peak ratio. The true ratio is likely far lower, as it is generally estimated by population research that 50-90% of cases remain undiagnosed. This “true ratio” is called an infection fatality rate (IFR), but that may not be known or understood for a long time until we get a grasp of how many undiagnosed cases there are in Israel.

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Our testing rate, other than weekends, remains slightly lower than our peak testing capacity, and there is talk about testing all exposed people to capture more cases and reduce transmission chains. Testing capacity must meet this demand before it is required. Our overall positive rate is declining, which indicates that we are capturing more cases in testing.

 


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Day 166:

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Day 166 (August 4th) cumulative cases 76,534 (+1,726) of which 67% or 51,307 have recovered. The daily calculation of recovered cases is delayed by 2-3 days and the new case count is adjusted for up to weeks. This is why we report a full day later – to get a more accurate picture of the situation, but even so we adjust numbers retroactively nearly every day.

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There are 562 total deaths (+9) with 341 critical (+10) and 99 patients on ventilators (+4). The delayed priority of the government is to lower these numbers, but unfortunately the complications are delayed indicators, which means that the people in the hospital now likely got sick 1-3 weeks ago or longer, and it is too late to prevent the complications that will arise from the small percentage of people who are already sick and at risk for severe complications. All we can do is move forward to lower the spread, to improve epidemiology tracing and to stop the chain of infection.

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2.8% of the 24,665 active cases are hospitalized, which is up from the average of 2% we held for many weeks.

 


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Day 165:

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Day 165 (August 3rd, 2020) total cumulative cases 74,815 (+1,802) with 553 deaths (+15) – a much higher number than reported midday and the highest daily death rate to date. A total of 68% of all cases have recovered and there are 24,557 active cases. Critical care patients number 331 (-11) with 95 ventilator patients (-5).

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Over the last week, we are averaging equal number of new cases and new recoveries. We are at that tipping point.

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The case resolution “bump” occurred with the new recovery criteria which fast-tracked thousands of delayed cases to be designated “recovered” in a short period of time. This is showing us that unlike 2 weeks ago, now the majority of our total cases are recovered.

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The selected city data shows the hotspots of Modiin Ilit, with 54% increased total cases in the last 2 weeks, followed by Elad with a 46% increase. Bnei Brak case growth has slowed, which is a good sign for the Haredi city.


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Day 164:

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Day 164 (August 2nd, 2020) total cumulative cases 73,012 (+711) with 538 total deaths (+9), 342 critical patients (+14) of which 100 (+6) are on ventilators.

 
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Our critical and ventilator cases will continue to rise for several weeks, but we are seeing a downward trend in new cases. It is not as dramatic as it seems, as we see the weekend effect clearly (but a lower weekend count in over a month). Note: The weekend effect also impacts hospital occupancy rates in Israel, with stable patients (not COVID of course) often discharged home for Shabbat (while their hospital bed remains reserved for them). This is not seen in the US, for example, as when a patient is stable enough to visit home, they are stable enough for out-patient care.

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Our one-week averages show declining numbers – and we see the same trend emerging as last wave – we double our numbers weekly for a few weeks, we flatten out and start dropping slowly. Of course, if we let our guard down (read: take our masks off) this can easily bounce back up, as has been seen in other countries and with other pandemics. Caution and vigilance is needed until we are vaccinated!

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Mexico overtakes the United Kingdom for the world's 3rd-highest COVID-19 death toll. The Mexican government has said the real number of infected people is likely significantly higher than the confirmed cases. This chart also shows how the raw death rate is not reflective of the Case Fatality Rate (CFR) or the number of deaths as a proportion of total cases for that country. The US and Brazil, with the highest numbers of deaths have CFRs of 3.3% and 3.4% respectively.

 


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Day 163:

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Day 163 (August 1st 2020) total cases 72,262 (+628 but don’t get excited yet), with 529 deaths (+12), 328 (+9) critical patients of which 94 (-1) are ventilated.

(The new recovered cases looks like that due to the redefinition of recovery which led to thousands of recovered cases over a few short days!). There are 26,131 active cases in Israel, of which 98% are classified as mild.

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63% of all cases have recovered and our case fatality rate (CFR) is 0.73%, or less than half of our peak.

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Good News: Our numbers are lower, there are fewer cases and we are on a good trajectory, with the percentage of new cases daily dropping (see chart % of New Cases Daily). Tomorrow we will analyze the weekly data to get a better sense of our declining numbers. Meanwhile, this wave appears to be less deadly than the first wave – due to 1) better care management 2) better preparedness – remember we were among the earlier countries to face COVID 3) better public awareness (although compliance was more challenging) 4) possibly a less-deadly virus sub-type (?) we won’t know this for some time. We obviously had many more cases, so the disease is spreading more easily, but killing less often so far (the delayed effects will not be showing impact for a few weeks yet).

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our number of new daily cases

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We continue to have significantly dropped testing rates over weekends, which creates a false sense of security and much fake news. Remember – on weekends only people really sick report and get tested. But our positive test percentage remains stable on weekends, as you can see from this chart (and the number is overall stabilizing – indicating that our testing rate, while lower than desired, is keeping up with the pace of the disease spread

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City analysis of active cases per 10,000 people normalizes every city to the same factor so we can see what the COVID concentration level is in any given city, town, or village. Three of the most concentrated 13 cities/towns are Arab villages in the Center and North of the country. Two villages in the South were badly hit and the first towns locked down during this wave. The lock downs helped get those towns out of dangerous territory. Among the surprises on this chart – Chashmonayim (a small heavily Anglo religious town near Modiin in the Center of the country) ranked at 10th most concentrated COVID town in Israel with 0.8% of the total population currently infected. Bnei Brak stands alone as the only MAJOR city on the list (hence why they are a “red city” and Jerusalem is not). The concentration of cases is very significant for the ranking of at-risk cities.


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Day 162:

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Day 162 (July 31st 2020) total cumulative cases 71,636 (+1,358 Friday; +1,786 cases Thursday). Cumulative deaths 517 (+12; +8) with 319 critical cases (-9; +6) with 95 ventilator patients (-4; +1).

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In the last 5 days we have tested 20-28,000 people daily, with a trend toward stabilizing or lower positive rates – another sign that things are stabilizing.

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Altogether, the month of July was not a good one, with 46,224 cases (compared to a peak of 10,588 cases in April during the last wave).

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This is the graph that shows (selected) countries on an algorithmic scale. Israel is highlighted in pink, whereby you can clearly see the second wave with exponential growth. Exponential growth is when growth doubles the total numbers in short period of time. In a case like the second wave, this can be calculated in terms of new cases within the second wave or active cases, although this chart is counting total cases from the beginning of the pandemic. We can also see that Israel was the first of these countries to have a second wave and that we have flattened the new case count. This “flattening” can precede a drop-down or another bump up depending on what actions are taken at this critical juncture. We can also see that many countries have had the beginning of a second wave, with Australia right in the throughs of theirs (with exponential growth evident from this chart). Australia is suffering from increasing cases in Victoria region, primarily in specific areas of Melbourne. Victoria has been locked down for several weeks in an effort to control the case numbers and spread.

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The city-by-city analysis (now color coded for their status in MOH) shows the percentage of growth over the last 2 weeks, with Elad at nearly 50% increased cases, Modiin Ilit at 47%, Beit Shemesh at 43%. So while the country is overall being stabilized – the hot spots are not. Vigilance is needed.

 


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Day 160:

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Day 160 (July 29th, 2020) Total cumulative case in Israel 68,491 (+1,966 – please note that ALL recovery and new case numbers have been adjust retroactive 1 month). Deaths 493 (+7) with 322 critical cases (+7) of which 98 are ventilated (+0).

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We can see the figures stabilizing, the curve flattening – although the delayed results (critical cases, ventilators, deaths) will not start flattening for another 1-2 weeks. Of course if we start spiking cases again, the pattern will reverse.

 
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With the new COVID Czar – Prof Gamzu, Israel is on a new, positive trajectory with a captain at the helm who has the knowledge and leadership skills to navigate us to safety. The pandemic won’t end anytime soon, but managing and controlling new cases, reducing transmission, improving testing, guiding our restrictions in a logical manner, improving the public’s trust in the healthcare government establishment, and increasing enforcement of regulations are keys to leading us in the right direction. The medical establishment believes Prof Gamzu will do these things.

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2 weeks ago our recoveries to the new case ratio averaged 40%. In the past week, it has been 127% average.

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By the 5th day of symptoms, patients can be categorized into diagnostic groups and treated appropriately. This can help researchers and medical practitioners find optimal pathways for monitoring and caring for the affected patients according to their symptom cluster. (Source: kcl.ac.uk)

 


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Day 159:

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Day 159 July 28th, 2020, cumulative cases 66,522 (+2,093) with 486 (+8) deaths, 314 (+4) critical cases, of which 98 (+2) are on ventilators.

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The “bounce” we usually see on Monday and sometimes Tuesday is related to the lower testing numbers on Shabbat/ weekend. Private testing is now available again in Israel, although in selected locations.

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Interestingly Qatar and Bahrain with the highest case rate per capita, have very low death rates. We have discussed how Arab States have different contagion and infection patterns, perhaps indicating that they are experiencing a different strain of COVID.

 


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Day 158:

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Day 158 (July 27th) total cumulative cases 64.428 (+2.058) with 478 deaths (+6), 310 critical care patients (+7), of which 96 (-3) are on ventilators. 32,157 people have recovered (+158 but the last 2 weeks have all been readjusted according to the new protocols so this is quite a jump) and there are 31,793 active cases.

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A bunch of misleading news came out today, which is either negligent reporting (the journalist doesn’t understand the history and context of Israeli health care, or deliberately misleading (the journalist reports are partial truths that make sexier headlines to draw more attention to their article), or the journalists really know nothing about the Israeli health care system. Let us recall that journalists strive to achieve attention, clicks, reads – and many journalists no longer do the research part of their job. There are also websites which do not vet their “journalists” and are in fact “grey” news or blogs. The Times of Israel, for example, allows anyone to contribute. Oftentimes people listen to the news and report it, but no verification or vetting or research is required (reader beware).

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Of national hospitals who reported their general occupancy, here is a list of hospitals and occupancy rates (general occupancy). Context: as we reported weeks ago and frequently repeat, Israel has the most crowded hospital system in the OECD (Organizational of Economic Cooperation and Development – or the developed, democratic countries of the world. Our national average occupancy rate is 93.3% as of last year, down from 98% in 2011 (Average is 75% internationally among the OECD members).

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Source: OECD health statistics 2019

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Regarding COVID hospital occupancy – there are a few COVID wards that are over-occupied. Of all active COVID wards, we can see that several have exceeded their designated bed numbers. What does this mean? The government designated numbers of COVID beds in the wards per hospital. MOST of the COVID beds are not ICU patients, but mild cases who require monitoring and some intervention (like oxygen). An insider who works in Hadassah Ein Kerem reports that the COVID wards for the most part do not appear crowded and there is room. How does this blend with the data we see in the chart? As more cases come in, we believe some hospitals have developed secondary COVID units to deal with spillover cases. These may not be counted as “official” COVID beds, but they are nonetheless COVID patients. We saw this being reported during the peak of the first wave- whereby hospitals would announce that they had expanded their unit, or took over another floor. These are not necessarily official acquisitions, but hospitals do not wait for bureaucratic red tape to provide care to patients. This is exactly how the rest of the hospital works when there are full wards.

Regarding COVID hospital occupancy – there are a few COVID wards that are over-occupied. Of all active COVID wards, we can see that several have exceeded their designated bed numbers. What does this mean? The government designated numbers of COVID beds in the wards per hospital. MOST of the COVID beds are not ICU patients, but mild cases who require monitoring and some intervention (like oxygen). An insider who works in Hadassah Ein Kerem reports that the COVID wards for the most part do not appear crowded and there is room. How does this blend with the data we see in the chart? As more cases come in, we believe some hospitals have developed secondary COVID units to deal with spillover cases. These may not be counted as “official” COVID beds, but they are nonetheless COVID patients. We saw this being reported during the peak of the first wave- whereby hospitals would announce that they had expanded their unit, or took over another floor. These are not necessarily official acquisitions, but hospitals do not wait for bureaucratic red tape to provide care to patients. This is exactly how the rest of the hospital works when there are full wards.

 


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Day 157:

Day 157 total cumulative COVID cases in Israel: 62,377 (+1,045) with 472 deaths (+12), 303 critical cases (-7) and 99 ventilator patients (+3).

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98.6% of all of the 33,876 active cases are MILD. 43% of our cumulative cases have recovered, or 27,029 (+92) cases. Testing rates have been low in the last 2 days (see below for weekend effect news), and that means that less people were tested and the ones that were tested were sicker. 9.2% of tests had positive results yesterday.

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Israel’s new cases are ranked 19th highest in the world. The weekend phenomenon of less testing and reporting of cases over the weekend is now seen internationally. You can see in the following charts that each country, including Israel, has drop off of reported cases over the weekend. In Israel that seems to be Shabbat and Sunday consistently every week. Some countries, such as Sweden, Spain, France, Peru, Brazil, and the US (even red states such as Florida and California) have markedly decreased testing and diagnosis rates over the weekends. It is critical to NOT assess daily changes but rather look for at least week-long averages to see pattern changes. (Source: ProMed and statistical patterns)

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The weekend effect is obvious in each of these epidemiology curve charts.

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When we look at the weekly averages in Israel over the last months, we can see patterns more clearly emerging. This past week has confirmed what we reported last week, that increased case numbers are stabilizing and the weekly average this past week was only 100 cases higher than the previous week. This certainly appears to be a flattening of the curve.

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What happened to start this change? 1) There are SOME restrictions that have been in place for a few weeks, such as reduced numbers of mass gatherings (shuls, wedding, reduced restaurant occupancy etc). 2) As the percentage of positive testing rates goes up, the chances of missing cases goes up – so perhaps we are not capturing as many cases as we were. While this is possible, there is evidence that a majority of cases are concentrated in families of infected people, and therefore primarily in Haredi and Arab neighborhoods. The positive testing rates in the Red Zones are much higher – with reported 20-30% positive rates. 3) The country has imposed lock downs or limited closures of some neighborhoods or cities while keeping the majority of the economy open. The neighborhood-by-neighborhood monitoring has been very effective in managing COVID geographically by “putting out fires”, but a majority of cases remain outside of “Red Zones”. 4) The country has stopped testing confirmed exposures, even in hospital settings, unless there are symptoms. This can potentially decrease the capture of more cases. 5) This wave has impacted the elderly somewhat less than last wave. The MOH “Magen Avot” policy has developed and implemented plans to protect institutionalized elderly, and it has been very successful with far fewer cases this time around affecting institutions.

 


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Day 156:

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Day 156 (July 25th 2020) total cumulative cases 61,258 (+1,106) with 460 deaths (+6), 310 critical cases (+2) and 96 ventilator patients (+10).

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Israel is reporting an average of 3% new cases daily.

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Israel is reporting an average of 3% new cases daily.

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Of the 3,069 health care workers in quarantine, ½ are in hospitals and ½ are in the community. The number of quarantined health professionals has been dropping in the last week, and we hope this trend continues.

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The cases in Haredi cities are surging with the highest increases over the last 2 weeks seen in Beit Shemesh and Beitar Ilit at 43% and 45% growth respectively. In Haredi cities not enough people are being quarantined in quarantine hotels, creating incubators in each affected family. Over 2/3 of cases in these areas/cities/neighborhoods are being transmitted within families due to inability to quarantine in the small apartments that occupy large families. This is becoming a public health emergency, and it is imperative for the MOH and COVID Czar to 1) improve access to quarantine hotels 2) communicate cultural and religious accommodations to the communities via community leadership 3) improve living conditions in quarantine/COVID hotels 4) make quarantine hotels mandatory for citizens who live in red zones and who cannot prove that they have appropriate access to secluded quarantine (defined as unshared bedroom and bathroom) 5) create methods of enforced/ improved testing among family members of those with COVID. Currently, household members of COVID patients are entitled to testing but it is not required, and not encouraged without symptoms. More proactive approach would be a benefit to public health and safety.

 


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Day 155:

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Days 155 (July 23rd & July 24th) Total cumulative cases in Israel 60,140 (+1,770 Friday; +1,926 Thursday). Deaths 454 (+7; +13) Critical Cases 308 +6; +29) with 86 ventilator patients (+3; +3). 26,839 people have recovered as of last night with 32,847 active cases.

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There are several positive indicators to look at: we have discussed new cases to new recovered cases as a ratio to understand trends. The recovered cases are a delayed indicator, but it is the positive resolution we seek. When the recovered cases start climbing relative to the new cases, there is a slow down of our accumulation of active cases. The less active cases, the fewer chances of prolonged, further spread. Of course the cases counted are the diagnosed ones and we know that diagnosed cases are estimated to be only 10-50% of total cases (based on several population surveys internationally and in Israel) because of very mild or asymptomatic cases that may remain undiagnosed. Still, this is a good indicator, particularly because there is more testing and higher rates of positive testing in the community (meaning even more testing is needed to capture most cases).

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In the last week the new recoveries to new cases ratio has risen to 37.4%, while the week before it was 16.7% - so more than doubled. This happened as the new case rate seems to be stabilizing and the recovery rate has more than doubled on average. Have we peaked? No way to know (and any claims to knowledge otherwise are fake news at this stage), but there are now several positive indicators.

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So what do we expect in the next few weeks? There will be more critical cases, there will be more deaths, as these were predetermined. Indications that the current regulations are working may spur a stabilization in further restrictions, although clearly getting 1700-2000 new cases daily is too high a number and must be better managed. Perhaps as COVID Czar Roni Gamzu takes the reigns we will see better tracking, less community spread, and a slow down of overall cases.

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In cities the cases rise, but at what rate? The RATE is the most important indicator of hot spots and trends. Of the cities we are following, Beit Shemesh (26.24%), Modiin Ilit (22.6%), Elad (24.86%), and Petach Tikva (23.24%) are the cities with the highest percentage of growth in the last week. Jerusalem is by far the most COVID active city with 1,814 people diagnosed this past week and a current 4,891 active cases. Bnei Brak had 1,041 new cases this week and currently has 2,736 active cases. The percentage of new cases is growing more slowly than previous weeks - and we will keep monitoring that.

 


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Day 153:

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Jerusalem is by far the most active COVID city with 1,672 new diagnoses this week. This chart reflects government ranking for risk of spread: yellow- caution; orange – moderate risk; red – high risk/ possible shut downs. The government considers all geriatric facilities to be red zones, as COVID is so deadly in these facilities. A vast majority of daily cases do not come from “red zones”. Yesterday 85% did not come from these areas, yet these are the national priority cities requiring more enforcement, more public relations, more monitoring and testing.

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An examination of neighborhoods in Jerusalem particularly affected by COVID – we can see clearly that the Haredi and Arab neighborhoods are more affected by this disease. As mentioned before many times – these areas are among the poorest in the country, where housing is crowded, families are big, and resources are poorer. Worldwide we have seen that even in wealthy countries, the poor are disproportionally affected by COVID, as are minorities.

 


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Day 152:

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Day 152 (July 21, 2020) Cumulative cases 54,395 (+2,000 – the highest single day new case rate to date; yesterday’s new cases rose to 1,878) with 430 deaths (+11; it’s been 95 days since we reached double digits in deaths). There were 264 people in critical care (-5 but it rose again today) with 77 people on ventilators.

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22,845 people have recovered (+562) to date.

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Our positive testing rate is averaging 7%, so we are still not testing enough. Private testing companies have started working to alleviate the laboratories. Yesterday we tested 30,176 – our highest testing day to date.

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This graphs shows the testing rate by city and in general. 

 


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Day 151:

Day 151 (July 20th) cumulative cases 52,354 (+1,855) with 419 deaths (+8 for the 3rd day in a row), 264 critical patients (+10) of which 78 are on a ventilator (+4). There are 29,652 active cases in Israel and 22,283 recovered patients. 

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The recovery rate is averaging 25% of the new case rate over the last week, but this is a vast improvement from the first week of July when the average was 13% or single-digit June.

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Jerusalem has double the number of active cases (4,638) from the next highest city (Bnei Brak with 2,327 active cases). The one week gains per city are still quite high (grey dots).

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we can see the real testing decline that has been going on for the last few days, leading to false low positive numbers over the weekend.

 


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Day 150:

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Day 150 (July 19th) total cumulative cases 50,493 (+1,008) – this “low” case number yesterday may be the Shabbat phenomenon (actually seen as weekend phenomenon around the world) whereby there is less testing and diagnosis on weekends. This is, however, a significantly lower Shabbat new case number compared to weekly data.

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Deaths 411 (+8) with 254 critical cases (+37 – highest jump this wave) and 74 ventilator cases (+19 also highest jump this wave).

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There are 28,336 active cases and 21,746 recovered cases.

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REALLY good news: mid June to early July we were doubling our average cases per day. Last week we reported that there was a slow down, but we can now see a significant slow down, which means we may be “flattening the curve”. We are getting more cases weekly but this last week we had an average of 18% more cases than last week. We were at 100% (doubling) more cases per week only 2-3 weeks ago.

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As you can see, there is a stabilization between the active and recovered cases, with death rates remaining stable overall.

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The testing rate remains high with a growing percentage of positive cases, peaking yesterday at 7.9%.

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Source: AllianceBernstein
Harvard GIH = Harvard Global Institute of Health Israel (ISR) has a 10.7% testing capacity, which is higher than most other countries. Iceland has the highest capacity at 35.2%.

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More good news: Another COVID unit has opened up in Jerusalem in St Joseph's hospital. The hospital has recently become popular for births among the haredi population, as they have the highest level kosher certification. We hope in the coming days we will see a reduced occupancy rate in Hadassah Ein Kerem COVID ward, reporting a 164% occupancy rate. Shaare Zedek is also over capacity at 108%.

 


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Day 149:

Total cases 49,481 (+1,437) deaths 403 (+8), critical cases 217 of which 55 are on ventilators. There are 27,776 active cases in Israel with 21,302 recovered cases. One week ago the recovered and active cases were equal, but the recovered cases are catching up as the people who got sick in early July (when the bigger surge began) start recuperating.

