Yesterday afternoon, as it has been doing everyday, the "National Coronavirus Campaign Information and Knowledge Center" issued a report analysing the rate of infection with the Covid-19 virus in Israel. The report, which paints a gloomy picture of the situation in Israel, has been widely quoted in the press and media. "The State of Israel is currently entering a second wave of the coronavirus pandemic no less severe than the first wave. Unless action is taken and the present rate of growth is substantially reduced, within about a month the number of new cases will be 1,000 daily and the number of fatalities will reach several hundred," the report says.
The report sounds worrying, even apocalyptic, and it cannot be ignored, but at the same time it raises several questions.
Who wrote the report?
The National Coronavirus Campaign Information and Knowledge Center is a research team that is part of the IDF Intelligence Corps. None of the report's compilers is named. It is distributed to the press, and represents an official state document, but there is no way of asking questions about it, and its scientific basis is not revealed.
The report's finding have come in for severe criticism by experts in the field, as has the practice of publishing reports without the public being informed who is behind them and what research tools they used. Why, for example, is it not the Ministry of Health that coordinates the professional work on the spread of the pandemic in Israel, but rather a body that belongs to the IDF?
"When there was confusion in the management of the disease at the beginning, the Intelligence Corps stepped in," says Prof. Nadav Davidovitch of the Center for Health Policy Research at Ben Gurion University of the Negev. "They are very creative people with good intentions. They take a subject and study it, and issue a report. It is not clear that any medically qualified person examines it. The document published today is a strategic document with many implications that go to the core of the matter, and it is inconceivable that it should be released without someone professional reviewing it. It just generates noise and alarm."
On what data is the report based?
The document published yesterday indeed raises professional questions. What is the basis for its recommendations to, among other things, review the relaxations concerning gatherings of people? The data on which the document relies, which do not appear fully in the version that finds its way to the media (the report is "leaked" to reporters each day, and is not sent in an orderly manner to newspapers and media outlets) are insufficiently clear. For example, two graphs that project the cumulative number of fatalities and the daily number of new cases are based on unclear, perhaps even wrong, data.
The first graph, which presents the projected and actual cumulative numbers of fatalities presents actual data up to May 23, despite the fact that more up to date figures are available. In addition, the number itself is wrong. According to the graph in the report, the cumulative number of fatalities to May 23 was less than 200. In fact, according to the Ministry of Health's numbers, there were 279 fatalities by that date.
The second graph presents the projected daily number of new severe cases against actual daily numbers. This graph is updated to June 20. Although the projection indicated that the number of new cases daily was likely to grow substantially, since June 7 the reality has been otherwise - the number of new severe cases has actually fallen from week to week, despite earlier estimates that it would rise geometrically. The report states that the number of severe cases is likely to grow substantially in the future, but it conflicts with Ministry of Health figures on severe cases in the past month.
Epidemiological analysis by the Israeli Association of Public Health Physicians raises hard questions about the data and findings in the report. First of all, on the factual level, the report's findings do not fit publicly available data. According to the document, the average daily number of new patients is 200, rising to 300 in the past few days. According to Ministry of Health figures, the average of the past two days is 228.
The Intelligence Corps document states that in the past week there have been more than 20 additional severe cases, whereas a month ago there were almost no new severe cases. The Ministry of Health does not publish daily figures for additional severe cases, but the total number of such cases is stable, which does not tally with 20 new cases daily, unless 20 people died or recovered each day last week as well.
According to the Intelligence Corps document, in the previous wave of infection, a significant proportion of the new cases arose from Israelis returning from overseas. This group was largely easier to identify and contain, once it was decided that everyone returning from overseas should stay in isolation for a period. In the current wave, "the source of infection is solely within the community, and it is therefore harder to gain control of it and suppress the spread of the virus." According to epidemiologists who analyzed the document, for a long time, although the source of infection was believed to be people returning from overseas, only those coming from Europe were sent into isolation, whereas this was not done for people coming from the US until a later stage. In addition, there were hardly any tests carried out within the community. "Even in the first wave there was a considerable degree of local transmission," the epidemiologists state, adding "The evidence for this is that even after the borders were closed in mid-March, the pandemic worsened, so the extent of local transmission was unknown."
How is the number of fatalities calculated?
The Intelligence Corps report states that the total number of fatalities will rise by 2.5 times within a month, to about 800. Epidemiologists who tried to analyze the data say they do not understand the basis of this calculation. The report speaks of a daily rise of 4-8% in patient numbers. Taking the high end of the range, at a rate of increase of 8% daily, within a month there will be another 34,000 new patients, 1.5 times the number today. This does not tally with 2.5-times growth in the number of fatalities.
The report's compilers assume that "the proportion of fatalities and severe cases in relation to the total number of known cases in each age group will be similar to the proportion in the first wave." In the first wave, the proportion of confirmed cases that were asymptomatic was 20-25%, while in the past month it has been nearly 50%. The report treats the 65+ age group as monolithic, but in the first wave (according to the Ministry of Health) about a third of the fatalities arose from infection in nursing homes for the aged, and there are no figures for the number of patients infected in the current wave who live in nursing homes in comparison with the first wave.
"The report contains serious factual errors"
Dr. Hagai Levine, an epidemiologist and chairman of the Israeli Association of Public Health Physicians, severely criticized the report today. "Unfortunately, the report contains serious factual errors," he said. "It looks as though someone set a target and adapted the data to it. Dealing with the pandemic in the best possible way requires professionalism and transparency. Both these elements are lacking in the report. Unprofessional reports of this kind damage not only preparedness for the pandemic but also public confidence. I esteem the capabilities and excellence of Intelligence Corps personnel very highly. Some of them are personal friends from my army service. But like the improper use of Israel Security Agency tools, the use of the Intelligence Corps for public health purposes, without professional epidemiological supervision, is unfortunately also liable to harm public confidence in the Intelligence Corps and the IDF."
An IDF spokesperson said in response, "The National Coronavirus Campaign Information and Knowledge Center is a national research body that reports to the Ministry of Health and is intended to improve the way the fight against the coronavirus is conducted, through research on the pandemic in Israel, in the surrounding region, and in the world. The center was set up when the pandemic broke out by the IDF Intelligence Division under the direction of the Ministry of Health and the National Security Council. The report in question was distributed as part of the daily distribution of information since the Center was established in March. The reports are distributed to a set list of people in the IDF, in the Ministry of Health, the National Security Council, and other decision makers. Since the report is unclassified, it is distributed on the civilian network."
Published by Globes, Israel business news - en.globes.co.il - on June 21, 2020
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