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Reasons for optimism: look at the delay of critical cases chart. You can clearly see that although our numbers are higher than last time, our ventilator use is greatly reduced. As being on a ventilator is the single greatest indicator of death rates, this is a huge accomplishment. We have to find the positive signs that things are improving, that there is an end to this wave (and of course the disease).

 
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City data shows an overall reduction of new cases in Ra’anana over the last week, but with high percentage case gains of 32-68% in all noted cities.

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The new cases diagnosed in the last week (for cities with over 100 new cases) we can see that Jerusalem by far remains the most active city, yet has the fewest COVID beds officially available. We urgently call on the MOH to open more COVID wards in Jerusalem. The red cities are considered highest risk, orange high risk, yellow – cities of concern regarding large local outbreaks.

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Testing in Israel – Israel’s positive rate is increasing, which indicates that much more testing is needed to capture any undiagnosed cases. How does Israel size up in testing compared to the world?

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This graph shows the number of tests performed per people in the country. Israel has performed one test for every 6 people in the population or tied for 3rd place of most tests per capita among countries with the same or more overall cases (removing the peripheral/extreme cases for statistical purposes and removing countries with poor reporting).

 


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Day 148:

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Day 148 (Friday 7/17/2020) total cases 48,041 (+1,595; Thursday’s numbers were raised to +1,930) of which 26,751 are active. Deaths 395 (+9), critical cases 213 with 56 people on ventilators.

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The ratio of recoverees per day and new cases has improved dramatically this week, but we have a long way to go yet.

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There are violent protests tonight in Tel Aviv and Jerusalem, with protesters using pepper spray against the police, arrests have been made.


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Day 147:

Day 147 (July 16th) Total cumulative cases in Israel 46,320 (+1,819) with 386 deaths (+7), 202 critical patients (-2) of which 58 (+3) of whom are on ventilators. There are 25,492 active cases in Israel (+1,486), which is double the rate of 11 days ago.

 

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Epidemiology: 6% of new COVID cases are in older adults (65+ years old). As we can see in the data from 2 days ago (sent Wednesday) – they remain the primary age of moderate, serious, and ventilated patients.

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This graph shows all hospitalized COVID patients (not including Hadassah, which is the only over-full COVID unit in the country) in the last month. Green= mild / Yellow = moderate / Red=critical / blue=ventilated. 5 mild and 2 moderate patients are children. No mild cases among the elderly are being hospitalized in COVID units (they may be in COVID hotels). 63% of critical cases are in adults aged 65+. Of these hospitalized patients (again not including Hadassah), 37 have recovered as indicated by testing, but their clinical picture has not recovered (see yesterday’s analysis) – 11 of them remain critical.

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This weekend, beginning 5pm Friday, Israel’s government has called for a lockdown as an interim step to avoiding the general lockdown planned for next weekend (which would presumably last for more than the weekend). The restrictions were voted on by the Cabinet and approved by MOH and National Security Council.

 


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Day 146:

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Total cumulative cases 44,408 (+1,780; on Tuesday +1,581). Deaths 379 ( +5) with 204 critical patients (+21) among which 55 are ventilated. 20,023 people have recovered (+320 – a significant uptick for recoveries- double the rate of 9 days ago). See notes below about symptoms after “recovery”.

 

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Note the uptick of recoveries - starting to catch up.

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In the first half of July, we have had 18,941 new cases of COVID in Israel. We have doubled our total cases in 21 days; doubled our active cases in 10 days.

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Outsourcing labs through My Heritage has led to an increased capacity for testing, although a new, faster method is being approved which will provide results in 15 minutes and further eliminate delays in getting results. My Heritage is taking the spillover labs from the kupot holim.

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The number of healthcare workers in quarantine seems to be stabilizing, with 2,886 people in quarantine.

 


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Day 145:

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total cumulative cases 42,619 (22,511 or 52.8% are active) with 374 total deaths (+7 and 0.88% of diagnosed cases). There are 183 critical cases (no change from the day before) and 57 ventilator patients (+3).

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Today we will discuss an anaylsis of raw data from the MOH (updated 7/9/2020. This includes: There is an average of 15 days between diagnosis and death (range from 0-106 days) with 124 people over 14 days

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Testing has broken the 30,000 mark for the first time, and the positive testing rate has gone down slightly (but we need to look at long term numbers before we decide the significance).

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Only 8/28 public hospitals who report to the MOH have a general occupancy under the 75% safety line (as designated by international standards and evidence-based medicine). 3 hospitals are filled beyond capacity. The can mean there are free beds in one ward, and people in the halls of another ward. This frequently happens in maternity wards during baby booms. In the winter, hospitals can be filled up to 200% capacity.

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An Apple news article discussed what I have discussed and published in a prestigious international epidemiology report on June 1st – that this second wave began with the disorder that occurred when middle and high schools were opened with no implementation plan, no enforcement plan, and little preparation or coordination between the Ministry of Health and Ministry of Education and a complete disregard for the capsules suggested by the MOH.

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Amnesty International’s analysis has shown that over 3000 health workers have lost their lives due to COVID-19 during the pandemic – a figure that is likely to be a major underestimate given a lack of reporting - and many others have worked in unsafe environments due to shortages in personal protective equipment (PPE). They have further faced reprisals from the authorities and their employers for raising safety concerns, including arrests and dismissals, and even in some cases been subjected to violence and stigma from members of the public. (Amnesty International; ProMed)

 


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Day 144:

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Total cumulative cases 40,981 (+1,681 – highest single-day increase) with 367 deaths (+3), 183 critical cases (+32 – biggest single-day jump this wave) with 54 people on ventilators (+7).

The number of active cases and the deaths in Israel.This is an analysis of the daily average in certain cities in Israe.

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Overall case fatality rate is falling - currently 0.9%

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The recovered cases are starting to uptick (discussed in video) which is a good sign, but mostly indicated that the younger people who got sick early in this wave are recovering.

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Day 142:

Day 142 (July 11th) Total cumulative cases: 38,015 (+1,148 all this week’s numbers have been adjusted and continue to be adjusted for days afterwards due to straggling reporting by the overwhelmed kupot labs. Yesterday’s new cases numbered 1,406). Deaths 357 (+4) with 134 critical cases (+4) of which 49 (+7) are ventilator patients.

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With 18,878 recovered cases and 18,780 active cases – we have now crossed the line of 50% all of cases since February – are now active cases. Our case fatality rate remains low at 0.94%.

 
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We posted this in April when we had many fewer people in these groups, but it’s a good reminder to know the timelines of this disease and why the deaths and critical cases and ventilator cases are so delayed.

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The labs, according to the Kupot Holim, are about to collapse under the weight and pressure of so many tests. More efficient methods of mass testing must be utilized in labs. The technology exists, as invented in the Weitzman Institute, but have not been implemented nation-wide. These systems would allow faster, reliable PCR testing of 80,000 samples at once or per day. The government must also open private labs to outsource testing to spread the burden out to other personnel. This was suggested by MK Naftali Bennett in his 15-point plan for COVID, but as a member of the opposition, it was waylaid. The current government tends to not follow good advice unless there is some benefit to those in power (commenting on a continuing trend, not meant to be political statement).

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(previous chart was unclear) This shows the trend of growth in July (11 days) and in the last 2 days.

 


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Day 141:

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Day 141 (July 10th) Total cumulative cases 36,821 (+1,360) with 17,784 active cases sand 18,684 recovered cases (50.2%). In the next 1-2 days our active cases will exceed our recovered cases. With 6,698 new cases in the last 5 days (average of 1,340 daily) we are averaging nearly double the new case rate as the peak of the first wave.

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There are 130 critical cases (doubled from 10 days ago) and 49 ventilator patients (doubled from 11 days ago). At the rate we are increasing our cases (averaging 5% daily)- we will double our case numbers in 13 days. As it is, we have doubled our cumulative cases in 1 month.

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New daily cases

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Selected city assessment shows how cases have jumped in July, and this has had an impact in a few areas in particular. Over the weekend, the COVID wards in some hospitals have significantly increased their patient load. New Corona units are opening, and others are expanding operations in preparation for more critical patients. New corona hotels are opening to care for people who cannot quarantine at home and mildly ill patients who need some care.

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Our concern at the moment is Jerusalem. With 4 general hospitals (Shaare Zedek, Hadassah Ein Kerem, Hadassah Mt Scopus, Al Makasad) and several specialty hospitals – and the highest rate of active cases in the country (2,548 of which 1,197 were diagnosed this week) there is a need to boost capacity for critical patients. Hadassah Ein Kerem already has more patients than capacity, so the MOH must open Mt Scopus and other facilities for COVID care. Suggestions to use the military are excellent, as they have tremendous management teams, medical personnel, and logistic support that can build new unit quickly and staff them. The Prime Minister thus far has resisted using the military for COVID support.

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Nationally, the general occupancy level at hospitals has decreased. Many medical personnel have also come out of quarantine, so those numbers that were increasing by 100+ daily are starting to stabilize.

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Regulation news: MOH announced changes regarding the epidemiology investigations for confirmed cases:

1) If it is known when symptoms began, contacts will be traced back 4 days from when symptoms start. 2) If it is unknown when symptoms began, contacts will be traced back 10 days from getting positive results. 3) If someone is asymptomatic, contacts will be traced back 7 days from getting positive results. These guidelines will necessitate less people to be quarantined. The cost of possibly missing contacts is worth the benefit, according to (soon to be retired) Professor Sigal Sadecki (head of public health/epidemiology for the MOH). (Source: YisraelHayom)

 


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Day 140:

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Day 140 (July 10th) Israel had the worse day on record with a cumulative 35,368 (+ 1,464) cases. Deaths 349 (+3) critical cases 112 (+9 and doubling every 8 days) of which 39 are on ventilators.

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The ventilator rate remains relatively lower than last wave (see delay of critical cases chart) , and this is being seen in other countries as well. We don’t know if this is a new trend but if so it is attributed to a few things: 1) This wave is affecting younger people more, who are significantly less likely to have serious symptoms or require ventilation. 2) Our institutionalized elderly are better protected. In Israel this is included in the special “Magen Avot” program which include protocols. 3) There are treatments that are working better – last wave we were throwing darts scrambling to figure out what worked or not (treatments shown to work include antivirals, steroids, serum from recovered people, closer monitoring of saturations, and delayed ventilation. 4) Maybe - the virus is reacting differently to environmental changes (absolute speculation. We know the virus likes air conditioning and doesn’t mind the heat, but it is killed with extensive ultraviolet light exposure). 5) This wave is young and we will have further delayed ventilation cases.

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There is no doubt the number of ventilator cases will increase, but as of now it is not in the same proportion as last time. Ventilator cases are directly related to higher death rates and more significant long term adverse effects, so we are monitoring this number carefully.

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The * cities are in partial closure.

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Cities with 100 active cases or more (red is locked down), pink partial lock down (part list), yellow - under advisement.

 


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Day 139:

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Day 139 (July 8th) Total cumulative cases 33,786 (+1,231). Testing and case numbers are being adjusted retroactively which can happen with different reporting schedules, problems with tests and other factors. The adjustments are usually minor, but we like exact information.

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Critical cases 113 (+11 and double from 8 days ago). Ventilator cases 39 (+5) or about 1/3 of critical cases. 18,361 people have recovered (+112 or less than 10% of new cases – making the case load increase dramatically). Current active cases 15,079 (doubled from 9 days ago).

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Israel has now surpassed Switzerland and Afghanistan in total cases, we are now 44th highest case numbers in the world of nations (we were 50th).

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31 cities with over 100 active cases in Israel. Based on rise in active cases and concentration of active cases in cities/neighborhoods, several other cities/neighborhoods may be shut down in the coming days.

 


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Day 138:

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Total cumulative cases (adjusted twice already, and yesterday’s numbers we also adjusted twice): 32,516 (+1320. Yesterday there were +1128 new cases). Deaths 342 (+5, yesterday there were 6 deaths) 92 critical cases ( (double the rate of 2 weeks ago; this has gone up again today) with 34 ventilator patients.

 
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Recovered cases 18,249 or 56.1% of all cases. A vast majority of all new cases do not include the hot zones/ hot spots – indicating that the closures have stopped major spread in those areas, but most cases are now spread throughout the country.

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At the current rate of increase daily, we will double our active case numbers within 9 days.

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The national positive testing rate is climbing, currently 5.1%, which is high (see yesterdays report). There are 2465 health professionals in quarantine, or double the rate from 10 days ago. With expected staffing shortages this is a significant consideration.

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The MOH is preparing to reduce routine health services in hospitals (as we discussed earlier this week) as the delay in critical cases (see above) is going to lead to much higher ICU and ventilator rates even with the current restrictions that were too late to prevent these surges.

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States with highest rate of new cases include Florida, Arizona, Georgia, Texas, Louisiana, and California (orange line is what's going on NOW, blue line is the results of the "first wave" in the US that did not leave but shifted to other states.

 


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Day 137:

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Total Cumulative cases (Monday July 6th ) 31,137 (+1,076) with 336 deaths (+335). There are 88 (+2)critical patients (doubled in 8 days and highest level in 62 days!) of which there are 35 ventilator patients (+5 and highest level in 35 days).

Here are some of the cities that are infected 

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The increasing critical cases and ventilator cases is the most critical indicator of how the system will cope with the expected increases. The restrictions imposed yesterday will not have an impact on overall numbers for 2 weeks or so, but it wont impact critical cases, ventilators, and deaths for 4-7 weeks. So those designated to become critically ill, ventilated, or die – will not be saved from cases that are already ongoing or soon to be ongoing. These restrictions will save lives undoubtedly but it is likely too late for the small percentage of the 12,749 current active cases in Israel who are destined to have one or more of those outcomes.

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We gained 1,076 cases and 78 people have recovered on this day – so we have a net GAIN of cases of 998. The concern with this discrepancy is – will our health system be able to manage the upcoming critical cases?

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This is why we have been monitoring hospital occupancy rates throughout the country. Medical studies (internationally) have shown that occupancy over 75% in a hospital leads to increasing errors, infections, and higher mortality rates. Of the major hospitals in populous regions – nearly all are over 75% occupancy currently. Although COVID wards are not more than 40% occupied at the moment (average open COVID floor has 18.7% occupancy rate – and other wards will be opened), we must remember that COVID wards require a huge amount of personnel and resources that are pulled from other parts of the hospital. So ventilators are transferred from regular ICU to COVID unit. ICU staff are pulled out and replaced by less experienced staff, which also leads to problems, but often they are not fully replaced because there are medical and nursing shortages in Israel. Lack of staff logically leads to lower level of care and treatment for non-COVID patients.

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As it is, hospitals are restricting accompaniment to ER or hospitals – so the normal means of getting medical attention for loved ones in hospital are limited to the patient himself (and in some cases a caregiver). As resources become tight, elective (non-urgent) medical care will be limited or restricted. This includes scheduled surgeries, routine procedures, and tests, consultations. As it is, the system is still playing catch up for canceled appointments from the lockdown.

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The CFR (case fatality rate) international chart includes countries with same or more cases than Israel but excludes countries with poor reporting/ resources where there are reported inaccurate reports.

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CFR is not terribly accurate (but we lack other indicators) as there are reportedly a large percentage of undiagnosed cases. If there were 50% unreported cases, the CFR would be half the rate. The true death rate is called the infection fatality rate, which is deaths from ALL infections - but we will not have this information for possibly years. I consider CFR as a way to understand how countries are managing their sick. As we can see from Brazil - there are different strains of COVID and this can affect fatalities as well.

 

 


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Day 135:

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Day 135 (July 4th) Total cumulative cases 29,236 (+803). Critical cases 84 (+7) – the highest level in 60 days with 32 ventilator patients (+4) (highest level in 35 days). Our critical cases have doubled over the last 8 days – indicating that we are not only exponentially growing in terms of overall infected people, but our critical cases are now growing at an exponential rate, which may lead to a health care resource crisis (as it has in many other countries).

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There are 11,024 active cases (double the active cases from 11 days ago) in Israel and 17,847 cases have recovered, or 60.8% of all cases.

 
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Of the tests done in the last few days, we are seeing higher percentages of positive tests, meaning more people who qualify for testing (with symptoms or exposures) are actually positive. We are currently at 4.9% positive test rate.

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we can clearly see the exponential growth angle here...

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Hydroxychloroquine is back in the news with a large, peer-reviewed published study in the International Journal of Infectious Diseases. The study was done in the Henry Ford Health System, which covers large areas and multiple hospitals in Southeast Michigan. The study included 2,541 hospitalized patients given different combinations of hydoxychloroquine and azithromycin (both, one drug, or no drug) and results seem promising (just weeks after the WHO and CDC and NIH discontinued studies with these drug combinations). Results showed a 66-71% decreased overall mortality rate for people in the hydrochloroquine or combined drug group compared to neither treatment. Predictors for mortality included people over 65years old, white race, chronic kidney disease, and reduced oxygen levels on admission to the hospital (which means that the disease had been silently destroying the lungs well before the patient had symptoms), and ventilator use during their hospitalization.

 

 


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Day 134:

Israel total cumulative cases was 25,427 with 936 new cases reported (after adjustments today).

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As Israel will adjust the numbers in the morning for shabbat, we will report then, although we know there are usually less reported cases for shabbat because less people get tested and/or less tests get processed. As of reporting time we have had 737 new cases today, but this is not final.

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Another thing we note: critical cases are now double what they were 6 days ago – currently 84 and we are now seeing an increase in the ventilator patients – 32 which is the highest in the last 35 days.

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Several ultra-orthodox/Haredi rabbinical leaders have put out string statements about the need to report symptoms, get testing, wear masks, and follow the ministry of health guidelines, calling it a mitzvah to do and a sin to violate the regulations.

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In Jerusalem the number of active cases has doubled in the last week, although this number is not published by the MOH. There were as of Thursday 991 active cases with 487 diagnosed this last week. The cases are mostly being reported in Haredi and Arab neighborhoods. 32% of these cases are in young people ages 0-19, 35% ages 20-39, 21% ages 40-59 and 12% in people aged 60+. Most worrying, the reproductive rate in Haredi neighborhoods is 4, compared to 1.5 for the city as a whole. 37% of all city cases are in these neighborhoods, mostly spreading within families. Arab neighborhoods have about half of that rate. As noted in the previous wave where Haredi neighborhoods were hit particularly hard, as poor overcrowded living conditions prevents appropriate quarantine for even the most well-meaning families. The government is opening more Corona and quarantine hotels to limit the spread of this disease, particularly in these neighborhoods. (Source: IsraelHayom)

 


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Day 133:

Israel adjusted cumulative cases 24,491 (+1,107 ) Deaths 325 (+3 ). Israel has 9,618 active cases as of midnight (double the number of active cases 12 days ago). There are 65 critical patients in Israel, which is 34% more than a week ago and 40% more than 2 weeks ago. There are currently 27 (+3) ventilator patients in Israel.

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Israel is now adjusting the pervious days numbers in the morning so they account for all changes by midnight to keep the numbers consistent and reported at the same time. We will continue our morning reports because of this, as the night numbers are no longer accurate.

 
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Israel is now adjusting the pervious days numbers in the morning so they account for all changes by midnight to keep the numbers consistent and reported at the same time. We will continue our morning reports because of this, as the night numbers are no longer accurate. A total of 64.9% of all patients have recovered. This is down from our high of 87% recovery rate on May 27th. New cases diagnosed in this second wave, which now exceeds the first wave, are recovering but this is a slow process of up to 7 weeks. The roughly 1,000 new cases daily will stay in our “active patients” list for many weeks. 

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Of our resolved cases, please note that 1.2% have died (That is our case fatality rate).

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The percentage is the percentage of new cases this week compared to total cases in the city.

 


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Day 132:

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Day 132 – (July 1) Israel total cumulative cases 26,355 (+966) with 8,581 active cases. We have doubled our active case load in 14 days. We are on our way to doubling our total case number within 21 days. Very much the “exponential growth” we all fear. 868 new cases is higher than our first wave and is now inline with many countries in Europe that we have been monitoring. Including Sweden (who has a similar population to Israel) and the UK. Again – we expect this wave to be slower, longer, and not going away anytime soon. A few weeks ago Israel was removed from the “safe travel list” of Europe, but there is consideration to make us a “red country” which will further impede any attempt to normalize tourism.

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There have been 322 deaths (+2) with a case fatality rate of 1.22%. Our critical cases have started spiking with 57 (+5) (2 days ago there were 43). Yet ventilator patients remain stable at 24 (we discussed this yesterday). The number of moderate patients (who cannot stay home or stay in “corona hotels”) has also been steadily climbing.

 
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The 1,591 quarantined medical personnel include about 1.3% of actively working nurses nationally. We have discussed nursing shortages and medical shortages before. This will have an impact as more critical case begin to come in.
Hospitals with highest occupancy rates: Hadassah Ein Kerem (109%) with 103 quarantined personnel; Rambam Haifa (90%); Hillel Yaffe (83.9%); Sheba (97.3%) and 114 quarantined personnel; Shaare Zedek (95.7%); Sourasky Ichilov (107%) with 102 quarantined personnel; Kaplan (98%); Scottish hospital (118%); Rabin Beilinson (96.4%); Naharia (86.9%); Schneider (84.4%); Holy Family Nazareth (148%); Hadassah Mt Scopus (89%);

 


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Day 131: 

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Day 130 Total Cumulative cases in Israel 24,441 (+686) deaths 319 (+1) Active cases 6,904. Recovered cases 17,218 (+144) with 43 critical and 24 ventilator patients.

This is how the new wave is effecting different age groups 

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more false number reporting today by various media outlets who do not read the instructions on interpreting the epidemiological data. beware of sensationalist headings- usually corrected the next day on page 10. Our Case Fatality Rate is currently 1.31% with 70.4% of total patients recovered.

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We note that we are 1 month into the second wave. Although serious cases and moderate cases have risen, ventilator cases have not. This indicates that this wave may be virulent, perhaps more than the first wave, but may not be as deadly. We shall hope and pray.

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New cases in the last 2 days and since the second wave began - looking at populations affected (by age group)

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New cases. The Ministry of Education pledges to keep schools open for younger students over the summer. although the 0-9 population is approximately 18% of the population, they consist of 7.5% of all COVID cases.

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City by city analysis - the grey line indicates the percentage of new cases in the last week. Ashdod is doing poorly, yet are not yet in quarantine (48.3% gain), followed by Tel Aviv (18.3% gain). Is it the beaches? We do not know where these cases are and where they were spread (see below about staffing shortages).

 


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Day 130:

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Day 130 Total Cumulative cases in Israel 24,441 (+686) deaths 319 (+1) Active cases 6,904. Recovered cases 17,218 (+144) with 43 critical and 24 ventilator patients.

This shows how the new wave effects different age groups. 

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(more false number reporting today by various media outlets who do not read the instructions on interpreting the epidemiological data. beware of sensationalist headings- usually corrected the next day on page 10). 

Our Case Fatality Rate is currently 1.31% with 70.4% of total patients recovered.

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We note that we are 1 month into the second wave. Although serious cases and moderate cases have risen, ventilator cases have not. This indicates that this wave may be virulent, perhaps more than the first wave, but may not be as deadly. We shall hope and pray.

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New cases in the last 2 days and since the second wave began - looking at populations affected (by age group)

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New cases. The Ministry of Education pledges to keep schools open for younger students over the summer. although the 0-9 population is approximately 18% of the population, they consist of 7.5% of all COVID cases.

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City by city analysis - the grey line indicates the percentage of new cases in the last week. Ashdod is doing poorly, yet are not yet in quarantine (48.3% gain), followed by Tel Aviv (18.3% gain). Is it the beaches? We do not know where these cases are and where they were spread (see below about staffing shortages).

 


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Day 129:

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Day 129 – Israel total cumulative case number 23,755 (+334 ) Israel is now 50th ranked country in the world for total COVID-19 cases, with Bahrain, Armenia, and Nigeria surpassing us in the last week.

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Our weekly averages have risen to the same point we were 3 months ago. This second wave is slower moving but will last longer and potentially peak higher without significant interventions (which will not be forthcoming due to economic factors).

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Deaths 318 (+1 today) with 39 critical (earlier today it was 44) and 22 ventilated patients. There are 6,363 active patients in Israel. 17,074 patients have recovered (see notes below about “recovery”).

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Higher positive percentage is not because we are testing more, because testing rates have remained the same (except the very slowest weeks). It means we need to test more to capture all of the cases - our case load is higher and MOST people with direct exposures or symptoms do not have COVID, but MORE do than previously percentage-wise. We want the positive test numbers to be diluted to 0.3% again.

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As you can see, CFR rates are very low in Asia (and no, most countries are not falsifying their numbers like China). Although there are some countries listed with poor resources, which limits accurate testing capabilities, it gives us an overview of a very different picture than Europe. In Europe’s analysis we have removed countries with less than 1 million citizens. Countries included have similar or more total cases as Israel.

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European and Asian nations have faced similar ranges of cases but the case fatality rates are very different. In Asia, average CFR is 2.12%, while in Europe the average CFR is 6.06%. In Africa, South Africa is the hardest hit country, but reports from many other countries indicate that testing and reporting are limited due to unrest, poverty, lack of resources. The WHO is working on projects to improve health access for developing countries, but it is unlikely we will see significant progress during this pandemic.

 


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Day 128:

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Day 128 Israel cumulative cases 23,421 (+621 today, +400 yesterday). Highest increase in daily cases in 85 days (April 3rd). Deaths 317 (+3 today, +5 yesterday). A 19-year-old woman with pre-existing conditions (cardiac and obesity) dies on Shabbat, efforts to resuscitate her resulted in several medical personnel from Hadassah Medical Center (Ein Kerem) going into quarantine due to exposure to her high viral count. Recovered cases 17,002 (+413 today, +582 yesterday).

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The uptick in recovered cases is likely due to the significant increase in cases we started seeing 3 weeks ago. Due to the flood of new cases, our recovered rate is now 72.5% of all cases compared to 87% on May 30th.

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Israel has 41 critical patients of which 23 are on ventilators. Only 1.6% of current active cases are critical or moderate, with the rest considered mild cases. There are currently 1,213 medical staff in quarantine.

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The biggest percentage of new cases in cities seems to be in Ashdod, with a 35% increase of total cases in the last week. Tel Aviv was at a 14% increase, Petach Tikva 11.5%, Jerusalem 7.7%.

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Total world cases now exceed 10 million with 500,000 deaths (5% Case Fatality Rate). There is growing concern over a major resurgence in Europe, which has already begun in 30 countries that have re-opened their economies. In 11 countries the significant resurgence that “if left unchecked, will push health systems to the brink once again in Europe.” (source: WHO Regional director for Europe). The WHO has praised Israel, Poland, Germany, and Spain for early interventions to lessen the impact of the resurgence of COVID (in Israel they are talking about school closures and local closures to prevent local spread in hot spots). 27 European countries now use digital contact tracing to improve communication with contacts of sick people.

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The UK is reopening the economy on July 4th, so they have not yet seen a resurgence, although they are the hardest hit European country with 310,250 cases and 43,500 deaths to date. In the US, Florida had 9,585 new cases today alone, bringing the total to 132,545 cases with 3,392 deaths. Texas (+4,408), California (+3,627), and Arizona (+3,593) were among the hardest hit states in recent days. New York (+809) and New Jersey (+286) have seen a slow down of cases in recent weeks, with NJ the 29th highest new case number in the USA today.

 


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Day 126:

Day 126. Total cumulative cases 22.400 (+356 new today). There are 309 deaths (+1) and 47 critical cases (+1) of which 29 are ventilated (+1). Israel did not release numbers this evening- we will provide an update in the morning. The Ministry of Health has stated that they are short-staffed in their epidemiology department which is creating the lag of information and inconsistent reporting times.

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Be wary of sensational headlines in the press with daily numbers – the numbers they gather are being collected in an irregular way, which leads to misleading higher figures. For example, if numbers at 1 pm are 200; 7 pm is +100; midnight is +250, and 11 am (next day) +150 the headlines mayday “701 new cases in a day” because they are double-counting the +150 because of the timing of the release of numbers. In this group, we try to give you a full day’s picture at the same time daily (with some sleep deprivation). The MOH has admitted being short-staffed in their epidemiology department so they are unable to maintain regularly scheduled number releases.

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16,007 recovered cases (71.5%) +67 compared to +356 new cases create the widening gap. There are 6,084 active cases in Israel or double our active case count from 15 days ago.

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We can see the upslope of critical cases starting, although ventilator cases have remained relatively stable (they are a more delayed factor).  News: After exposure to COVID in the ER, an additional 22 medical staff were placed in quarantine. There is currently 1,190 medical staff in quarantine in Israel. Hospitals with the highest rates of staff quarantine: Sourasky Ichilov (114), Rambam (Haifa) 73, Soroka (Beer Sheva) 42. Rabin (Beilinson, Petach Tikva) 44.

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The restrictions on Arara are continued for another week. Additionally, 3 neighborhoods in Ashdod are restricted with school closures and gatherings limited to 10 people. Bat Yam – grades 5 and over are closed, gatherings limited to 10 people. More stringencies at weddings and other areas (Read: inspections). Rahat and the Aj’mi neighborhood in Yafo (Jaffa) – the restrictions are lifted with more vigilance (read: more tickets to non-compliant people/businesses).

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False Negative tests: Study in the Annals of Internal Medicine: Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% to 20% on day 8 (3 days after symptom onset) then began to increase again, to 66% on day 21.

pic 6 a reminder 
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News about countries opening up borders for tourism: Spain is opening its borders to Portugal and France on July 1st. Czechs can enter Austria, not vice versa. Italy open to Austrians, but not vice versa. At the same time, Germany and Portugal reimpose localized restrictions. See below for the slight indicator of Germany's uptick in cases, for which they are showing aggressive countermeasures.

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Sweden is currently in another upswing of COVID.

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Emphasizing PM Johnson: “The virus’… only ambition is to exploit any opportunities to recapture any ground that we may carelessly vacate and re-infect our communities.”


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Day 125:

  

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Day 125 total cumulative cases 22,044 (+532 today – worst increase in 55 days) with 308 deaths (0 today). There has been a 1 day 15% spike in critical patients with 46 (+6) and 28 ventilator patients (+1). Total active patients 5,520 (3.5% increase since yesterday). We continue to double our active patient numbers every 16 days, but we expect this to narrow as cases surge.

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Deaths have remained stable, although this is always a delayed measure in COVID.

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Since 5/27 we have had 4,975 new cases in Israel, or 29.6% increase in total cases from that date. Since 5/28 we have had a 289% increase in active cases in Israel. In which populations are the cases currently spreading?

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This chart reflects the changes since 5/27 and also the trends of the last 2 days. Even though the numbers appear small for the older population, we have significant concerns about the turning trend for older adults.

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This shows the percentage of change from 5/27 per population and the % of cases in each age group in the last 2 days. This chart also shows the raw data (grey line) of cases in the last 2 days. Since 5/27 the 90+ age group has had a 0.45% increase in cases, but they represent 0.92% of all cases in the last 2 days – showing a potential trend that can endanger this frail population. Higher trends are reported in all populations with the exception of young people ages 0-19 and 40-49-year-olds. The drop in children’s numbers indicates that the initial school wave is ending, and the spread within school-age populations has decreased substantially, the disease is now spreading in communities among adults of nearly all ages.

 pic 7  Top cities with active cases
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International News: Saudi Arabia, with the 2 holiest Muslim cities of Mecca and Medina, normally host a 2 million person strong pilgrimage “Hajj” annually. This year, the Hajj is supposed to take place at the end of July. With 167.267 cases (over 3,000 new today) and over 1,300 deaths, the government of Saudi Arabia announced today that it will be limiting the Hajj to include representative Muslim populations of no more than a few thousand people this year. Saudi Arabia is the largest Arab country and has been hit hardest with COVID after Turkey (Iran and Pakistan are not Arab countries).

 

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Florida's cases are surging with 5,511 cases today alone. Texas has 4,956 new cases and California has 2,960 new cases today. As death rates lag weeks behind, we expect to see fatality rates rise in these affected states within a few weeks, unfortunately.


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Day 124:

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Day 124 Total Israel cumulative cases 21,512 (+430 today!). This is double the average number of new cases from 8-10 days ago.

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Deaths 308 (+1) with a 1.43% Case Fatality Rate (CFR) which is defined as deaths in identified cases. World Average CFR is 5.13%, so Israel is still doing well relative to the rest of the world in this respect. There are 40 critical cases (-40) of which 27 (-2) are on ventilators. It is still too early to see how this current upsurge in cases will affect the critical cases, ventilators, and deaths, as these figures are delayed indicators as you can see below.

 
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Critical cases start surging 2-3 weeks later with ventilator cases following within a week or so, although cases can languish for up to 7 weeks and some people require repeated or extensive intensive care stays during their illness. The slight rise in critical cases you can see in this chart is from the initial “school outbreak” of 2-4 weeks ago. Although we are still having reverberating cases from the school outbreaks, the spread of COVID is currently too widespread to contain at this point.

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Recoveries are delayed 2-6 weeks, with 3-4 average. The retesting policy in Israel is able to convert people to “recovered” within 2 weeks (which covers some but not most cases), with follow up tests every week or two. The “automatic recovery” time is 4 weeks after initial diagnosis for people who have had mild to no symptoms. Even without a test, these people are considered recovered and can come out of quarantine.

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The Ministry of Health (MOH) has imposed a lockdown on several neighborhoods in Tiveria (Tiberius) and the city of Elad. Restrictions include an entry for residents of those areas only and exit for people going to work or taking matriculation exams (Bagrut). Lockdown is in place from tomorrow at 8 am for 7 days. MOH reporting city data is not consistent with these strictures, making us realize that the MOH is not releasing real-time numbers. We estimate data is 2 days old based on total active case numbers. The MOH is also not being transparent in the DAILY positive tests per city, but rather giving 3-day percentages and total case numbers (since February – which tells us nothing about the status quo), testing rates, and the percentage of the population who have had positive tests.

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The number of medical personnel in quarantine has been going up by about 100 cases every 3-4 days (currently over 1,000). Tel Aviv Sourasky Medical Center (Ichilov) had the 2 major exposures from their personnel being non-compliant with the regulations (discussed last week), but currently 1% of actively working nurses are quarantined nationally. In normal circumstances, Israel has one of the lowest percentages of nurses per population in the developed world. Severe shortages are to be expected, since we are in a continuous state of nursing shortages as a baseline.


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Day 123:

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Israel's total cumulative cases 21,082 (+307 since yesterday).

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Deaths 307 (+1 today) with 44 critical patients (+4 today) of which 29 are ventilated (+1 today). These are all delayed indicators of COVID activity.

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We can see the activity increasing, but we can now see an increase in critical patients steadily in the last 2 weeks, which correlates with this outbreak. This means that even though most of the people catching COVID at this stage are under 70 years old, there are still people developing critical illness. In the interview with Dr. Jonathan Marcus (last week – see video) he discussed how in his experience, as head of the largest COVID unit in South Florida, 80% of ICU (critical) patients end up on a ventilator, out of which 80% die eventually (people can be on ventilators for weeks before succumbing to the disease). So out of 100 critical care patients, 64 will die. See previous discussions about rehabilitation post-COVID for survivors.

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Assessing this new wave by age groups show that most cases are 10-64 years old with only 7% of cases in the highest risk group of 70+ years old.

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In the last 3 days, the highest number of new cases were 10-19 years old (19%) followed by 20-29 and 30-39 year olds (16% each). Only 1 COVID case in a 90+ year old woman.

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In the last 6 days, the fastest growing case loads are in Ashdod (12.2%, followed by Petach Tikva (9.3%) and Tel Aviv (7.3%). Higher numbers were reported in Jerusalem and Bnei brak have had over 100 new diagnoses in the last 6 days. Beit Shemesh had only 7 new cases in 6 days, or a 1.2% growth. Jerusalem and Bnei Brak were epicenters of the last wave, and have among the highest risk populations in the country – with overcrowded poor living conditions. Good news is there are several campaigns in ultra-orthodox communities to improve mask wearing compliance. Driving through these communities one can see that the majority of people wear masks. The living conditions is not solvable by masks, and therefore the population remains a significant risk.

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Although Switzerland has more overall cases, they have kept their low COVID numbers since their surge, with less than 100 new daily cases for 51 days. The recovery rate is 92.6% of all cases with a case fatality rate of 6.2%, which is higher than the world average.

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Overall epidemiology chart looks good, but when examined more closely we can see that Switzerland is languishing with daily new cases and increasing numbers, albeit slowly. This is where Israel could have been if not for the new wave we are in.

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5 days ago Sweden stopped publicly reporting case numbers, new cases, deaths, or any other numbers. This is rare in a democracy and may be related to fears about other countries not admitting Swedish travelers and Sweden being considered a “red zone” by other EU countries. The non-transparency is only going to make things worse for Sweden, as there is significant distrust and misinformation or cover-ups going on for a democratic country. The UK and Netherlands are also not reporting accurately regarding the information people need in order to make decisions about their health risks. This includes the accurate number of recovered cases and active cases by region. In the US, many states are not providing the county-by-county rates of active infection so people can determine how safe it is to leave their homes.

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OVERALL – world cases are rising exponentially but deaths are stabilizing – which can be explained by the lack of accurate reporting in poor countries currently being affected (remember that the first spring wave hit mostly Western, developed countries) or by climate conditions (Northern Hemisphere summer) or by mutations. (source: worldometer)

 


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Day 122:

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Israel cumulative cases 20,778 (145 new). Every weekend we see a dip in tests and diagnoses – very common in many countries. We expect a rebound by Monday/Tuesday. Only 6,012 tests were performed on Shabbat compared to an average of 15,300 daily tests that happened during this past weekday week. Tests are taking less time to process – 1-2 days on average.

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Deaths 306 (1 new), 40 critical cases with 28 ventilator patients. There are 4,778 active patients in Israel, or double the number we had 16 days ago. 98% of all cases are considered mild, with people remaining at home or in quarantine hotels.

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You can see the subtle rise of critical cases, where we had been in a descent for 2 months. Critical cases, ventilators, and even deaths lag behind rising active case numbers.

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Our weekly averages have more than doubled the rate in the last 2 weeks. The rise of cases indicated a longer, slower epidemiology curve than the previous one. As you can see, we nearly quadrupled the new case numbers within two one-week periods of 3/23-3/29 through 3/30-4/5.

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We can also see that trend here looking at the day-by-day figures.


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Day 121:

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Day 121 Total Cumulative cases in Israel 20,633 (294 new today, 303 new yesterday). 305 deaths (1 new today, 1 yesterday). Israel’s case fatality rate is 1.48%. Critical cases - 40, of which 27 are on ventilators. 15,659 people have recovered, or 75.9% of all cases. There are currently 4,668 active cases in Israel, double the number 16 days ago.

 
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In this chart you can see which populations were most affected by this new wave in Israel. In the last 2 days, there has been increased cases in all populations, especially in 10-39 year olds.

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Tel Aviv gained almost 1% new cases today with 10.55% increased cases in the last 6 days. Ashdod has had a 11.40% increase in the same period, while Jerusalem, Bnei Brak, Modiin Ilit had less than 4% increase each.

 


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Day 119:

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Day 119 Israel Cumulative Cases 20,036 (253 new). Active cases 4,201, or double the number from 16 days ago.

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This shows a 2+ week delay between surges of cases and when patients become critical and require ventilators. We are starting to slowly see a trend towards an increase in critical cases. Since this epidemiology curve is flatter than the first one, the affect of rises in cases are also more subtle.

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So cultural events are opening up next week, meaning that all sectors of the economy are now open to a degree. PM Netanyahu says no more will be open until the outbreak/surge is under better management. He is not talking about economy sectors, but rather the limitations currently in place for the different sectors. Such as the percentage of capacity for restaurants, transit, pools, and other commercial spaces.


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Day 118:

Day 118 Israel cumulative cases 19,783 (288 new) out of which there were 303 deaths (1 new) and 15,487 people who recovered. There are currently 3,993 active cases in Israel. Our active case count doubled in 18 days.

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This curve is less of a sharp spike, likely due to measures in place that continue to mitigate disease development. But the fact that we have this wave at all is a tribute to non-compliance.

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Raising the number of tests, widening the scope of who gets tested is a positive thing. When there is an absence of disease this will lead to a dilution of positive numbers in the community. When there is an increase in testing AND an increase in positive numbers, that means the community is experiencing more cases, or there is an outbreak.

 


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Day 117:

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This is a view of the entire pandemic in Israel - total cases (blue line) is supposed to flatline, as it briefly (almost) did last month. The grey line should continue rising until it is at the blue line less the number of deaths. The orange line - active cases - is supposed to look like a "bell curve" - but as we can see it is going back up again.

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Critical cases: 39 (4 new - this has been slowly rising over the last 9 days... we are in the "danger zone" of new critical cases from the beginning of this outbreak/wave - 20 days). Deaths 302 (0 new). Active cases 3,744.

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The recovered case count has slowed down (34 today) while new cases continue to rise, so the disparity between the new (incoming) cases and recovered (outgoing) cases is widening, indicating a larger scale problem.

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When looking at Case resolution as a percentage of the total cases, we can see that the percentage of active cases is not rising, shrinking our recovered percentage to 79.2% - less than 80% for the first time in 29 days.

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Clearer picture of our active case numbers. While this curve has a slower trajectory than the original (because we have already implemented rules even if not being followed by many) - it is nonetheless now looking like it is inevitable that we will have a significant case count this time around and we have failed to stop it. 

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This does not include countries who are extremely poor and unable to test/ report accurately. Otherwise all countries with similar or more cases as Israel is represented here. The tests per million tells us if widespread testing is going on, which has a better chance at finding more cases, especially the asymptomatic or pre-symptomatic cases.

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Here is the case fatality rate (CFR) for these same countries. France has a very low test rate per million people. Although the UK has the most deaths in Europe - when calculated as a percentage of cumulative COVID cases, France is the worst worldwide. There are also different strains/mutations of this virus out there. Some are more deadly than others. In Arab countries the fatality rate is very low, even with countries with significant case loads such as Saudi Arabia and Qatar. Interestingly, these are among the countries most affected by MERS (another coronavirus) annually - is there some immunity in the population or is this a less fatal strain of the virus?


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Day 116:

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Total cumulative cases in Israel: 19,237 (182 new- the post-shabbat bump we seem to get every week - but many countries have weekly waves with people less likely to get tested on weekends

Here is our epidemiology curve as measured by new cases per day. Whether this will be a flatter curve or will peak as the first part of this first wave did we have yet to see. So far no pulling back of regulations has occurred.

Deaths 302 (1 today) with a case fatality rate of 1.57% see CFR charts later this week for comparisons. 40 new recoveries (total of 15,415 or 80.1% of all cases) and 3,520 active cases. There are 35 critical patients of which 25 are on ventilators. That translates to 1% of our active cases are critical, which is 1/2 of the worldwide average.

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This chart shows the incoming and outgoing cases and their disparity. Once New cases exceeded newly recovered cases, that indicated that this new wave began. monitoring the discrepancy will help us determine trends.

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Interestingly, even though in all age groups except 90+ years old (because most people that age are female) male cases exceed female cases - in 1 populations we have seen a significant shift in this trend in the last 3 weeks: 20-29 year old women had 120 new cases compared to 39 in men...

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This is a comparison per age group of pre-"school wave" and today. we can see that the older adult population has been minimally affected thus far. The largest shift has been in teens and tweens with 700+ new cases; 0-9 year olds AND 20-29 year olds AND 40-49 year olds have 300+ new cases in each group. This is the school children, foreign workers, teachers impacted.

529 students and teachers have tested positive or 0.02% of all teachers and students in the country - so overall the numbers look better when seen in the wider scope of national statistics. There are 25,669 students and staff in quarantine, which is 1% of the national student and staff totals. 193 schools, nurseries, and educational facilities are closed or 0.77% of all schools and pre-schools combined (There are 20,000 pre-schools in Israel!). Source: Jerusalem Post.

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New cases and percentage of new cases - so we can see more clearly which populations are most impacted in this wave so far. Important to track so we can understand which populations are getting and spreading this illness.

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Sweden (where you can see the clear weekly rises and falls of cases as we see here in Israel) is in another upsurge of cases in the last 2 weeks.

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In this new wave we are not yet seeing any impact on deaths, which is a delayed marker. the timeline of COVID is such that deaths are 2-7 weeks after diagnosis (usually 4-6 weeks).

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By city, the cities most impacted with new cases in the last 3 days include Tel Aviv-Yafo (50 new cases), Rahat (32), Baq'a al Jarbiya (27), Haifa (24) and Jerusalem (19).


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Day 115:

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Israel cumulative cases 19,055 (83 new). Although the Israeli Ministry of Health reported no deaths today, we are sad to report 1 death of a 26 year old (more on that later) so total deaths 301. There are 3,380 active cases and 15,375 (or 80.7% of total) cases have recovered.

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 There are 32 critical cases with 23 people on ventilators (we adjusted for the death) and less than 1% of current cases are critical, while in world statistics - 2% of current active cases are critical. 0.2% of out population has been diagnosed with COVID, or 2,072 people per million population.

The country with the highest percentage of diagnoses per population: Qatar with 2.8% diagnosed followed by (not including countries with less than 1 million population) Bahrain, Chile, Kuwait, Singapore, Peru. Why are Arab countries so infected? They are in their peak now but have low death rates. Many Arab countries are doing widespread testing, but the virus does not appear as lethal in those regions.

Of countries with the highest death counts: Last week Brazil became the second deadliest country with 42,800 deaths compared to Britain's 41,700 (now third place). US is first in deaths with 117,800 deaths to date

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Israel:Deaths as a delayed indicator, are still "honeymooning" from our brief respite of cases last month. By July we may start seeing the results of the current infection wave.

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Our weekly averages are moving up. One Ministry of Health (MOH) official stated today that this is a second wave. The reasons for saying that are due to community transmission and lack of clear cut sources for many new infections. Also the volume of infections has risen significantly throughout the country. We believe it is confusing to state that this is a second wave, because people have been expecting the "bigger, badder" second wave in the fall. This wave is not that, although could turn into that. The seasonal elements, whether pollen count, humidity, heat, cold affect coronaviruses replication ability, so another Fall wave is realistic. Plus the first wave never went away, despite many people in the population in denial about it. So this is a rebound effect from our opening of schools and relaxation of economic strictures. PLUS the inability of many people to take the restrictions seriously.

 


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Day 114:

 The total cumulative cases 18,972 (177 new today, 226 yesterday). There is usually a dip for shabbat and a bump of numbers on Sunday. Cases are most common in the South Tel Aviv/ Jaffa area with 77 new cases in the last 3 days. The Bedouin city of Rahat (North of Beer Sheva) had 40 cases followed by Bnei Brak (38) and Jerusalem (30). we will be analyzing the city by city this week.

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The concern of course is - will this be as big as the first wave? bigger? is this the second wave? As mentioned before, in a normal epidemiological setting there is a second wave that correlates with flu season when viruses tend to thrive. We started off calling this the "First Wave Not Behaving" which is accurate, but with an increased spread in communities, this can nonetheless become as impactful or even more than the first wave. (This means the anticipated second wave may end up being the third wave instead. There is a difference between the biological and environmental conditions for an epidemic, for viral spread being optimal (typical second wave) and people relaxing the safety and health standards with low case counts - and incidental spread to occur.

 
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The problem with this time around: last time no one knew what to expect. We saw what was going on in Italy and thought that would happen here. We were scared of the unknown. Since then, we have had 300 deaths in Israel, which are terrible but much lower % than most other countries, many people with long term effects from COVID (we don't hear about those, do we?), and relatively few Israelis were affected. The reasons for these were because of the restrictions we mostly kept to, although they were severe. Many lives were saved, especially since we know most strains were the same as the one in the US, which has a much higher spread, impact, death toll relative to the population as here.

 


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Day 112:

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Day 112 18,569 cumulative cases in Israel (214 new). Discussions on the significance of 200+ new cases daily coming up.

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There have been 300 deaths (1 new) with 34 critical patients of which 24 are on ventilators.

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Total recovered: 15,250 (63 new) but the disparity is still significant. Had we maintained regulations and kept our new cases down to 14 average a day, we would have been at 90% recovery rate, which is excellent and where most countries have plateaued (those who are recovering well). Our case fatality rate is 1.62% and we have 3,019 active cases - highest since May 18th. We have reversed the course.

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Here is our epidemiological curve and the PM showed this graph tonight at a news conference.

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Israel is now at a critical juncture. We have gotten to a place, where at the beginning of the first curve, led to exponential growth of the disease. On March 19th when we passed the 200 new cases per day mark, we had no deaths in Israel to date. Only 14 days later we peaked with nearly 4x the number of new cases per day and we were seeing deaths daily. The death rate peaked a few weeks later, as it is a delayed indicator. (people do not usually die until weeks after their diagnosis).

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These cases account for less than half of today's new cases, because new cases are now throughout the country. An analysis of cases in Tel Aviv showed that cases are focused on the migrant workers' children population (African refugees and foreign workers) and Arabs in Jaffa area. I volunteered for years at the Refugee Clinic in Tel Aviv, published a peer reviewed article about my experiences, and presented research projects at an international conference about this population - so I am very familiar with this population's health needs. The problem with the migrant workers is that they are not part of the national health care system, they live in crowded, poor housing often without basic services, or in abandoned buildings or apartments. They do not have the capacity to quarantine, often they have poor access to local health information or regulations due to language barriers. If the children are not in school, or in childcare settings, parents cannot work - and they cannot afford not to work. They are not entitled to the financial benefits the government is providing to citizens. I would imagine with schools closed that many of these children are being watched in groups and quarantine is not possible.

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In international news, on June 8th the last active COVID case in New Zealand recovered, making New Zealand officially COVID free. This is what a good epidemiology curve looks like:

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All restrictions in the country have been lifted, but the border remains shut to tourists. Only citizens may enter the country.

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(Diagnosed) cases per million population give some idea of what percentage of the population has been infected. This represents OECD (developed) countries only. This neutralizes the size differences between these countries. Because these are all developed countries, the capacity to report accurately is similar (although you can see from yesterday that some countries are manipulating their numbers). Chile, with 5500 new cases today alone, has the highest rate per population, while France with the highest case fatality rate, has only a slightly higher percentage than Israel.

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What we see here, case fatality rates is that high concentrations per population do NOT translate to high fatality rates. Chile has a similar CFR to Israel, while France is reeling at 18.86% CFR.

 


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Day 111:

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Day 111 Israel total cumulative cases 18,355 (175 new cases today). Deaths 299 (0 new) with a Case Fatality Rate of 1.63% off of the peak of 1.68%. This is because our case count is diluted with new cases (1,598 since the beginning of this outbreak)

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15,187 people have recovered (28 new) or 82.7% of all cases. 15.6% of cumulative cases are still active. When comparing newly recovered and new cases we can see the trend is not a good one.

 


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Day 110:

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Israel's total cumulative cases 18,180 (148 new). The only thing flatlining is the recovery number that has remained low, an average of 31 daily in the last week. we would normally expect a slower recovery rate several weeks after a slower new case rate - so this was expected. The current surge was expected but in smaller numbers and more contained.

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Deaths 299 (1 new) with Case fatality Rate of 1.65%. 15, 159 people recovered (32 new - which is quite imbalanced to the new case rate). 31 critical cases - this may be on the rise. 24 ventilator patients (1 new). Of the 2,722 active cases only 111 are hospitalized.

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To date, the total cases in Israel by age and sex are broken down as seen in this chart. Males get COVID at a higher rate than females - this is seen around the world, one of the more consistent characteristics of this disease. Most people ages 90 and over are female, which is why they dominate cases in this age group.

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Since this upsurge began on ~May 27th the blue bars represent the NEW cases in this surge. Unlike the overall COVID trends in Israel since February, this upsurge is affecting adolescents/teens much more. The uptick of 30-39 is also consistent with school staffing patterns. This wave has affected the elderly relatively minimally, which is a relief.

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Another way to look at this surge - where the numbers are emerging in the population.

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Of the 8 cities we are tracking, which are population centers or former hot spots, we see the highest growth in Tel Aviv. We have discussed possible causes, but we must include that Tel Aviv has a smaller percentage of children per capita than most of the other cities here, especially those with Ultra-Orthodox populations.

 


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Day 109:

Israel's total cumulative cases 18,032 (169 new). Deaths 298 (none new).

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People keep asking if this is a second wave. My answer is no. This is the first wave not behaving... nevertheless the numbers and impact are real and because we are not getting more restrictions at the moment - this is actually more dangerous than the initial wave. The second wave is usually calculated with a different season or with a few months reprieve with decreased numbers. In Israel, as has happened in many other states and countries when economies reopen quickly - there is a resurgence. Some level is always anticipated, we get into danger when the numbers become exponential. Does this uptick have this potential - yes. It depends on how the citizens behave.

 
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The number of deaths is still low.

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Our recoveries have decreased relative to our new cases: 36 vs 169 and that disparity is continuing to grow, as seen in this chart. This tracks trends, and so far this does not look good.

 pic 4  

and as we can see, the active case numbers have increased dramatically while the death rate has remained consistent and is even dropping as deaths are delayed indicators. In the current outbreak with most newly infected people being young, the death rate may not swing up even in a delayed calculation, as young people are far less likely to die of COVID. Unfortunately, some elderly were also infected by the young people so we do unfortunately expect to see more critical cases and mortality. Israel currently has 29 critical COVID patients and 23 on ventilators. We have 2,607 active cases (remember that we had 1,917 eleven days ago).

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The top hot spot in the country is currently Tel Aviv, with 148 new cases in the last 10 days. In the last day, Tel Aviv reported 36 new cases (21.3% of the total daily new cases nation wide), or more than double the new cases in Jerusalem. Although previous outbreaks have been deemed, and even demonized, as "Haredi" (ultra-Orthodox) outbreaks, this surge is clearly targeting non- Haredi sectors. Even in Jerusalem the primary cases came from a secular high school (Gymnasium). Bnei Brak (Haredi city) during the same period had 8 new cases today and 50 over 10 days. Beit Shemesh (religious partly Haredi city) had 9 new cases today and 17 in the last 10 days. Modiin Ilit (Haredi city) had 12 cases in 10 days. Beitar Ilit (Haredi city) had 21 cases in 10 days.

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Of countries and states with equal or more cases as Israel, with countries with poor reporting reliability removed, Israel is doing relatively well with a slightly lower CFR than 2 days ago. CFR changes daily as new cases emerge and new deaths are recorded.

 


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Day 108:

pic 1

Day 108 Israel total cumulative cases 17,863 (111 new) with 298 deaths (3 new) and 15,091 recovered.

 pic 2

Critical Cases 27 with 23 on ventilators (2 more than yesterday). There are 2,474 active cases in Israel (557 more than our low of 1917 on May 30th).

 
 pic 3  

Our weekly averages help us see trends more clearly. In this model, we can see that average daily rates have exceeded 100 for the first time in 5 weeks. Our respite was short, and it seems that the government is trying to balance the different needs of the population at this point (more on that later).

 pic 4  

We were able to get data from Swedish government records, as an example. This shows the average death rate per week (this is for annual weeks 9-21 out of the 52 weeks per year) of 2015-2019 compared with the weekly death rate of 2020. The 5-year average gives us a statistically fair comparison rate.

 pic 5  

How is Israel (and other countries) sizing up compared to the world? Case Fatality Rate (CFR) is calculated by deaths divided into cumulative reported cases. It is not as accurate as Infection Fatality Rate (IFR) - which is deaths divided by total actual cases (including people who have not been diagnosed because of lack of symptoms). For many illnesses, like flu and measles, almost no one is asymptomatic so the CFR and IFR are the same if not similar. With COVID because it is possible that MOST cases are asymptomatic, the IFR is probably MUCH lower than the CFR. The IFR will only be able to be calculated when there is mass antibody testing.

 pic 6  

In this chart, France surpassed Belgium as the country with the highest CFR. 7/10 of the top fatality countries are in Western Europe. The CFR changes as the country numbers change. The CFR of worldwide data was 7.28% on April 30th and is now 5.78% due to the lower number of deaths reported in recent weeks (see above for possible explanations). source: worldometer accessed June 7th, 2020.

 pic 7  

This is CFR in order of country population size (from smallest population to biggest). As you can see - there is no pattern. The essential point is - we know that early management, early shut downs, social distancing, masks (which the WHO finally endorsed en masse), and hygiene are the key elements to reducing fatalities.

 


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Day 107:

Total cumulative cases: 17,752. Total of 257 new cases in the last 2 days. Today had the highest number of new COVID cases in 42 days.

 pic 1

295 deaths (3 new today, 1 new yesterday). 106 schools of all ages are now closed in Israel. Policy is to quarantine the whole school when there is a positive case, and the school and staff are tested en masse. Testing levels have risen dramatically with 23,000 tested over Friday and Shabbat. 0.8% of tests were positive, which indicates that the volume of testing is getting closer to accurate. We were at 0.2% during the low period, and the goal is for widespread testing to screen larger circles of contacts and keep the positive numbers relatively small.

 
 pic 2  

With 37 newly recovered cases in the last 2 days and 257 new cases - this chart, which indicates current trends of incoming and outgoing active cases, is now showing a sharp spike or disparity between the two. So more people are consistently getting COVID than the speed of newly recovered cases. This leads to a rise in active cases. Since May 27th there has been an increase of 465 active cases in Israel. Active cases = total cases - deaths - recovered cases.

 pic 3  

As a result, our nice-looking recovery chart is starting to curve upwards again. The trend we are seeing abroad is that with good maintenance of health regulations - most countries level off with an 85-91% recovery rate (depending on the death rate). Israel was on its way to leveling off at about 90% as there was a slow down of recovered cases due to a continuous low-level new case rate every day. Until the pandemic is over (with a vaccine) - there will always be some active cases.

 pic 4  

 What age groups are being affected by this new outbreak (and NO - this is not a second wave. This is the first wave behaving badly)? Youth ages 10-19 have 304 new cases since 5/27. People 30-39 have 128 new cases, while people in their twenties and forties have 115 and 116 new cases respectively. This represents the school children and staff testing positive. Some elderly were also impacted - with 38 new cases in people aged 70+. A senior living facility in Or Yehuda has seven residents who tested positive in recent days. As we know, the elderly have much higher rates of morbidity (complications) and mortality (death) from COVID. This was likely due to younger people visiting the facility or staff members with teens at home who tested positive. The senior facility also had 3 staff members test positive. After the first positive case all residents and staff were tested negative. A follow up test showed the new cases. This shows that the new policy of double testing is critical in finding new cases. the second test is usually done 5 days after the first negative test. A positive test does not require a second test. This does not mean that tests are inaccurate. As discussed previously, the test depends on a certain viral load, or a certain amount of virus in the body, to be picked up in a COVID test. If someone has the virus, but the virus has not replicated enough in the person - the test will be negative. A few days later, when the virus has a chance to replicate more - the virus will have a "load" (or viral count) high enough for a positive test. Many people are not following through on the second test, and this is problematic because then outbreaks, clusters, and at risk people can remain undetected - which exposes more people to COVID.

 

 pic 5  

A select few cities are in the chart, but these were cities that were hit particularly hard by COVID. new cases are primarily in Jerusalem, Tel Aviv, Bnei Brak. There are currently over 16,000 students and staff in quarantine, with 330 who tested positive.

 

 

 

 


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Day 105:

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Day 105 Israel total cumulative cases 17,495 (118 new).

As a reminder, the cumulative cases in this type of chart are supposed to flat-line when few/no new cases are reported. We were very close to a flat line but we are now slightly edging up with the new case surging (school based). The orange line (active cases) should eventually drop to zero, but have also upticked in the last week. Recovered cases (grey line) will never meet the blue line as the gap represents the total deaths from COVID

 pic 2

Deaths 291 (none today) with 30 critical cases (3 more) and ventilator cases dropping to 23 (lowest in 74 days and 2 less than yesterday . Since there were no deaths today, that means the 2 people have improved clinically). If the majority of current cases in the outbreak (no longer a cluster because it is country-wide) are young people, it is entirely possible that the numbers represented here will not have a significant impact on the mortality, critical cases, or ventilator use in Israel - as this population has good outcomes in general.

 

 


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Day 104:

 pic 1  Day 104 Israel total cumulative cases 17,377 (92 new).

This is our epidemiological curve, as shown by daily new cases reported. The current trend is not considered a second wave but considered an uptick based on non- compliance with the safety regulations (more on that later).

 pic 2  

One of the things we look at for long term trends is daily deaths from COVID. This will often precede epidemiological curve trends, as we saw in the UK.

 pic 3  

This may appear confusing but it compares and tracks new cases and newly recovered cases. If you compare the number of people actively sick to a water urn holding a certain volume - this tracks the rate of the urn filling vs pouring out of the bottom. if more new cases (or more filling of the urn) is a higher number than the number recovered (or the water drained from the urn) - then the net number of people who are actively ill grows. In this chart when the blue line crosses above the orange - we are in an upward trend in case numbers. Its not a huge gap between the numbers, and is currently very manageable. Also when looking at the epidemiology curve you can see that the current "blip" is very small when looking at where we were. We need to keep this in perspective, although remaining ever cautious and following health guidelines. This is not time to panic.

 pic 4  

Israel deaths 291 (1 new) with 27 critical patients and 25 on ventilators.. 86.2% of all cases have recovered (this dropped from a high of 87% a few days ago due to the new cases). there are currently 2,103 active cases in Israel (net gain of 48).

 pic 5  

We can see that Israel has bounced up in the case number per week but not a significant bump of case numbers - meaning we have relatively more numbers per week but altogether not a huge relative leap in numbers. So we went from 14.3 average daily new cases to 50.6 average daily new cases (through 5/31) but the overall impact is not huge in the bigger scheme of things. Southern Hemisphere is struggling as we anticipated, while Sweden and US are "flatlined" in similar weekly numbers but no downward trend (no upward trend either - which is good). The UK is decreasing slowly.

 pic 6  

Interestingly, Sweden reported the highest number of new cases since the beginning of COVID pandemic - 2,214 new cases. Previous high was 812 new cases in a day. we will try to find out what is going on there.

 pic 7  

the UK daily reported deaths have been overall decreasing with a "blip" in the last few days that we are keeping our eye on. Whether an indication of a trend or coincidence we will understand soon. Remember that many European countries are beginning to open up their international travel and economies (except Sweden which never closed).  the UK is also not publicly tracking their recovered cases or active cases, and the lack of transparency makes decision making for her citizens and for potential travelers very difficult.

 pic 8  

The assumption that 60% immunity will be herd immunity is guess work. Every disease has a different level of herd immunity required. Herd immunity is indirect protection from a specific infectious disease imparted on the community/population based on the number of people who have immunity due to having the disease or being vaccinated. Herd immunity is especially important for vulnerable populations, such as people with compromised immune systems and people who cannot get vaccinated for health reasons.

 

 


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Day 103:

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Day 103 Israel total cumulative cases 17,285 (116 new). Active cases have risen to 2,055 (49 new) with 62 newly recovered cases.

 pic 2  

This means we are net gaining cases daily because our new case rate is higher than the recovery rate. This is why the chart above is important to track. - we want daily new cases to fall below daily recovered cases.

 pic 3  

Deaths 290 (4 new) with 28 critical cases and 29 ventilator patients. The reporting figures may be off by one, as ventilator patients are considered critical. Our death rate is 1.68% and 86.4% of all cases have recovered. 96.6% of all active cases are ranked "mild".

 pic 4  

as you can see - there is a slight rise in the active cases in recent days.

 pic 5  

Cases per decade. young males most likely to get COVID. The biggest jump in the last week: 10-19-year-olds where nearly 200 new cases were diagnosed followed closely by 20-29-year-olds with 100 new cases.

 pic 6  

Some good news for Israel: The Ministry of Health is now allowing tourists who have had COVID to provide proof of immunity plus a test before departing to Israel, and an additional test performed either at the airport or privately funded by the tourist. They must be quarantined only until the test comes back negative. This covers for the possibility of waning immunity but assures with relative certainty (although nothing is foolproof) that there is some immunity and no active infection over the last few days. This shows that the country is planning on finding alternatives to quarantine to allow tourism and travel. This is not yet announced or official policy, but I have confirmed it with the Ministry of Health and I have many reports of people having this type of testing done.

 


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Day 102:

 pic 1  

total cumulative cases 17,169 (98 new) deaths 285 (0 new). Recovered 14,878 or 86.6%. Active cases 2,006 (12 more).

 pic 2  

Our new daily case rate is increasing faster than our recovery rate. these figures are related to school exposures. As discussed (by the editors) regarding the article I wrote for the International Society of Infectious Diseases (above), "The challenges of reopening schools are clearly identified by the school cluster presented above. Teenagers are notoriously non-compliant with health-related messages, as seen with the management of chronic diseases in this age cohort. With respect to COVID-19, there is the added challenge of a higher mild to no disease infection in this age group as seen by the lower age-specific proportional infection rates. While one school is profiled in the report above, there is mention of multiple clusters occurring in other high schools around the country and the concurrent observed rise in positive testing rates and increased testing demand.

Other countries beginning the return to schools might take this into consideration and proactively plan for managing social distancing and mask use compliance in this population."

 pic 3

 

Among the countries and states (many epidemiologists believe that the separate states must be counted as separate entities to track higher risk zones and state responses) - Michigan has the highest CFR of all US states, and the governor announced today a reopening of the economy. Israel is learning a difficult lesson regarding children and specifically teen compliance. lessons should be learned to develop a mechanism for implementing masks, social distancing, and hygiene in this population. We will see if Israel's joint effort by the Ministry of Health and Ministry of education.

 


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Day 101:

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Day 101 Israel total cumulative cases 17,071 (59 new), 285 deaths (1 new). Active Cases has risen to 1994.

 

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Critical patients has dropped to 33 with 30 ventilator patients (lowest in 2.5 month). These are delayed figures, as the people currently critical likely tested positive weeks ago.

 
 pic 3  

Our average of new daily cases increased this last week due to the clusters in high school students, primarily the Gymnasium cluster, currently ~160 people including over 120 students. The source was a "super spreader" staff member who was asymptomatic. Super spreaders have been reported in many countries. It is not known why super spreaders remain asymptomatic, nor why they spread/shed the virus more than others.

 pic 4  

As our daily recovery numbers dip below our daily new case numbers, we are concerned about a larger impact of this cluster. Most clusters resolve with tactics being employed. This includes closures of the institutions/schools impacted, wide-scale testing of those potentially impacted, and mass quarantine. there are currently 1400 students and staff from the Gymnasium High School in quarantine in Jerusalem.

 pic 5  

Our recovered percentage has dropped and flatlined for the first time and has remained thus since this outbreak began on May 26th.  The CFR is not likely to be impacted significantly, as teens have not suffered high mortality rates in COVID. In Israel, to date no one under age 50 dies without significant pre-existing medical conditions. No one under age 33 has died in Israel of COVID to date.

 pic 6  

Since the decrease in cases in Israel began in April, testing has decreased significantly. Although Israel has the highest testing per capita a month ago, the low demand for tests recently has decreased on the international scale, although Israel remains in a good position with 61,804 tests per million population. While average positive testing rates were 0.3% for the last few weeks, the rate has increased to 1.4-6.2% nationally in the last few days.


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Day 100:

Israel cumulative cases 17,012 (25 today, 115 yesterday, 79 on Thursday). Deaths 284 (3 new on Thursday, none since).

 pic 1  

Although we have had this uptick in cases, relatively fewer people have been reporting symptoms and testing numbers have been very low - with 671 tested today and 1,825 tested yesterday. The percentage of positive cases has risen from an average of 0.3% over the last few weeks to 1.5%, 6.2%, and 2.1% over the last 3 days respectively. Because of this, the ministry of health has launched a campaign through all of the kupot holim to encourage people to be tested if symptomatic. Additionally, drive-through test sites have been re-installed in all 4 major Israeli cities and kupah-based testing is being run every day including weekends, although none of these services are being offered 24/7 because of relatively low demand.

 pic 2  

Our case resolution numbers are excellent, but we must recall that these are delayed figures - up to 7 weeks after diagnosis. currently 87% of cases have recuperated. 1.67% have died. There are 1,917 active cases in Israel currently. The number of active cases has rebounded for the first

 pic 3  

This is an analysis of new daily cases compared to newly recovered cases. There is a delay in recovered cases because 2 negative tests are required and the virus can take weeks to clear from an infected person. When the daily recovered cases started outnumbering the new diagnosis cases, Israel started speeding up the recovery and relaxing of restrictions policies. In the last 3 days this number has crossed again - warranting a high level of concern. Specific actions to be taken will be discussed below.

 pic 4  

Israel now ranks 40th country worldwide of total infection rate (as counted by individual countries). The CFR rate is a proportion of deaths per total cases per country. The world CFR is 6.04%. As discussed last week, the CFR is a changing number with some analysis issues. Countries with poor testing resources or poor accounting of true case numbers are excluded, although testing policies in these countries vary widely. it is possibly more accurate to look at total deaths of countries in the same months last year and to compare the numbers. In Israel, this calculation would include the deaths related to fear of COVID, such as the people who experienced symptoms of a heart attack or stroke but were afraid of going to the hospital for care.

 pic 5  

Sweden, with a similar population to Israel has mandated few if any restrictions in the hope of maintaining the economy and providing the population with herd immunity. we now are seeing that most studies show that long term immunity does not exist for coronaviruses. Their epidemiology curve (based on new cases per day) is erratic at best with wave after wave of new cases.

 pic 6  

The UK appeared to have a similar pattern but we can now see a more positive curve developing, indicating that they are slowing down the spread.


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Day 97:

 pic 1

Israel cumulative cases 16,793 (36 new)

 pic 2  

Total deaths 281 (none today) Critical cases 41 (4 more today) with 38 of them on ventilators (5 more). This is the biggest increase in critical cases and ventilators since our numbers peaked on April 11th.

 pic 3  

86.7% of our total cases have recovered. We are seeing in European countries that this number is stabilizing around 90% with a slow downward trend, but since there are still active cases everywhere, it will remain an active measurement until this pandemic ends. Deaths in Israel still account for 1.67% of all cases and we have 1,942 active cases currently.

 pic 4  

Although young people are most likely to get COVID, in Israel there have been no deaths in these age groups. The people most likely to die or suffer long term morbidity include those age 60+ with exponential increase in deaths by decade. An analysis of New York State deaths shows that 48.7% of deaths from COVID were in people aged 75+. 24.9% in people 65-74 years old; 22.4% in people 45-64 years old. 3.9% in 18-44 year olds and .06% in minors.

 pic 5  

we can see the case fatality rate by age groups internationally with exponential increases per decade. The real jump is at about 60 years old.

 pic 6  

In world news, you can see that the UK has weekly waxing and waning of new deaths with each reiteration smaller. The cycle seems to be almost exactly every 7 days.

 pic 7  

Of the OECD (developed, democratic) countries of the world Case fatality rate is a tool we use to measure and compare us to other countries. There are flaws with looking at the CFR: 1) CFR does not tell us what the risk of death is in a country. When, as in COVID, there are a large number or people who remain undiagnosed worldwide (and we have seen undiagnosed numbers ranging from 50-90% in population studies), The CFR will overestimate the death rate. 2) When there are high numbers of currently sick people who will eventually die of COVID, the CFR underestimates the death rate. In COVID we also have critically ill people worldwide who will eventually die. Likewise, due to reporting differences in different countries and states, many deaths may be attributed to other causes. For example if a COVID patient developed kidney failure because of COVID complications and dies, his death may be recorded as caused by kidney failure and not COVID. The CFR changes throughout an epidemic/pandemic/outbreak. The more accurate number that we cannot calculate in the infection fatality rate - or the proportion of deaths out of total infections. In this case, because many people are asymptomatic or untested, we do not know the true infection rate. CFR tracking is the closest we can come (with other parameters) for tracking how countries are doing and comparative analysis.


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Day 96:

Israel cumulative cases 16,757 (23 new). 2,019 active cases remain, most of whom are at home.

 pic 1  

Israel's epidemiology curve looks very different when we insert key dates and events that have influenced the curve.

 pic 2  

We can see here in orange the holidays (Purim was March 10-11 in Israel), the restrictions in red, the alleviation of restrictions in green. Most restrictions were well in place before the peak hit. Israel waited for a full quarantine cycle to reduce some restrictions, and 2 cycles to reduce major restrictions. In consideration of re-opening these timeframes are important. The rule of thumb is the epidemic/outbreak/pandemic is over when there are no new cases in 2 incubation periods (in this case 28 days). It is doubtful we will get there, as international travel is going to re-open in 3 weeks.

 pic 3  

Israel COVID deaths: 281 ( none new today).

 pic 4  

The following analysis is US states with similar or more total cases as Israel with countries (excluding developing countries who cannot or do not provide accurate epidemiology information). 

These are cases per million population, which eliminates discrepancies in larger vs smaller countries/states. Unfortunately, New York State has the highest rate of the disease of all 61 analyzed countries (55 included). As we saw in New Jersey, New York is not reporting active cases per county, so the percentage of actively sick people can only be assessed on a state-wide level.

 pic 5  

As we can see, New York State has the largest concentration in the southern and eastern tips of the state, which is also the location of the largest Jewish populations in the state. The highest concentration is in Queens County, followed by Brooklyn (Kings County).

 


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Day 95:

pic 1

 Israel cumulative cases 16,734 (17 new) deaths 281 (2 new)

 pic 2  

Critical patient numbers have steadily decreased- currently 41 (lowest in 2 months) with 29 people on ventilators (5 less than yesterday). For those who were not on this group when we discussed this many weeks ago - the length of time it takes to clear the virus is often weeks - up to 6 weeks for more complex cases. So the long "tail" of our critical caseload, as seen internationally, is expected and normal for this disease.

 pic 3  

85.5% of all cases have recovered. This is defined as 2 negative tests. because of the "long tail" of this disease - there is a lag between when people recover symptomatically and when they are counted as "recovered" virologically. There are still 2,146 active cases in Israel 96.6% of whom are considered "mild" (which includes people no longer symptomatic). 1.68% of total patients have died.

 pic 4  

Case fatality rates are proportions of deaths per total cases of disease. This chart includes all countries with approximately equal or more cases as Israel (Israel has dropped to 39th highest case count in the world) less the countries who are either 1) not reporting accurately (China) 2) Does not have the resources to test and record widely (Indonesia, Peru, India etc.) or 3) countries that do not report their recovered cases or active case counts (UK and Netherlands). UK and Netherlands have 14.13% and 12.83% CFR currently but we cannot use them for our next comparison. Poor recording of recovered and active cases helps citizens and residents of the country feel safer, but will also be a major determinant in the re-opening of international borders with those countries. For example, Switzerland, with over 90% recovery rate, may be considered a relatively safe place to travel to in the near future. The problem the case fatality rates as a marker is that it does not account for testing shortages, extreme testing limits (Sweden tests only patients who are hospitalized), lack of tracking of critical cases (which can change the proportion), and discrepancies in reporting deaths. In some places, patients with COVID who dies of heart failure (likely a complication of COVID) may not be recorded as a COVID death at all. In other places, like New York, even suspected COVID deaths are recorded as such because reimbursement rates are higher from insurance companies for COVID patients.

 pic 5  

Another way to look at these numbers is to see the resolved cases and to measure the proportion of deaths (vs recovered patients) when analyzing resolved cases. COVID can only resolve in 2 ways - death or recovery. Yes, many people recover with significant disability and long term affects, but they are considered recovered when their blood tests (serological studies) show no active viral count. The weakness of this assessment method is that some countries track recovered cases more accurately than others. Sweden has not updated their "recovered" patient numbers in 18 days even though their case numbers have risen by 25%. there is no doubt that more people have recovered, but Sweden is not keeping up to date with reporting - again - to their detriment. The UK and Netherlands dont publish this data at all, as mentioned above. But in most countries, reporting is in fact accurate as countries want to show their citizens progress. Some countries are doing better than others, with Egypt the worse of the Arab countries currently on the list. Most Arab countries have low CFRs and low percentages of deaths in resolved cases, although their total case numbers are higher than Israel's. Although this is not serologically proven, it is likely that this indicates a different strain of the virus affecting these countries. Israel's strain of COVID was traced back mostly to the US (70% of cases are attributed to this) even though Israel's CFR is much lower than the US. Those differences, if strains are the same, can be attributed to policies and management of the illness. Israel as a world leader in emergency planning, had a strong pandemic plan in place before this began.

 


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Day 94:

Day 94 Israel total cumulative cases 16,717 (5 new). Deaths - 279 total (none new in 4 days!)

 

 pic 1  

This "latent" stage we are in is challenging in 2 ways: 1) people are relaxing their own sense of personal responsibility for following the regulations about hygiene, social distancing, and mask wearing. There was a "protest concert" in Tel Aviv this weekend with large crowds, as an example. 2) On the opposite spectrum, with 2,285 active sick people and thousands of more unknown "silent spreaders" - many people are holding their breath waiting to see the backlash. If there will be one. The reasons why we discuss other countries is because it is vital to LEARN from others so we do not make the same mistakes. Yes, there are different strains of this virus in different parts of the world, and Israel has BH done well compared to other countries, even though every death and serious case is a tragedy. But even countries that did well have suffered backlashes for errors or lack of observance of regulations by the masses. A balance must be maintained and we must pay attention to the trends.

 pic 2  

84.6% of total cases have recovered/ 1.67% have died. As we can see from the chart above, our recovery rate and active case rate is stabilizing. We will likely continue having a significant slow down of active case rate and recovery rate, but we should not expect to get to zero active cases. The slow down is anticipated to stabilize at just under 2000 cases, after which we may have a trickle downward trend.

 pic 3  

In the weekly analysis - we can see the post-Purim peak, the post Pessach closure sudden drop of new cases due to full closure for several weeks.

 pic 4  

when we just look at the new cases (you can see the UK had a testing glitch that was corrected last week) - until mid-May the UK epidemiology pattern was unclear.

 pic 5

 

The UK's new death chart showed clear downward trends and continues to do so.

 pic 6  

The country that chose not to shut down. All eyes are on Sweden to see how they fare long term. 

and in fact, their epidemiology curve is a mess - new cases coming in waves with no apparent end in site. Sweden has high total case rates per capita and high deaths rates but not as bad as many other European countries that had more restrictions.

 pic 7  

But when we look at the new deaths per day - we see clearly that there is in fact a downward trend in Sweden and they are making progress. The daily death rate is more accurate when comparing countries with different testing criteria. Sweden does not test liberally, only for people admitted to hospital. But deaths are recorded accurately.

 pic 8  

And we can see that this chart in Israel is likewise a positive indicator besides the lack of new deaths reported in 4 days. With 34 people on ventilators, it is unlikely that we will see no more new deaths unfortunately. But the trend indicates that we are in a good place.

 


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Day 93:

pic 1

Total cumulative cases in Israel - 16,712 (4 new today, 25 new yesterday).

 pic 2

There have been no new deaths in three days. This has not happened since the first death was registered on March 21. Our critical cases and ventilator cases have not changed in 3 days.

 
 pic 3  

84.3% of all cases have recovered, 1.67% have died. The death rate number is slightly improving over the last few days as the cases increase slightly with no deaths recorded. There are currently 2,343 active cases in Israel.

 

 


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Day 91:

 pic 1  

Israel cumulative cases 16,683 (18 new). There were no new deaths today (the first time in 55 days). Critical patients are now 47 (1 more) but ventilator patients reduced by 4 to 36 with a COVID ward closing in Nahariya.

 pic 2  

Israel has 2,680 active cases (or 16% of our cumulative cases remain active cases). 82.3% of our cumulative cases have recovered.

 


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Day 90:

pic 1

 Israel cumulative cases 16,665 (6 new)

 pic 2  

279 deaths (1 new), 46 critical patients (the lowest rate in 56 days) of which 40 are on ventilators (2 more since yesterday). Active cases 2,812.

 pic 3  

81.4% of cases have recovered. 1.67% have died.

 pic 4  

Of the countries we were tracking, the Asian countries with low incidence and low death rates are all having hotspots or resurgences. South Korea had an outbreak within days of reopening nightclubs - with 12 people infected and contact tracing occurring. Within days the cluster was 187 people infected. Japan's first curve peaked in early to mid April, and their mortality rate is relatively low (although nearly triple Israel's). They have very low testing rates reported. Singapore, one of the first countries whose travelers were banned from entering Israel, had a late April-early May surge with many hundreds of daily new cases reported. Their case fatality rate remains the lowest (0.07%) among developed countries- with 22 deaths only and nearly 30,000 cases. Reports from China today indicate that the northeast region of Jilin has been closed down, with 108 million people under severe restrictions, the strictest yet observed in an effort to suppress a new outbreak. The cases have mostly been imported from Russia, which is currently averaging 10,000 new cases daily and is the second most affected country in the world (after the US). Dozens of people were reportedly diagnosed, yet China reports only 5 new cases today and 6 yesterday. There were also clusters reported to international epidemiology associations in Wuhan (economy reopened 6+ weeks ago) and Guangdong (considered among the most populated areas of the world). It is important to understand the discrepancies in official reporting and what health professionals are reporting within closed circles.  The severe restrictions on the 108 million people include closed off residential compounds with one family member allowed to go food shopping for up to 2 hours every other day. China is concerned about a second wave hitting population centers, and is, therefore, enacting these restrictions. They would not be doing this for 5 new cases daily. The inaccuracies highlight the overall distrust felt by the international community over China's allegedly false reporting. The world has been somewhat handicapped by the lack of transparency, even in light of these glaring

 


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Day 89:

 

 

Israel cumulative cases 16,659 (16 new). Active patient numbers dipped below 3,000 today. Of the active patients in Israel, there are 50 critical patients, 42 moderate patients, and 2,854 mildly ill patients, or 96.9% of all active patients.

 pic 2  

Of the resolved cases in Israel, 80.6% have recovered, 1.66% have died.  Israel has dropped to 37th country in terms of cumulative cases. We were 35 at the beginning of the week. Romania, South Africa, Kuwait, has surpassed Israel this week. we will discuss the latest study to come out regarding actual vs reported cases. We have not discussed for a while the impact of the silent carriers - people who have no recognizable symptoms but who have the disease and can potentially spread it. In the past, we discussed 50-80% of all cases could be silent carriers.

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Of ALL countries with the same or similar cumulative case rate as Israel, here are the CFRs. The world CFR is slowly dropping as the cases climb but recorded deaths are reduced somewhat. Not sure how significant this is since many countries currently very active are developing countries with poor resources and testing. Because of war and terrorism, Yemen is unable to test, report cases or deaths accurately, and is unable to get appropriate international health intervention to assist. Cases from Yemen are considered by the WHO to be climbing at a dangerous rate, but few cases have actually been reported. India has thousands of new cases daily, and are currently number 11 in the world in reported cases, but outside of the more developed cities, access to testing, reporting, treatment is limited to nil so much higher numbers are estimated. Reported cases "cannot be equated with 'total cases'" due to these silent carriers. This includes 1) asymptomatic people 2) people with mild or atypical mild symptoms who are not tested and 3) people who do not seek medical assistance and are not registered. A national study in Spain showed that 5% of the general population tested positive in a highly accurate screening process. Based on current reported cases, Spain has a national case rate of 0.5%, so if we calculate the potential "total cases" based on this study - the actual infection rate is 10x higher with the death rate remaining the same. so the current 9.96% Case Fatality rate is actually 0.99%. In regular language - if this study hold true for other countries - then up to 90% of cases may be "silent carriers" - which dilutes (reduces) the death rate ten-fold. But it also means 10x the current reported infection number is accurate. instead of Sprain having 278,000 cumulative cases, they would have 2.78 million.

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issues: we do not know if 1) if different COVID strains affect the silent carrier numbers 2) if there are country/cultural reporting differences 3) how much is the variance of testing between each country - Israel has criteria, but other countries are testing only if people are critically ill. some countries are testing for anyone who wants a test. but what we do know is that there is probably a high percentage of people who are or were silent carriers, so our CFR is likely much lower.

 


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Day 88:

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Israel cumulative cases: 16,643 ( 26 new).

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Deaths 276 (4 new); Critical cases: 52 (lowest in 52 days) of which 42 are on ventilators. There are 13,253 recovered cases (79.6%) and 3,114 active cases to date.

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When analyzing the USA as a country, most epidemiologists believe that national figures are less accurate than state-by-state figures as each state has their own testing and management policy. There are also wide variations in how COVID is affecting states. The International Society for Infectious Diseases recommends assessing each state as a separate "country" for fair analysis. We have included countries with same or similar gross number of cumulative COVID cases except for extremely underdeveloped countries where testing and reporting is considered inaccurate. Many people attribute Israel's low death rate to the relatively young population we have. In the early years of the country, there were few elderly (less than 1% in 1948; 4% after the influx of Mizrachi Jews immigrated in the 1949-1953 period) because so few elderly were able to exist in the harsh pre-WW2 conditions of the pre-state. Needless to say the elderly did not survive the holocaust, so those who moved to Israel were by definition young. Although the immigrants of yore have aged, and 12-14% of current immigrants are elderly, relative to other countries, we have low percentages of elderly people. Israel also has the highest birthrate of the OECD countries. And we know that COVID does not cause high death rates in the young.  Florida is a known haven for retirees with 20.5% of the population over the age of 65 (4.3 million people). New York has 16.4% population over 65 (3.2 million people) (26th highest rate in the USA). Israel has approximately 12% rate. Florida took early precautions to protect the elderly that are being praised. This included reducing outside contacts to facilities, and providing personal protective equipment and prioritized testing to this highly vulnerable population. New York was criticized for not protecting its elderly population.

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As we saw last week, the UK daily death rate was an early indicator of a positive trend in their COVID cases. Today they had 2,711 new cases, or the lowest number in the last 49 days. what we also see in the epidemiological curve is a potential significant downturn in the trend, that appeared to be otherwise chaotic Since the beginning of April. we believe this is significant as it correlates to the second chart. The UK has a long way to go, but we feel confident they are heading in the right direction.


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Day 87:

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Israel cumulative cases 16.617 (9 new today). Our epidemiology curve is flat and low. This last week we had an average of 23.3 new cases daily (compared to 34.3 the week before)

 
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Total deaths 272 (4 new or 1.63% of all cases) Total recovered 12,942 (or 77.8% of all cases). There are currently 3,403 active cases in Israel.

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Most of the people who have had COVID (or currently have it) in Israel are young - with people in their 20s most often infected, followed by teens, and then people in their 30s. Men are more likely to have this disease, a phenomenon seen around the world since the onset of the pandemic. We don't know why men are more susceptible to catching COVID. The exception is 80+-year-old populations, where there are more women than men. The life expectancy in Israel is approximately 81 years for men, 84 years for women. This is likely the only reason for women being more dominant in the 80+ age groups - there are more of them. In the last week, Israel performed 42,854 tests with an average of 0.37% positive rates. Shabbat seems to be the consistently lowest testing day of the week, possibly because people do not realize they can get tested on Shabbat or lower staffing levels. This also means of all of the exposed people or people with COVID symptoms, more than 99% do not have the disease.

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OECD (developed countries) case fatality rates average 6.2%. Mexico has moved up this unfortunate list and is currently seeing thousands of cases daily with a 10.70% case fatality rate. CFR is a proportion of deaths out of total cases.

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Why do we look at deaths per 1 million population? to reduce testing variances, reporting errors, and to equalize analysis of all OECD countries. As you can see, Mexico is right above Israel on this chart. OECD countries are developed and value democracy under specific criteria, which is why some developed countries are not included.

 


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Day 86:

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 Day 86. Summary of yesterday and today: As of today 16,608 cumulative cases (19 new today; 10 new yesterday). Total deaths 268 (2 today, 1 yesterday). The case fatality rate (deaths as proportion of total cases) is 1.6%. The world CFR is 6.63%.

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Critical cases are now 59 including 49 people on ventilators. Some hospital COVID wards have been closed or significantly reduced. 97.2% of all current cases are classified as mild. The chart above shows the back end of the curve slowly reducing - which is related to the significant delay in critical cases clearing/resolving. This can take up to 6 weeks. Cases are considered recovered after 2 negative tests.

 
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 77.4% of all cases in Israel have recovered. There are currently 3,485 active cases.  In the last week, Israel has averaged 0.13% new cases daily

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Of all countries with similar or more total cases as Israel, we can see that Western Europe clearly is at the extreme of the CFR rates. But epidemiologists are warning that it is early in the spectrum of worldwide disease, and many countries are only starting their first wave. This includes Eastern Europe (near peaking) and Southern Hemisphere (specifically S. America and African nations). Notably, Japan's death rate has risen significantly in this recent uptick of cases, which is attributed to a fast, early re-opening of the economy in specific regions. Belgium, with a population of 11.5 million people (compared to Israel's 9.1 million) has 3.3 times the case rate with 33.6 times our death rate. Belgium has social distancing laws in place. There is a high percentage of migrants in cities, and this has not been examined as a possible factor in the high case and mortality rates of Western European countries. Before COVID Belgium and France were reporting challenges policing and managing the migrant populations.  Sweden has reported high case rates but comparably lower death rates relative to other Western European countries, but they are faring much worse than other Scandinavian countries with Norway CFR 2.82%; Finland 4.72%; and Denmark at 5%. Sweden's cases are primarily in Stockholm with few cases in other metropolitan areas.  Sweden is being praised and criticized for their approach to COVID, which was to limit public gatherings to 50 people and encourage (not enforce) social distancing. No economic closures occurred.

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Worldwide resolved cases include 14.77% deaths, with 38% of world cases recovered. Ecuador has just started its peak so many cases remain active. UK and Netherlands do not report their recovered or active cases accurately (see last week) and are not on this chart. Of Israel's resolved cases only 2.04% resulted in deaths.  Countries with many active cases have a higher % because deaths often take a shorter time to occur compared to recovery. Middle Eastern Arab countries are being hit hard, as are Asian countries (even where reporting and testing is scarce in many regions - such as in India)


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Day 84:

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Israel totals cumulative cases 16,579 (31 new). Active Cases have been reduced to 3,793. 12,521 people have recovered (75.5%)

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Deaths 265 (1 new) or 1.59% of all cases.

 
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Israel's epidemiological curve- looking very healthy especially considering that the economy is opening up.

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This is Germany's epidemiological curve. As you can see - they have a very similar shape to Israel's except that they had 10.5x the caseload Israel had, higher case fatality rate, higher deaths per population... but the curve clearly indicates a downward trend, with the waves continuing but smaller with each reiteration. Germany has been lauded as a model for other EU countries with a relatively lower death rate than others.

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I am also looking at the UK for a few reasons. First of all, you can see from the international comparative charts that there is an anomaly in the UK and Netherlands for recovered cases - their numbers were abnormally high as reported. Furthermore, unlike most EU countries, the UK is struggling to lower their numbers yet feel pressure to open their economy without measurable changes to their epidemiological curve. This curve is similar to Sweden's -with little direction either up or down and thousands of new cases daily. As a comparison - Germany has 380 new cases today, Italy has 992 (still much better than they were), Belgium 307, Netherlands 270. The UK has not broken the pattern and remains even more active than the peaking Eastern European countries such as Romania, Poland, Ukraine...

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A point of hope - death rates have been on a downward trend with each wave/iteration lower than the previous one. So even though total cases is going up the death rate is being reduced, which is a good indicator of progress. Many countries and states are using a combination of these factors in determining the rate or "re-opening". This indicates that there is an improvement in treatment options for critical cases or prevention of cases from becoming critical. The current holding pattern of new cases (epidemiology curve) indicates that social distancing measures are not sufficient - the disease continues to spread.

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This is the data collection or reporting issue UK is having, as is Sweden and a few other countries - UK is not updating or possible collecting the data about recovered cases. This means the "active cases" number is inaccurate. Proof: PM Boris Johnson officially recovered on April 27th but even his recovery did not get recorded in national statistics... This is a critical error for countries and states. Understanding the accurate % of active cases in a community/ county/ state/ country is important in measuring the risks to the population. Germany has an 85% recovery rate with 17,537 active cases. We just do not know what is going on in UK, so very difficult for policy decisions to be made. This will impact opening borders to other countries. Israel is looking at criteria for re-opening tourism and travel - and among the measurements are the figures discussed above. The UK is either not collecting this data, not testing for recovery markers, or not reporting the data to the international community. All three of those are bad ideas. Transparency is key to opening the borders. After one of the group members from Teaneck, New Jersey (my hometown) mentioned the lack of info available to the public, I discovered that NJ does not record data about active cases/ recovered cases per county or community/town/ city. This is information that can help communities, towns, counties determine the risk to its citizens. People want to go back to work safely, want to go shopping and go to the bank, they want to send their kids to school if possible, and eventually want to open public facilities. Decisions must be "data-driven" or based on objective health / epidemiological data if it is to be intelligent and assure the best chances for returning to relative normalcy.

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This chart from Germany indicates that they are moving in a positive direction, as is Israel. I cannot even gather this data from the UK, making decision making challenging for people and other governments. Lufthansa is starting to fly to Israel because of this chart... Let's hope other countries catch up!


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Day 83:

Israel total cases 16,548 (19 new) with 264 deaths (4 new). Less than 100 new cases daily in the last 12 days. We have averages 22.4 new daily cases in the last 5 days.

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61 Critical cases (we have had less than 100 for the last 11 days); 52 people on ventilators (less than 100 for the last 19 days).

 
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Israel's epidemiology curve - a very clear picture.

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Switzerland's epidemiology curve as a comparison- clear pattern. we have been comparing ourselves to Switzerland because of similar population and same timing. Switzerland got hit harder (see the actual numbers on the scale - much higher than Israel) but they started recovering earlier.

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A very big difference when we look at Sweden's epidemiological curve - no real pattern - just wave after wave. Sweden has had no real shut down of the economy and no mandatory social distancing. They are languishing in this pattern for the last 2 months, while most countries peak clearly and then decrease cases.

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Israel's case resolution: 73.9% recovered. 1.6% died. only 4,052 active cases remain.

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Of all countries (whether developed or not, whichever hemisphere, whatever testing policy or capabilities) with more cases than Israel (or similar) - these are the case fatality rates - or deaths as a proportion of total cases.

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These same countries - looking at the proportion of deaths among the resolved cases. Low numbers indicate that many more people have recovered. World average: 15.3% deaths out of resolved cases.


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Day 82:

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 Israel cumulative cases: 16,529 (23 new).

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Bi-weekly averages show that we have been on a declining long term trend since mid-April. Last week we had 34.3 average daily new cases compared with 477 average daily new cases in early April.

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260 deaths (2 new) which is a case fatality rate of 1.57. 73.1% of all cases have recovered. Israel now has 4,186 active cases. Of these, 66 are critical (out of which 55 are on ventilators).

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We took a look at the OECD (developed) countries by population per square kilometer to see if there was any relationship with more crowded countries and higher death rates - we did not find a rational relationship. 

These countries are in order of population density, with Australia having the lowest population density. There appears to be no pattern at all. Note that Israel has a relatively high population density among these countries (small country) with 415 people per square kilometer, yet we have an excellent management of the disease, while Belgium with a similar population density has a much higher case fatality rate.

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Among OECD countries, Israel has a low rate of deaths per 1 million population, a measurement that neutralizes the testing variability between countries.

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>When we look at US states as countries (instead of the cumulative USA with 50 different health policy bodies etc.) we see that among states with 10,000 cases or more (26 states) ALL of them have higher case fatality rates than Israel, and there is a wide range. This chart includes every country with the same or more cases as Israel (whether testing reliably or not). Some global trends to look out for: Western Europe, on the whole, is on case decline, while Eastern Europe is on a sharp rise. Russia has had over 10,000 new cases daily for many days and will soon surpass Spain as the highest case count in Europe. (projected by the end of the week). In the southern hemisphere - South America (led by Brazil who will overtake Germany and France this week) and Africa are also being hit hard, although few countries there have peaked. Many African countries have inadequate testing facilities and resources, and we expect many cases to be unrecorded. Middle Eastern Countries are also seeing increasing cases. Countries like Syria, ravaged by war and unrest will be unable to legitimately record cases. Yemen has been facing war and unrest for years, accompanied by disease and malnutrition - and their ability to test and treat their increasing cases is poor. The German press has reported an upsurge in cases following a relaxation of restrictions. Germany has been lauded as Western Europe's model for COVID management with 900 new cases this week. There is an evaluation to reconsider the speed of the "re-opening" of markets.  Singapore has seen an upsurge of cases, although their critical and death rates have been among the best in the world.


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Day 81:

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Day 81 (night of Lag B'Omer) total cumulative cases in Israel 16,506 with 29 new today. Deaths: 258 (6 new) leaving Israel with a case fatality rate of 1.56%.

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66 critical cases (lowest since March 29th) 58 people on ventilators. As we can see, on a daily basis there is a strong correlation between the reduced number of ventilator patients and deaths. Many people on ventilators do not survive. Total recovered cases 11,843 (3.4% increase since yesterday)

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71.7% of all cases have recovered with only 4,405 active cases left.

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Of resolved cases, worldwide there have been 15.85% deaths. Countries like the UK and Netherlands have so few recovered cases that their death % seems very high. This is skewed accordingly. 

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Case fatality rates for all countries with same or more cases as Israel of countries that are relatively developed with reported reliable testing.


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Day 80:

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Today is day 81. Israel's total cumulative cases are 16,477 (23 new cases today).

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Active cases: 4,795. New Cases account for 0.14% of all cases. Total deaths 252 (5 today). Total recovered: 11,430 - or 69.3% of all cases. From this graph, you can see that the % of recovered is slowing. We have been in the 60-70% range for 8 days. This is normal as it takes 3-7 weeks for cases to resolve.  Israel's case fatality rate is 1.5%.

 
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As a comparison, Switzerland which has a similar population and developed COVID within days of Israel has had a cumulative 30,305 cases, an 87% recovery rate and a 6% case fatality rate. Israel has more than double the number of active cases as Switzerland.

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Israel has more critical cases than many developed OECD countries, yet we remain in a much safer zone than most of Western Europe/US/Canada. Many of the critical patients die, which is why we are keeping an eye on these numbers (as opposed to absolute numbers that do not account for country size).  City statistics are released daily with little difference accounted for. There are new restrictions for Ramadan, as there are some major resurgences in Arab towns and neighborhoods.


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Day 79:

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Israel total cases 16,454 (18 new today; 55 new yesterday).  remember that in this chart - the blue line of cumulative cases, now flattened, does not come down. The orange line of active cases will drop, and the grey line representing recovered cases will rise to nearly the level of cumulative cases (less deaths).

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We have 79 critical cases (one more since yesterday) and 64 people on ventilators. We have had 247 deaths (2 today and 5 yesterday). I urge everyone to consider that we still have 4,703 active cases in Israel, and people are still critically ill, even if in smaller numbers.

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Although we are on the down side of this epidemic wave, we are not out of danger. People must continue to wear masks, to keep apart from others, even if rules have been relaxed regarding first degree relatives. These are the keys to maintaining a more open (but safe) economy. Not wearing your mask endangers those around you. Wearing your mask is selfless and protects the community.

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The OECD is the Organization for Economic Co-operation and Development. It is an intergovernmental economic organization comprised of developed countries to stimulate economic progress and world trade. It is a forum of countries describing themselves as committed to democracy and the market economy, providing a platform to compare policy experiences, seek answers to common problems, identify good practices and coordinate domestic and international policies of its members. Most OECD members are high-income economies with a very high Human Development Index (HDI) and are regarded as developed countries. This index covers countries throughout the world who are of high socioeconomic and democratic status, so comparing these countries is closer to comparing "apples to apples". We expect to understand in greater detail how these countries acted differently that changed the deaths rates and infected rates. Some factors include testing strategies, border closures, social distancing measures, and adaptability. Europe has been particularly affected despite a range of policies, likely related to open border policies with EU states.  Israel has several advantages: one major international airport, tightly controlled borders, early border closures from affected countries, social distancing orders - early and well maintained by the majority of people, adaptability to times of stress (by the population), ability to close down cities/neighborhoods, and tracking of residents to provide early fast information about exposures.

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New cases are trickling in. but none of the cities we are tracking (and were considered the highest risk 1 month ago) have case growth over 5.5%. Highest growth cities: Beer Sheva with 5.4% in the last 6 days and Beit Shemesh 5.25% in the last 6 days. Jerusalem cases have dropped to 2.28% growth rate in the last 6 days, which is the lowest rate since the outbreak began. Tomorrow begins the nursery schools/ ganim and a few other openings. Please keep in mind that we do not know how each opening will affect the national picture - so use strict precautions when returning to "normality".  A few people asked id they should be concerned about daily case fluctuations such as daily new cases creeping up. The answer is no. day-by-day data is of little significance when tracking a disease pattern. Too many variables can account for a one day spike. The overall trend needs to be accounted for. The downward slope of the epidemiology curve is a slow one and it is unlikely that we will be completely rid of this disease before the second wave comes, even if things go well until then. For a disease to be considered "cured" 2 incubation periods must pass with zero new cases. In this case - 28 days. But opening up the economy is appropriate if trends continue to remain low, even if not for high-risk people at this stage. Tomorrow outdoor gatherings may occur for up to 50 people (with masks and 2 meters apart) including davening and religious events (weddings, bris etc.). Many people have relaxed with mask use and social distancing, particularly the younger population of adults. Emphasis must be to re-educate our family members as we are responsible even more than before to prevent disease from affecting others, particularly those at higher risk. COVID has not disappeared as you can see - and as inconvenient as these rules are, they keep our families safe. Now that our homes can once again be opened to immediate family members and even healthy elderly, we must be even more careful than when we were on full lock-down. A mask is a selfless act to protect others, and the middle age and older adults who are keeping the rules are not being protected by the populations who are most likely to have the disease.  The most common ages for this illness in Israel: Ages 20-29: 23.1% of all cases. Ages 10-19: 15.1% of all cases in Israel. With the exception of very young children, the COVID diagnoses in Israel go down for each decade of life. But the people dying are the populations that rarely get the disease. So the YOUNG must protect the older.

 


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Day 77:

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Total cases 16,381 (71 new) with 5,268 active cases in the country. We are not sure why the daily "new cases" being reported by the MOH is not adding up to the actual released numbers - but we are reporting accurately.

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The percentage of new patients daily has been less than 1% for the last 9 days. The trend line indicates a sharp downturn.

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In developed or near developed countries with same or more total cases as Israel, the critical cases per million is indicative of how concentrated serious cases are, indicating potential problems with medical capacity for higher rates. The USA with 50 states is peaking in different states at different times. We will look at this in another way shortly. Some people state that Italy with a higher percentage of elderly than other European countries would have more serious cases, but they are currently managing relatively well compared to countries with similar caseloads, such as Spain.

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Even though Israel has slowed down testing in recent days due to low rates of illness (and low rates of diagnoses) - Israel remains a country with very high testing rates relative to the population.

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Yesterday we did not have data for Netherlands or UK, but we calculated that they have extremely low rates of recovery now, as both are peaking in case loads. In UK 85% of total cases are still active and 14.8% have resulted in deaths. So recovery rate is very low. This skews the data, but currently since most resolved cases resulted in death - this is the accurate chart.

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Of OECD (developed) countries, Israel's case fatality rate remains very low. The total world average is 6.91%. In evaluating worldwide epidemiological data, there is grave concern about extremely high new cases in Russia (11,231 new cases today alone), UK with 5,614 new cases today, and over 3,000 new cases in Peru, New York, & Spain. In the USA. the states with the highest new cases in the last day include New York (13.2%); California (7.4%); New Jersey (5.3%) Illinois (8.9%), Massachusetts (6.8%).  New cases in Brazil (and South American countries) are very concerning as they have not yet reached their peak and have poor resources relative to the Northern Hemisphere.

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If each US state was considered a country, the top countries with the same of more cases as Israel would include 19 US states. Case fatality rates are highest in Michigan (9.51%), Connecticut 8.8%, New York (7.82%, and Louisiana (7.2%). I urge caution for people to take it very slowly in returning to normal activity because the virus does not know boundaries. As time progresses we will see clearly if it safe to resume mall-going and gyms, but in the meanwhile take it slow. The gung-ho folks will go out immediately, while much of the population realizes that we have lived for weeks without malls and a couple more weeks are not going to hurt us. Most of us. There are discussions about opening up travel and how to set our parameters for doing that. The delicate balance of freedom of movement, economy, and health is challenging for every country in the world.

 


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Day 76:

 Israel total cases 16,310 (21 new cases) - our fifth day with less than 100 new cases. As the economy opens more, we are all keeping our eye on this critical number. One of the cut-offs for the continued opening of the economy is 100 new cases a day. At this rate, Israel would double the infection rate in 700+ days.

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Israel currently has 89 critical cases (lowest since March 30 when we had only 4,695 cases); We have 69 ventilator patients (lowest since March 31). 239 people died (1 today). Let us remember that these numbers are significantly delayed from onset of symptoms. Most people represented here have been sick for 3-5 weeks or longer. The virus can take up to 7 weeks to clear from an infected person. The more critical cases have higher viral loads which takes longer to heal from.

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Our epidemiological curve looks good, especially considering that we are 2.5 weeks after opening the economy began. We will look for a possible "bump" within 2 weeks of when schools opened this week, and within 2 weeks of when malls open tomorrow.

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My favorite graph. 65.2% of all cases have recovered, which is a remarkably good percentage relative to the world, as we saw in yesterday's graph.

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Case fatality rates as compared to % deaths in resolved cases

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Please note that the Netherlands and UK are not measuring or reporting recovered cases so they are not included in this chart. These 2 charts show that the case fatality rate may not reflect the countries with higher rates of deaths as outcomes. Portugal has a 4.16% case fatality rate, which is well below international averages (especially in Europe). But 34.41% of resolved COVID cases resulted in death. This means the CFR is skewed by the large number of active cases they have that have not resolved. Switzerland and Israel have even numbers - the CFRs reflect pretty accurately what resolved cases look like.  An example of this is Efrat - where almost all 64 cases were diagnosed shortly after Purim. 14 people still test positive and are not considered "resolved" - so it is a virus that lingers for some time and those "recovered" figures are not calculated into these statistics.

 


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Day 75:

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Israel total cases 16,289 (43 new). Israel has 91 critical patients with 70 on ventilators. Total active cases 5,586 (and dropping)

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64.2% of all cases have recovered. 1.46% have resulted in death. A reminder that this chart's bars are always 100% of total cases. so if a week ago we had 15,800 cases and today we have 16,289 cases total - each bar represents the number current for that day and the percentages are adjusted accordingly.

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Of all countries with equal or more total cases as Israel, this chart looks at resolved cases ONLY - not deaths as a percentage of total cases (including active ones that have not resolved yet). This is perhaps a more accurate way to look at the death rate comparison per country. We do not know how current active cases will resolve.  In discussing Sweden in the last few weeks, as a country that did not shut down its economy with a plan to pay in lives for "herd immunity" that is not believed to exist for this disease - their death rate in resolved cases is highest. Out of the 3.7 million recorded cases of COVID in the world - 17.22% of resolved cases were people that died. 33.29% of the total world recorded cases have recovered.

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The great news is (as evident from our low national numbers) - the hot spots are resolving and of the select cities in this graph - none have growth rates over 10%. Two Arab towns have higher growth: Hura (21% growth of cases in the last 3 days) and Mag'd Al Krum (11.8% in the last 3 days).

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These are the select cities in a pattern that is recognizable from the post-Purim surge to a second, smaller surge post-Pessach. Some cities were able to control their outbreaks early and it has been sustained. These cities were initially considered the most high-risk cities in Israel where outbreaks were significant.

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A neighborhood in Beit Shemesh and a few neighborhoods in Jerusalem will remain under closure until the hot spots are controlled. Out of total cases in Beit Shemesh, 49.7% have recovered and 8 people were diagnosed in the last 3 days. In Jerusalem, 55.5% of cases have recovered with 30 new cases in the last 3 days.


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Day 74:

 

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 Israel total cases 16,246 (38 new). 61.9% of cases have recovered and active cases have fallen below 6,000 for the first time Since April 1.

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Deaths 235 (2 new) with 90 critical patients (lowest since March 31) and 70 ventilator patients (lowest since March 30th) 96.7% of patients have mild symptoms only.

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Epidemiology curve is a positive one. Please see the video today on using the logarithmic scales to track rates of change in cases internationally. This will augment your interpretation of the epidemiology curve.

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This is a screenshot of the logarithmic trajectory select countries are on with Israel highlighted. Israel is now on a sharp downslope trend-wise, which is why restrictions are letting up quickly but carefully. The government has determined that the standard is 100 new cases a day as an indication that more restrictions are needed. SLOW integration of relaxed restrictions is needed to assure a return to normal. As a result of the low rate, Israel has slowed down testing from a peak of 16k tests a day to 5-7 thousand tests daily in the last 3 days with less than 1% of tests having a positive results. Many people with symptoms now just have viruses (normal ones) or allergies. A week ago positive test rates were 1.6% (which is also incredibly low).

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Many of you may recognize this chart from the prime minister's speech today. It is the case fatality rate for OECD countries worldwide. Another video from today discusses how the coronavirus affected Jewish communities around the world - disproportionately (and this wave is not over).  Japan's CFR is now 3.27%. The states hardest hit in the US are also among the states with the largest Jewish population in the US. And within those states, the Jewish community suffers a disproportionate number of cases and deaths.


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Day 73:

Israel's total cases 16,208 (23 new cases). We have not had these few new cases since March 15 (when we had 213 total cases). Deaths 232 (3 new).

 pic 1  

Critical cases 94 (11 less than yesterday), total active cases 6,227. We have 76 ventilator patients (decrease of 8)

 pic 2  

60.1% of our total cases have recovered. 1.4% have died.

 pic  

Our epidemiology curve looks pretty good now - recovery rate is currently over 6 times the rate of new cases. At the peak of activity we had 9,923 active cases (April 14) and we have reduced that number by 38%.

 pic 4  

In the selected countries - we can see the vast difference between death rates per million population in developed Asia and Europe/ America. Israel falls in the middle but closer to developed Asian countries.

 pic 5  

Case fatality rates for countries with the same or more total cases. Unfortunately, Belarus did, in fact, surpass Israel today as anticipated.

 pic 6  

The 2 areas with over 10% growth of numbers in the last week include Yehud and Beit Shemesh. Areas of NO growth include Herzelia, Efrat, Tiveria, Kiryat Yearim. All other chart cities have a growth of under 10% this week. Although there are some areas we saw in Jerusalem which are flaring "hot spots" and have since been quarantined, the rest of the city seems to be improving and there seems to be a decent level of containment.




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Day 71:

1 graph

Israel totals cumulative cases 16,185 (84 new). Last time we had so few new cases was mid-March. We have 6,360 active cases with 59.3% of all cases recovered. Israel is replicating patterns seen in recovering European countries, such as Switzerland. The USA and other European countries in more acute situations are a few weeks behind us on the curve. The USA's major case numbers also started well after Israel's - so keep in mind for timing.

 2 graph

Critical cases 105 with 84 on ventilators. 97.4% of current cases are considered mild.

 
 3 graph  

ase fatality rates of ALL countries (as they report and test cases individually) with the same or more caseload as Israel. Of major concern here: Brazil's numbers have jumped and all other South American countries are starting to surge. Southern Hemisphere tends to be a season behind, although many countries have had mild numbers of cases to date (Australia, New Zealand). The developing countries in the Southern Hemisphere fare far worse than developed countries, although with poor accessibility to testing and reporting, the actual figures may be heavily underreported and number skewed accordingly. Some other countries of grave concern: Belarus, who will exceed Israel's case numbers by tomorrow, surges in Arab countries such as Qatar, United Arab Emirates; the reemergence of COVID in Singapore and Japan, both of whom were stabilizing. Japan opened restrictions in specific prefectures before cases were well controlled, which is believed to have triggered the increase. The national state of emergency will be extended a month in Japan.

 4th graph  

Deaths per million people normalizes the testing policies between countries to see how the disease is being managed.


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Day 70:

pic 1

 Israel 15,946 cumulative cases (112 new). deaths 222 (7 new); Recovered 8,561 (53.7%)

 pic 2  

The peak activity for this wave appears to have been in early April. Most new activity in Israel is confined to current "hot spots" (details coming).

 pic 3  

My favorite graph - most cases have recovered. Recovery numbers continue rising and mortality rate is stable

 pic 4  

Critical cases 105 (lowest since April 2 when we had 6,857 cumulative cases)

 pic 5  

case fatality rates are a proportion of deaths of total cumulative cases. We have included data from developed countries with same or more cumulative cases as Israel. World CFR is 7.07% (do you remember when people discussed 2-3% mortality rate back in February?) Singapore - another topic for discussion today's video - started slow but has surged in recent weeks. They started this new wave when Israel peaked in early April. Their mortality rate is among the lowest in the world.

 pic 6  

Critical cases per million tells us about the management and severity of cases. This also speaks to the resources being used for critical patients. higher numbers indicate higher peaks of the epidemiological wave.

 pic 7  

Among these countries, Israel has the highest test rate. This includes the developed Asian nations.

 pic 8  

Deaths per million reduces statistical error from CFR by eliminating the differences in testing requirements/ standards. Some countries test often and others require critical illness before testing. Israel is somewhere in the middle. About 16.3% of tests are for post-positive patients being re-checked. Most people require 2-4 tests for a negative confirmation.

 


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Day 69:

pic 1

Israel Cumulative Cases: 15,834 (106 new). Today we crossed a major threshold - Israel now has more recovered cases (52%) than active cases! This graph shows the recovered patients vs active cases and the total of cumulative cases

 pic 2  

Critical patients: 115 or 1.5% of all active cases. Ventilator patients: 1.2% of all active cases. Deaths 215 (5 today).

 pic 3  

The epidemiology curve shows that we are continuing on a decline off of our peak a month ago.

 pic 4  

Our new case rate is less than 1%.

 pic 5  

The yellow arrow indicates a 10-19% increase in cases in the last 6 days.

 pic 6
   pic 6 2
 

This is a comparative trend analysis of these cities, which were early on identified as high-risk cities in Israel. Many of them have stabilized but it shows clearly where the peaks were by date. The percentages reflect the change in the last 6-10 days (depending on the availability of data). In the next few days, we should start seeing if the easing of restrictions had an effect thus far on cases.

 


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Day 68:

pic 1

Israel total cases 15,728 (173 new). This is the epidemiology curve based on new cases per day

 pic 2

A Ph.D. student in Vietnam published this to demonstrate different kinds of epidemiology curves. (Vo Huu Thuan, 2016). This is for food-borne illness but the graphic represents different types of exposure. No beautiful symmetrical bell curves here. The type of illness, when it is identified and managed, how long incubation periods are, and source of spread (in our case person-to-person) determines the type of curve we have.

Person to person is considered a "Propagated source" because the virus does not have a common source (like spoiled food), but is spread from one susceptible person to another; transmission may occur directly (person-to-person) or via an intermediary (object, for example). This type of curve tends to have a series of irregular peaks, reflecting the number of generations of infection (one person spreads to 3; 3 people spread to 9, etc); peaks are usually separated by an incubation period, but in seasonal viruses, which this is believed to be, the "bumps" may get smaller as the season's change (until a second wave).

 
 pic 3  

Total deaths 210 (6 new); Critical patients - 116 (lowest since April 3); Ventilator patients - 92.

 pic 4  

49.4% of all cases have recovered. 1.3% have died. We currently have 7,746 active cases in Israel.

 pic 5  

For those who have been following our posts for a while, you may recall Switzerland's Case analysis when their recovered patient percentage started rising rapidly. Ours was pretty flat because Switzerland had an earlier peak than Israel (even though we started about the same time and we have a similar population). Switzerland had a 49% recovery rate on April 12, so we are 2 weeks behind percentage-wise. When their recoveries started some people questioned what we were doing wrong or what they were doing right. Bottom line: they had more cases, higher case fatality rates, and lower testing per population. They did a test earlier, and faster than Israel did (although we have surpassed them now). hard to understand the variance but important to see where we are going.

 pic 6  

Sweden, on the other hand, believes that herd immunity will work (even though no epidemiological or infectious disease experts have evidence of immunity). Their recovery rate is currently 5% with a 12% death rate.

 pic 7  

In Critical cases per million population, Israel falls well below Europe and well above developed Asia. I have added the UK to the analysis due to requests.

 pic 8  

Covid deaths per million population smooth over testing gaps between countries and is a good indicator of how well countries are doing with their sick. The UK is better than most of Western Europe but developed Asia beats us all. This is why there is chatter about different strains in different regions. It is too early to know.

 

 


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Day 67:

pic 1

Israel total cases 15,555 (112 new). Lowest new number since March 20th. On March 20th we had 705 cases, which had doubled from three days earlier. That was the beginning of the post-Purim surge that plagued Jewish communities in Israel, the US, and parts of Europe.  Deaths 204 (3 new) representing a 1.3% case fatality rate (deaths as a proportion of all diagnosed cases).

 pic 2  

Critical Cases 126, Ventilator cases 96 - both of these numbers represent the lowest rates since April 4. When looking at this remember - the virus peaks relatively quickly and goes down slowly. This is not a bell curve type chart.

 pic 3  

Recovered: 7200 (469 new) representing 46.3% of all cases. There are currently 8,151 active cases in Israel, lowest we have seen since April 5th (when we had 8,430 cumulative cases and only 6.4% recovery rate. The new patient percentage is the lowest recorded since we have had since getting new cases daily at 0.72%. This is still representative of 112 people but is a lower proportion.

 pic 4  

A follower of this chat asked the question about some of the developed Asian countries - full explanation in the video for today (that will be posted in the morning). Basically - we will look through these select countries and see what the charts explain about testing vs social distancing enforcement in understanding the position Israel is in relative to Europe and developed Asia.

 pic 5

Israel's testing rate per population is higher than even those developed Asian countries.

 pic 6  

This chart includes countries with the same or more total cumulative cases, excluding developing countries or countries with inaccurate reporting.

 


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Day 66:

Israel total cumulative cases: 15, 443. 145 new cases today, the lowest number seen in 37 days at least (some controversy about tests at day 37-38 because of poor Shabbat reporting).

   

Deaths: 201 (2 today); critical cases: 133; ventilator cases 99 (tied with yesterday the lowest numbers since April 4th). Reminder that These are delayed indicators as people who are now critical became sick 2-5 weeks ago.

 pic 2  

43.5% of all cases have recovered. This is my favorite daily chart because it is finally moving. AGAIN - delayed. People must have 2 negative tests to be considered "recovered". This can take 2-6 weeks after the initial infection.

 pic 3  

Israel's case fatality rate is 1.29% or 5.3 times lower than the world average. This chart has developed countries with same or more cases as Israel and who are not "underreporting" (China and Russia).

 pic 4  

The video from today (to be posted in AM Israel time) explains why this chart is important: it eliminates the fluctuations per country for testing policy and availability. Some countries have very high testing rates per population, but their management of cases regardless of testing policy is measured here in an equal way.

 pic 5  

Of those same countries, Israel has the highest testing rate per capita, with 3.52% of the population tested to date. In the video today we will discuss the politics behind the sudden "opening up" of the market places and being smart vs being right. We will discuss the myths about immunity including a review of other coronavirus disease immunity. We will also discuss how social distancing is impacting vaccines in Israel and how that can impact us.  As of this morning, the government performed 300,565 tests. In all countries, the test number includes repeat testing for people who were positive

 pic 6  

The spread over the last week included Beit Shemesh decreasing to just under the 30% threshold, although 29.36% is still high - going in the right direction. Modiin Ilit, Raanana, and Jerusalem increased their rates by 20-30%. Bnei Brak, once the hotspot in Israel increases cases by 16% in the last week - vast improvement from the 60% of 2 weeks ago! All of the hot spots in Israel are now in Arab villages, several of which are on a shut down, even as they enter Ramadan. The Palestinian Authority is also having upsurges, indicating that like ultra-orthodox Jewish population - the Arabs have a tendency to follow the epidemiological path of their co-religionists more closely than their geographic neighbors. (I studied this during my doctoral studies in other health areas)


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Day 65:

WhatsApp Image 2020 04 25 at 11.57.56 PM

Israel Total cumulative cases: 15,298 (240 new).

 

 pic 2  

As of tonight, 199 deaths (6 new since Thursday); 127 critical (12 less than Thursday); 99 ventilator cases (10 less than Thursday)

pic 3  

new case numbers (epidemiological curve) remains on a down trend

pic 4  

42% of all cases have recovered.

pic 5  

We are back down to 1.57% new cases daily

pic 6  

Case Fatality Rate currently 1.31%. The problem with CFR is that most countries are not testing all people who are sick, while many people remain asymptomatic or minimally sick (and therefore do not qualify for testing). CFR is very accurate for a disease like measles and flu where everyone gets sick. Another, probably more accurate way to analyze how well a country is doing is to look at COVID deaths per million population. This removed the error of under testing and tells us how well a country is managing cases.

pic 7  

This includes all countries with the same or more cases as Israel but excludes developing countries, who often do not have resources to test en masse (India, Peru, etc). We have also removed countries with highly inaccurate reporting, such as China and Russia.  The opening up of shops and loosening of regulations is being criticized by the Ministry of Health officials as being done under pressure from other government bodies. Normally, we would want to see how well the country was doing with the lifting of restrictions this past Sunday over the following 2 weeks. The Minister of Health quit today in protest. What does this mean for us? It means that people should consider waiting longer before venturing out for non-essential shopping, avoiding socializing, and maintaining social distancing until we see how the country fares with the new regulations. The virus is still active, and the virus knows no regulations.


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Day 63:

 pic 1

Israel Total Cumulative Cases 14,803 (New cases 305). This is an overview of all cases since February 21 when our first case was diagnosed. The cumulative cases you see from the last few weeks are flat (see yesterday's charts) but were not providing an overview of where we are. This is a better picture for reference.

 pic 2  

Total Deaths: 193 (4 today); 5,611 recovered or 37.9% of all cases. Critical Cases: 139; Ventilators: 109

 pic 3  

sometimes testing issues result in temporarily inflated numbers that are not long-lasting (in this case -a day). We suspect that explains yesterday

 pic 4  

As mentioned - 37.9% of cases are recovered with 1.3% case fatality rate. Green is Good!

 pic 5  

New cases rose by 2.06% today.

 pic 6  

Among the countries with the same or more cases as Israel, Israel has one of the highest testing rates. These figures are from 22 April when the latest data was available. Israel is testing roughly 11-13,000 people daily and just signed contracts with companies to perform thousands of additional tests daily. Timing of implementation is unknown

 pic7  

Israel's case fatality rate remains the lowest in the developed world. Countries selected include countries with same or more total cases as Israel. Some countries, such as China, have not reported their cases an mortality rates accurately. Most epidemiologist believe that this virulent disease is much more wide spread than number being gathered by tests. This would significantly lowers CFR. For example - a country with 100,000 REPORTED cases and10,000 deaths has a 10% CFR. If in fact there were 200,000 cases the CFR would be 5%. If there were 300,000 cases the CFR would be 3.33%

 pic 8  

City-by-city most hot spots have stabilized and have been downgraded to a reasonable level of growth. In the last few days, there has been a spike of new cases in Beit Shemesh leading authorities to consider shutting off the more infected neighborhoods. In the last week, there was a 30.6% increase in new cases, particularly in Ramat Beit Shemesh Aleph and Bet and the Kirya areas. Although Jerusalem remains at an infection growth rate of 21% in the last week, this is a significant decrease since the 59% growth rate we saw less than 2 weeks ago - better trending. Understand that the highs and lows of this chart are not as important as the increases between measured days. larger cities, like Jerusalem, have a relatively low rate of illness per population but have the most cases in the country with 3,061. Once diluted into a population of 914,559 - the actual infection rate per population is 0.33%. We are looking at trending changes between short periods of time in areas that were originally defined as "high risk". 

In the last week, Bnei Brak increases cases by 16.9%; Ashdod by 10.6%; Elad by 15%; and Beitar Ilit by 14.1%. These are significant improvements from where we were a week ago. Areas that were shut down have been reopened as a result. 

2 concerning trends that should be tracked: Raanana, which was doing well throughout this pandemic relative to its population, has a 28% increase of cases in the last week. That is the highest percentage increase seen yet. Modiin Ilit remains at a 22.1% increase but this is a decreased overall trend for a hotspot, although not as much of a decrease as other similar cities fared under lockdown.


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Day 62:

WhatsApp Image 2020 04 23 at 12.08.33 AM

Israel total cases 14,498 (556 new). We have not had this many new cases in 13 days and this "bump' may correlate with Seder night/pesach violations of social distancing. although fluctuations are normal and anticipated, many of us witnessed flagrant violations of the "stay at home" law over the holiday, including with public officials. We hope this does not become the beginning of a new increased wave of cases over the next week or so.

 pics 2  

Critical cases - 141. Ventilator patients - 106 (lowest level in 19 days). Deaths - 5 new (189 total).

 pics 3  

The sudden more than doubling of our new cases has caused a "bump" - whose significance we will see in upcoming days.

 pics 4  

36% of total cases have recovered! 9,094 active cases (lowest number in 13 days).

 pics 5  

New cases % for today is 3.84 - highest since April 10th. Israel has tested 11-13, 000 cases daily in the last few days, so testing capabilities is increasing. Antibody testing has not been publicly addressed for the public, which is the direction many countries are going in.

 ics 6  

The world case fatality rate is now 7%. Israel is 1.3%

 


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Day 61:

pic 1

Day 61 Israel total cases 13,942 (229 new; 9,251 active).

 pic 2  

ALL numbers on this chart reflect people who have infected an average of 2-5 weeks ago. Critical cases 139 (10 less); ventilator patients 113 (6 less); deaths 184 (7 new). The decreased number reflects changes to social distancing that occurred 2-5 weeks ago, as these are delayed indicators.

 pic 3  

We seem to have stabilized at 200-280 new cases daily (average 240 new cases daily in the last 6 days).

 pic 4  

32% of the total cases have recovered. 1.3% have died.

 pic 5  

In last 6 days, there has been an average new patient rate of 1.8% (today 1.64%).  Among the countries with the highest patient rate - Israel has the highest population percentage that has been tested. we are averaging 10,000 tests daily. 12,000 were performed yesterday.

 pic 6  

Case Fatality rates show a worldwide average of 6.92%. Israel is 1.32%. Our big concern is for the Southern Hemisphere countries in Africa and S. America who are starting to get many cases and have poorer populations and health systems. The only protective consideration is that the average life span is shorter in most African countries, so fewer elderly will be infected relative to the population. High rates of tuberculosis and HIV, however, mean a higher rate of younger immunosuppressed patients.  African country life expectancy ranges from 52.9 years (Lesotho) to 74 years (Mauritius) Average is 62.1 years.

 


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Day 60:

pics 1

 Israel total cases 13,713 (222 new; 9,487 active); Deaths 177 (5 new)

 pic 2  

Critical cases 149; Ventilators 119 (10 more) this may be a normal variance in the downturn of activity.

 pic 3  

Less than 300 cases per day for the last 6 days. doubling our cases every 19 days... which is flat.

 pic 4  

1/3 of all cases led to recovery, which is more than doubled where we were a week ago.

 pic 5  

New patients increased by 1.62% today, we expect these numbers to naturally drop and the total patients rises (and the proportion changes). The danger sign would be a sudden increase in the percentage.

 pic 6  

Test rate. In the video today (released in AM), I discuss the conflict between the test rate and social distancing. neither works without the other. Of countries with more or about the same total case numbers as Israel, Israel has the highest test rate. this includes many countries that were lauded for their high testing rates. Israel plans to increase testing to 20-30,000 daily which would give people the ability, once immune, to not have to perform social distancing. This would also help capture the asymptomatic carriers among us!

 pic 7  

Long term we will need to see the entire picture of economy impact vs lowering the curve with social distancing, but we do know that Israel is in an excellent place in terms of managing this disease and reducing the fatalities.

 


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Day 59:

WhatsApp Image 2020 04 20 at 2.07.17 AM

Israel Total Cases 13,491 (226 new; 9,565 active). 30 days ago we had 883 cases and 1 death.

 WhatsApp Image 2020 04 20 at 2.07.17 AM1  

Critical cases 146; ventilator patients 109 (7 days ago we had 183 critical and 133 ventilator patients). Total Deaths 172 (8 new).

 WhatsApp Image 2020 04 20 at 2.07.18 AM  

Cases per day continue to be on the decline, but we have been over 200 cases for the last few days.

 WhatsApp Image 2020 04 20 at 2.07.19 AM  

28% of the total cases are recovered.

 WhatsApp Image 2020 04 20 at 2.07.19 AM1  

The case fatality rate of 1.27%. Belgium is the country with the highest case fatality rate (consider the inaccurate reporting by some countries). World CFR is 6.87% and slowly rising.

 


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Day 58:

WhatsApp Image 2020 04 19 at 1.28.11 AM

Israel Total cumulative cases 13,265 (9,645 active; 283 new); Deaths 164 (13 new); Recovered 3,456 (26%). Sweden has 10 million people (Israel has 9 million), they had very loose restrictions, did not close businesses. Sweden has a similar case rate to Israel 13,822 but with a mortality rate nearly 10 times ours. I am proud to live in a country that is safe and protects our vulnerable populations.

 WhatsApp Image 2020 04 19 at 1.32.48 AM  

last 3 days we had less than 300 new cases daily. testing has been 9-10 thousand daily.

 WhatsApp Image 2020 04 19 at 1.34.39 AM  

The critical and ventilator rates are similar because by definition everyone on a ventilator is critical, but these figures indicate a stabilization of the critical cases and ventilator usage in the last week. as discussed last week, these are delayed signs of a successful flattening of the epidemiology curve and evidence that the pandemic in Israel is under control.

 yesterday  

In the last few days we have had a 1-2.1% new patient growth per day. Israel is now doubling our numbers every 16+ days.

 WhatsApp Image 2020 04 19 at 1.37.29 AM  

26% of all cases have recovered. 1.2% have died.

 WhatsApp Image 2020 04 19 at 1.40.38 AM  

The "hot spots" have not yet been adequately managed, but we are seeing an overall down trend even in these cities. in the past 8 days Beitar Ilit increased their rate by 53%; Beit Shemesh 41%; Jerusalem 35%; Ashdod 33%; Modiin Ilit 36%. Good news: No new cases reported in Kiriyat Yearim, Kfar Chabad, Efrat for 8 or more days.

 WhatsApp Image 2020 04 19 at 1.54.58 AM  

Global average case fatality rate: 6.88%. Israel is 1.24%

 


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Day 56:

WhatsApp Image 2020 04 17 at 12.53.12 AM

Israel total cumulative cases 12,758 (257 new, 9,797 active). we are now doubling our cases every 15+ days. very flat curve at the moment. 143 Deaths (12 new) with 2,818 recovered (>250 today). 181 critical cases with 137 people on ventilators.

 WhatsApp Image 2020 04 17 at 12.55.27 AM  

The 10 hour meeting with PM Netanyahu and his ministers determined that some regulations can be walked back as Israel is currently in a relatively stable downturn of the curve.

 WhatsApp Image 2020 04 17 at 12.56.49 AM  

The relative % of new patients is low, but of course we are still getting more cases and testing is ongoing with a goal of 10,000 tests daily.

 WhatsApp Image 2020 04 17 at 12.57.55 AM  

22% of all cases are now recovered, and this is a great sign that social distancing and restrictions implemented weeks ago are working (please see today's video - to be posted in AM - for detailed explanation about why these figures are so delayed).

 WhatsApp Image 2020 04 17 at 12.59.48 AM  

Israel remains a safe country, if not the safest country compared to developed countries when looking at the total Case Fatality Rate. CFR is the proportion of people who get COVID-19 who die. The international average is 6.46% and Israel is currently at 1.11%. Although the CFR rate is slowly growing in Israel and worldwide, we remain on the lowest end of the spectrum. Current countries in trouble/ hitting their peak include France with 17,000 new cases today and nerly 18,000 deaths to date. Germany, Turkey are also peaking. We are concerned about Brazil, which is mostly below the equator and is starting to see cases and mortality surging even as the Southern Hemisphere enters their winter. Africa is the biggest concern for the Southern Hemisphere, as there are no developed countries on the continent. Their cases began in earnest 2 months after Europe, and they will have a delayed peak of cases.

 WhatsApp Image 2020 04 17 at 1.20.21 AM  

Red arrow: Beitar Ilit has 50% more cases than 1 week ago. Orange arrows indicate 30-40% increase in the last week. The green arrow indicates less than 10% increase in cases per city in the last week. There has been 0% new cases in Efrat since a week ago, and no new cases in Kiryat Yearim in the last 3 days. These were the original cities of concern, most of whom have successfully lowered or are lowering the spread of COVID-19.

 


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Day 55:

WhatsApp Image 2020 04 16 at 1.28.21 AM

 Israel Total cumulative cases 12,501 (455 new; 9,807 active cases); Deaths 131 (8 new after adjusting for holiday reporting); Critical 180. Case Fatality Rate in Israel = 1%. Internationally 6.5%.

 WhatsApp Image 2020 04 16 at 1.28.22 AM  

The critical case numbers have been stable and the number of patients on ventilators has not gone up in 2 days. This is potentially very good news.

 WhatsApp Image 2020 04 16 at 1.28.22 AM1  

Epidemiology curve measured by new cases per day is stable but we are looking for a more significant downturn of new cases to feel confident in the downturn of this disease.

 WhatsApp Image 2020 04 16 at 1.28.23 AM  

We are finally seeing a significant 20% of people who have recovered of all cumulative cases in Israel. This is the most significant indicator of progress that we were waiting for.

 WhatsApp Image 2020 04 16 at 1.28.23 AM1  

The percentage of new patients per day relative to total cases has been stable for about a week. Once "hot spots" are under control we should see an even more significant decrease.


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Day 53:

WhatsApp Image 2020 04 14 at 1.16.17 AM

Israel Total Cumulative Cases: 11,586 (9,615 active); Deaths 116 (11 new); recovered 1,855; New cases 3.81%, which has been consistent for a few days.

WhatsApp Image 2020 04 14 at 1.16.29 AM   

Not thrilled that the epidemiology curve is less decided- we are not out of the woods yet

 WhatsApp Image 2020 04 14 at 1.17.13 AM  

The % of new patients per day is stable but not getting lower. We expect the impact of the 1-week old closures of some hot spots to have an effect on this in the next week.

 WhatsApp Image 2020 04 14 at 1.18.40 AM  

Overall CFR is 1% compared to the world average of 6.21%. This means we are handling the cases better than the average country (and better than the average developed country). The UK has been at its peak, and some US states are also at their peak, while others lag behind and have more time to manage their epidemiological curve.


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Day 52:

WhatsApp Image 2020 04 13 at 1.31.54 AM

Israel update: Total cumulative cases 11,145 (9413 active); Deaths 105 (4 new); Recovered 1627; Critical 174.

 WhatsApp Image 2020 04 13 at 1.31.54 AM1  

Number of critical cases has stabilized over the last few days. Israel has not come anywhere close to using all the available ventilators in the country due to significant lowering of the curve. We are now doubling our total case numbers every 12 days (2.5 weeks ago it was every 3 days).

 WhatsApp Image 2020 04 13 at 1.31.55 AM  

Epidemiology Curve shows a continued downward trend, but we MUST remain vigilant and cautious as this can easily turn into a second wave if hot spots are not put out.

 WhatsApp Image 2020 04 13 at 1.32.20 AM  

The number of recovered cases are starting to increase - in the last 3 days by several hundred a day, finally putting a dent in total resolved cases as compared to active cases.

 WhatsApp Image 2020 04 13 at 1.32.20 AM1  

The percentage of new patients per day is 3.61% for today with a significant downtrend. This is a percentage of total cases so it is diluted with the larger number of total cases but is nonetheless an indicator of trends.

 WhatsApp Image 2020 04 13 at 1.32.21 AM  

The government has set objective criteria for city closures/lockdowns (see the video in the morning for details). Current "hot spots" including percentage of increased cases in the last week: Jerusalem (59%); Bnei Brak (60%); Ashkelon (45%); Beit Shemesh (40%); Holon (49%); Elad (67%);v

 


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Day 51:

WhatsApp Image 2020 04 11 at 11.53.31 PM

Israel Total Cumulative Cases: 10,743 (335 new after adjusting for yesterday); Deaths 101 (7 new); Recovered 1,341; Critical 175.

 WhatsApp Image 2020 04 11 at 11.53.31 PM1  

The % of recovered is continuing to jump and this trend will continue in the coming 1-2 weeks at least.

 WhatsApp Image 2020 04 11 at 11.53.32 PM  

Daily critical cases vs daily deaths. critical cases remain critical for many weeks at a time, and a majority recover.

 WhatsApp Image 2020 04 11 at 11.53.32 PM1  

epidemiology curve of daily new cases - this is the most sensitive indicator of whether changes in social distancing is working. People usually develop symptoms within 2-7 days after being exposed. With the requirement to wear a face mask starting tomorrow morning, we expect to see a significant downturn in this curve about a week later if conditions remain at least the same.

 WhatsApp Image 2020 04 11 at 11.53.32 PM2  

The percentage of new patients relative to our total cases indicates a downturn but is significant if we have a resurgence or beginning of a second curve.

 WhatsApp Image 2020 04 11 at 11.53.33 PM  

Here is a comparison of all countries with more cases than Israel in the world with their Case Fatality Rate. Case Fatality Rate is a proportion of deaths compared to total case numbers. Israel is currently at 0.94%. Worldwide CFR is currently 5.98%, so looking at this chart gives us a good idea of which countries are doing a better job managing the pandemic in terms of fatalities. There have been reports from specific countries that fatalities are not being reported accurately, with many causes of death attributed to pre-existing medical conditions and not COVID-19. Developed countries are reporting accurately.


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Day 50:

Israel is now doubling cases every 10 days and the curve is obviously flattening. Cases reported today were reported early as they are on Fridays and Eve of Holidays, so we expect a "bump" tomorrow, which will report 1 1/2 days of case reporting. Blueline is total cumulative cases, the orange line is new cases.

 WhatsApp Image 2020 04 10 at 6.42.49 PM  

We have started seeing a significant downturn in the number of critical cases, with reduced numbers of people on ventilators relative to the total cases. People remain on ventilators for weeks, so most of the 125 people on ventilators have been on the machines for weeks. In Israel only 2.9% of confirmed COVID 19 patients have been categorized as critical. The international average is 20%.

 WhatsApp Image 2020 04 10 at 6.42.50 PM  

The ups and downs represent irregular reporting times due to the holidays

 

WhatsApp Image 2020 04 10 at 6.42.51 PM1WhatsApp Image 2020 04 10 at 6.42.51 PM

 

As the relative number of critical cases is reduced we should see more resolutions, mostly recoveries in the next 1-2 weeks. COVID 19 takes many weeks to "clear" from the system.

Good news: the Head of Hatzolah international is now off of a ventilator and conscious after weeks on a ventilator. 


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Day 49:

 WhatsApp Image 2020 04 10 at 12.43.31 AM

Israel Total cumulative cases 9968 (8871 active); New cases 564; Deaths 86 (13 new); Recovered 1011; Critical 166. Much of this data is skewed because the data release yesterday was early in the day because of the holiday. Please note that Israel is now doubling cases every 9 days. All numbers from today will seem like a big bump, but consider that yesterday the numbers had a false low appearance. We are starting to see a significant increase in recovered cases, as you can see in the following charts.

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 WhatsApp Image 2020 04 10 at 12.49.50 AM  

The recovered cases are starting to make a dent in our total caseload, currently accounting for 10% of cases. This number will always lag behind the lowered epidemiological curve. We expect this chart to continue with more dramatic patterns by next week.

 WhatsApp Image 2020 04 10 at 12.51.44 AM  

This " bump " in all likelihood is related to the early release of yesterday's numbers because of the holiday.

 WhatsApp Image 2020 04 10 at 12.52.34 AM  

even with this bump, we are in a statistically significant downward trend of % of new cases. National studies released today show that young children who test positive for coronavirus have a 27% rate of being symptom-free. Other age groups range from 4-7% asymptomatic cases (from the tested population). This indicates that young children ages 0-9 are more likely to be "silent spreaders" of the disease than other population groups. This is also the reason why the at-risk populations are being separated from young children. It can take several weeks AFTER symptoms resolve for the virus to clear from a person's system, which is another reason why the recovery cases are lagging well behind. The good news: Israel is installing high-capacity testing machines in all Kupot Holim, which will be able to meet the goal of testing 10,000 people a day. The reagent that was missing from tests has been flown in from South Korea yesterday, so expect higher testing rates in the coming days.

 WhatsApp Image 2020 04 10 at 12.57.44 AM  

Numbers released by city show that since April 1st there has been a continued spike in Jerusalem (51%) Bnei Brak (55%) Ashkelon (42%) Petach Tikva (41%) Beit Shemesh (31%) Elad (63%) Modiin Ilit (65%) Or Yehuda (45%) Beitar Ilit (32%) Rishon Letzion (34%). There seems to be a potential growth slow down in Holon, Netanya, Ramat Gan, Migdal Haemek, Rechovot, Efrat, Yehud, Kfar Saba, Kfar Chabad, and Kiryat Yearim. These spikes may guide continued policy as it applies to close-downs and curfews in specific high risk cities.

 

 


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Day 47:

WhatsApp Image 2020 03 27 at 12.04.19 AM

Israel total cumulative cases 9248 (active cases 8413); New Cases 344; Deaths 65 (8 new); Recovered 770; Critical 149. To date 117,000 tests done. Overall mortality rate of 0.7%. We are multiplying our cases every 8 days and well on our way to a flattened epidemiology curve if social distancing can remain strict.

 WhatsApp Image 2020 04 08 at 1.22.21 AM  

Switzerland (as a comparison due to similar population size and nearly the same date of viral infections): Total cases 22,253 (Active 12,728); Deaths 821 with an overall mortality rate of 3.6%. They have flattened their epidemiology curve and a higher percentage of people have recovered, although the mortality rate is 5 times higher than Israel's.

 WhatsApp Image 2020 04 08 at 1.23.17 AM  

Israel's epidemiology curve shows a significant downturn in the number of new cases diagnosed daily, which is a good sign. This is not close to over, and this trend down can easily bounce back up if current "hot spots" are not managed well, and people do not follow social distancing regulations.

 WhatsApp Image 2020 04 08 at 1.24.57 AM  

Israel's active vs resolved cases are slowly moving in a good direction - these are delayed findings as the "recovered" cases take weeks to follow the trends. We expect a significant downturn inactive cases in the next 2 weeks assuming social distancing is maintained.

 WhatsApp Image 2020 04 08 at 1.26.29 AM  

Israel had it's the best day in 3+ weeks in terms of the percentage of new cases relative to total cases. The rate today was 3.72%. Our worst day was March 19th with a 36% increase in new cases.

The death rate and recovery rates are delayed measures because they take time. So our active cases appear to be very high relatively speaking. Most of these cases (8075) are mild cases - many of whom may no longer be symptomatic but have not yet cleared the virus from their system. This process can take an average of 3-4 weeks, making the number of active cases lag behind by 3-4 weeks from the more current indicators. So patience is needed here. Deaths are also delayed indicators, as people who get complications from Covid-19 may be sick for extended periods of time before either recovering or dying. So in the coming weeks, we expect to see a significant downturn in the number of deaths (barring any major change in policy or compliance rate), and an upturn in recovery rate.

 


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 Day 46:

WhatsApp Image 2020 04 07 at 12.50.04 AM

Day 46 Total cases Israel: 8904; New Cases 474; Deaths 57 (8 new); Recovered 585; Critical 140. There will continue being a delay to "recovered" cases because the virus lingers for weeks in its host (people). Recovered is defined as 2 negative tests in a row. We are finding that this takes weeks after symptoms have resolved, and while the virus remains in its host, the host may be contagious.

 WhatsApp Image 2020 04 07 at 12.55.08 AM  

The epidemiology curve (new cases per day) could be in a downturn now, but this depends heavily on continued social distancing, putting out the "hot spots" through measures currently underway to find solutions for these communities and continued increased testing.

 WhatsApp Image 2020 04 07 at 12.56.53 AM  

 The relative percentage of new cases continues to decrease, and we hope this trend will continue. The death rate in Israel remains 0.6%, while international statistics show an overall 5.5% mortality rate - with great variation among countries.

 


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Day 45:

 WhatsApp Image 2020 04 06 at 1.06.14 AM2

Israel Total Cases: 8430; New cases 579; Deaths 49 (5 new); Recovered 546. Today for the first time in weeks the number of patients on ventilators remained the same, which may be a delayed reaction to the lowered epidemiological curve. Israel is now doubling our caseload every 7 days, while less than 2 weeks ago we were doubling every 3 days, which is in the highest bracket of exponential growth expected in a pandemic. These significant reductions are a direct result of the extreme measures put into place in Israel - social distancing and hygiene. There is room for cautious optimism, but there is no room to relax our defenses, as we must prevent a second, potentially more tragic "second epidemiological wave".

 WhatsApp Image 2020 04 06 at 1.06.14 AM1  

The epidemiology curve, based on new cases per day remains on a downward trend, although none of us can predict if this is a definite, permanent downturn.

 WhatsApp Image 2020 04 06 at 1.06.14 AM

 

The % of new patients per day is on a sharp downtrend. This is a good relative trend indicator that the spread is slowing. Although we have more cases daily, relative to the total cases we have had, this number is reduced.

 


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Day 44:

WhatsApp Image 2020 04 05 at 1.09.36 AM

 April 4 (chart was adjusted for shabbat) Israel Total Cases: 7851; New Cases 423; Deaths 44 (or 0.5% of Total Cases); Recovered 458; Critical 126. Israel is doubling our case load every 6.5 days, a significant improvement. Death rate, although low relative to other countries, is expected to lag behind because the people dying now are people who got sick 2-3 weeks ago on average. One of the more sensitive tracking methods is new cases.

 

WhatsApp Image 2020 04 03 at 5.57.22 PM   

Israel's new cases as a percentage of active cases is at the lowest point since March 20. our high point was March 19th with 36%. This reflects people who are being diagnosed daily. Out of the 90,394 tests performed in Israel to date, only 8.6% were positive. Most people being tested are people with symptoms or people with close contacts (household members) who were sick. Most people being tested now have developed symptoms in the last few days and were exposed within the last 1-2 weeks.

 WhatsApp Image 2020 04 05 at 1.51.53 AM  

Here is the most recent epidemiology curve, which is showing excellent signs that our new caseload is being reduced because of the extreme social distancing in practice now. Although there are hot spots flaring up (see Friday's chart), this is an excellent sign that what we are doing is working. These numbers reflect daily new cases diagnosed. unlike the black chart i send out daily - this one should go down like a "bell curve". The Total case chart should flatline when this ends.

 


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Day 43:

WhatsApp Image 2020 04 03 at 5.53.34 PM

Total cases 7030; New cases 173 (as of 10am); Active Cases 6634; Recovered 357; Deaths 39 (5 new). The decrease in the number of new patients likely due to Shabbat reporting so we expect a bump by tomorrow's report. Labs are working 24/7. Israel is approaching a 6-day exponential rate, which is a good sign. That means cases are doubling every 6 days (and not every 3). Continued slow down is what we are hoping for. 

 

 WhatsApp Image 2020 04 03 at 5.57.22 PM  

Rates by the city as percentages of the population. As you can see, Bnei Brak, currently fully locked down, is showing a cluster, as well as other areas. More about this after Shabbat.


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 Day 42:

WhatsApp Image 2020 04 03 at 12.41.12 AM

Israel: Total cases: 6857 (6485 Active); New cases 765 (11.2%); Deaths: 34 (8 new); Recovered 338; Critical 108. Switzerland (same population, similar start date) total cases: 18,827 (14,278 active); Deaths 536; Recovered 4013; Critical 348. As the world surpasses 1 million cases and 1 person is dying every 4 minutes in New York, there is evidence that social distancing efforts are helping in Israel.

 WhatsApp Image 2020 04 03 at 12.55.43 AM  

This chart shows actual total cases (which means this curve can't go down because is a cumulative number. When it flat-lines there are no new cases), new cases (stable yellow line on the bottom, projected cases that are adjusted for current reduction of our exponential growth rate, and non-adjusted projected cases had our efforts failed to reduce the epidemiology curve at all from 2 weeks ago.

 WhatsApp Image 2020 04 03 at 12.59.08 AM  

Our % of new patients as a part of the total cases has shown a significant trend downward in the last two weeks. So even though the numbers are going up, the relative numbers are lower, which is significant in an outbreak. Obviously, we want the actual numbers to be reduced but this is usually delayed when there is a significant uptick in testing, which there is. There is currently about a 10% positive rate for testing. so if 7500 people are tested, we will likely see 750 new cases that day. Up to date 87,108 people have been tested. Testing is now opened up to direct family members and close contacts of verified cases. As testing increases to the anticipated 10,000 daily, people with a wider range of symptoms will be more included in testing.

&> WhatsApp Image 2020 04 03 at 1.05.36 AM  

This represents active vs resolved cases. As time progresses the active cases in light blue will be reduced and the resolved cases (more recovered than deaths) will dominate the daily chart. we can see that this is at the very beginning of being reduced.

 


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 Day 41:

WhatsApp Image 2020 04 02 at 12.49.22 AM

Total Cases 6092; New cases 734; Deaths 26 (6 new); Recovered 241; 95 Critical; Switzerland (same population, got virus after Israel): Total Cases 17,137; Deaths 461; Recovered 2967; Critical 348. Switzerland is currently lowering its curve significantly and Israel is moving in that direction.

 WhatsApp Image 2020 04 02 at 12.50.40 AM  

Israel is still doubling cases every 5 days, which is a significant improvement from a week ago when we were doubling every 3 days.


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 Day 40: 

WhatsApp Image 2020 04 01 at 12.14.43 AM

Total Cases 5358; New Cases 663; Deaths 20 (4 new); Recovered 224; Critical 94. Switzerland (same population, got COVID days after Israel): Total Cases: 16,605; New Cases 683; Deaths 433; Recovered 1823; Critical 301. Switzerland is currently doubling its rate every 8 days; Israel is doubling every 5 days (was every 3 last week).

 WhatsApp Image 2020 04 01 at 12.18.01 AM  

The video coming out in the morning will explain how the lower curve represents a significant decrease in cases over time. It will also help explain the significance of how Switzerland lowered its exponential growth rate from 2 days to 8 days - flattening the curve significantly.

 cWhatsApp Image 2020 04 01 at 12.18.59 AM  

For those interested in seeing the New Case epidemiology curve - here is the updated version.


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 Day 39:

 WhatsApp Image 2020 03 31 at 12.48.27 AM

Total cases: 4695; Active cases 4545; new cases 448; deaths 16 (1 new); recovered: 134; critical 66. Switzerland (same population size, developed virus after Israel): Total Cases: 15,922; New Cases: 1,093; Deaths: 359; Recovered: 1,823.

 WhatsApp Image 2020 03 31 at 12.51.39 AM  

Epidemiology curve (see World Mizrachi video for detailed explanation): The lowest number of new cases in 3 days is not significant unless the trend continues. As you can see - lots of ups and downs along the way but significant pattern changes would indicate that restrictions in place are reducing the epidemiology curve! So stay home!

WhatsApp Image 2020 03 31 at 12.57.37 AM

 

For the 5th day in a row, it appears that we are no longer in the "exponential growth" phase, which corresponds to the beginning of the significant social isolation regulations. The exponential growth seen previously most likely corresponded to the Purim holiday, which included crowded synagogues, parties, and large festivals.


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 Day 38:

 WhatsApp Image 2020 03 30 at 12.52.17 AM

Total cases: 4247; New cases: 628; Deaths 15 (3 new); recovered 132; critical 74. Switzerland (the same population, got the virus a few days later): Total Cases: 14,829; New cases 753; Deaths 300; Critical 301. Switzerland also appears to be slowing down of the peak wave.

 WhatsApp Image 2020 03 30 at 1.00.20 AM

As we can see, the pattern of actual cases (orange) continues the trend of being under the exponential target. A few days does not represent a significant trend, as this could be a slight dip before a bigger upturn, but this does represent hope. And hope should never be underrepresented (especially in epidemiology).

 

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 Day 37:

 WhatsApp Image 2020 03 29 at 1.16.14 AM

Total cases 3619; new cases 584; 12 deaths (none new); 89 recovered; 54 critical. Switzerland (same population; virus started thereafter Israel): Total cases 14,076; new 1,148; Deaths 248; Recovered 1,530; critical 301. There seems to be a promising trend in Israel that may indicate that the shut down is working. Purim celebrations and traditions could be seen as reflected in the upsurge we have seen in the last week or so, but we are now seeing a reduction from the exponential rate we have had: We seem to no longer be doubling our infection rate every 3 days, despite significantly more testing. In most countries with increased testing rates, there were higher rates than we are seeing currently. The Ministry of Health hopes to be able to get the current testing rate up to 10,000/day by this upcoming week (and plans for 30,000/day within weeks).

 WhatsApp Image 2020 03 29 at 1.43.25 PM

Here is a visual aide to understand that we were very much on target with projections until a few days ago, when actual numbers have been lowered. This could be an indicator of the lock-down restrictions working... lowering the curve.

 

 Day 36:

 WhatsApp Image 2020 03 27 at 12.04.19 AM

Israel: Total cases 2693; 324 new; 8 deaths (3 new); 68 recovered; 46 critical (most of whom are on respirators). Switzerland (same population, virus started after Israel): Total cases: 11,811; new cases 914; 191 deaths.

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