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Herd Immunity, or Big 2nd Wave? Israel Antibody Testing Hopes to Find Out | Herd Immunity, or Big 2nd Wave? Israel Antibody Testing Hopes to Find Out |
(4 days later) | |
JERUSALEM — Israel, whose aggressive response to the coronavirus has held its fatality rate to a fraction of those of the United States and other hard-hit nations, is readying a nationwide serological test of 100,000 citizens to see how widely the virus has spread across its population and how vulnerable it may be to a new wave of the contagion. | JERUSALEM — Israel, whose aggressive response to the coronavirus has held its fatality rate to a fraction of those of the United States and other hard-hit nations, is readying a nationwide serological test of 100,000 citizens to see how widely the virus has spread across its population and how vulnerable it may be to a new wave of the contagion. |
The survey, to be conducted at clinics run by Israeli H.M.O.s beginning in a week or two, is one of the largest efforts yet to determine the prevalence of antibodies to Covid-19. Germany has also announced antibody testing using a representative nationwide sample. | The survey, to be conducted at clinics run by Israeli H.M.O.s beginning in a week or two, is one of the largest efforts yet to determine the prevalence of antibodies to Covid-19. Germany has also announced antibody testing using a representative nationwide sample. |
The results could aid in deciding how quickly businesses and schools should be allowed to return to normal operations. On Monday, Israel announced that citizens could leave their homes after a 40-day lockdown, but many aspects of economic and social life remain curtailed. | The results could aid in deciding how quickly businesses and schools should be allowed to return to normal operations. On Monday, Israel announced that citizens could leave their homes after a 40-day lockdown, but many aspects of economic and social life remain curtailed. |
Even more important, officials said, the survey’s findings could spur preparations for any strong resurgence of the virus, perhaps when hospitals and health clinics are also busy with seasonal influenza. | Even more important, officials said, the survey’s findings could spur preparations for any strong resurgence of the virus, perhaps when hospitals and health clinics are also busy with seasonal influenza. |
“This is the most important mission: Get ready for the next wave, especially a wave during wintertime,” said Moshe Bar-Siman-Tov, director-general of Israel’s health ministry, in an interview on Tuesday. “Luckily, the Covid-19 caught us post-influenza season. But we can’t assume that there’s not going to be a next wave or that it will be during summertime.” | “This is the most important mission: Get ready for the next wave, especially a wave during wintertime,” said Moshe Bar-Siman-Tov, director-general of Israel’s health ministry, in an interview on Tuesday. “Luckily, the Covid-19 caught us post-influenza season. But we can’t assume that there’s not going to be a next wave or that it will be during summertime.” |
Officials say they hope the survey will identify the portion of the healthy population that has not yet been exposed to the virus, and the portion that has already been exposed but has developed antibodies to it. The answers could have enormous implications for a country’s capacity to withstand a new wave of the virus. | Officials say they hope the survey will identify the portion of the healthy population that has not yet been exposed to the virus, and the portion that has already been exposed but has developed antibodies to it. The answers could have enormous implications for a country’s capacity to withstand a new wave of the virus. |
If antibody tests show that a sizable portion of the population has developed antibodies, that could mean Israel is on its way to “herd immunity” and would be well equipped to withstand further outbreaks. | If antibody tests show that a sizable portion of the population has developed antibodies, that could mean Israel is on its way to “herd immunity” and would be well equipped to withstand further outbreaks. |
But if the tests show that only a tiny percentage of the population has been exposed, the country’s health system could still be overwhelmed by the spread of Covid-19, Mr. Bar-Siman-Tov said. He said estimates of the percentage of Israelis with antibodies range widely, from less than 1 percent to upward of 10 percent. | But if the tests show that only a tiny percentage of the population has been exposed, the country’s health system could still be overwhelmed by the spread of Covid-19, Mr. Bar-Siman-Tov said. He said estimates of the percentage of Israelis with antibodies range widely, from less than 1 percent to upward of 10 percent. |
“We want to know the truth,” he said. | “We want to know the truth,” he said. |
The World Health Organization has cautioned that no evidence exists that people who have recovered from Covid-19 or have antibodies to it are protected from another infection. | The World Health Organization has cautioned that no evidence exists that people who have recovered from Covid-19 or have antibodies to it are protected from another infection. |
But Dr. Yair Schindel, a member of a health ministry task force on the virus who pushed for a large survey, said the Israeli study could produce such evidence. “Part of what we’re trying to achieve here is to answer the questions the W.H.O. is raising,” he said. | But Dr. Yair Schindel, a member of a health ministry task force on the virus who pushed for a large survey, said the Israeli study could produce such evidence. “Part of what we’re trying to achieve here is to answer the questions the W.H.O. is raising,” he said. |
Dr. Schindel sketched out two scenarios for Israel. | Dr. Schindel sketched out two scenarios for Israel. |
In the rosier one, the survey would show that 10 percent of Israelis have antibodies to Covid-19. If so, and if a future wave of the virus resulted in the same proportions of Israelis becoming critically ill or dying as have occurred so far, that would mean about 2,300 people would need intensive care, Dr. Schindel said. That would be well within the capacity of the country’s health system. | In the rosier one, the survey would show that 10 percent of Israelis have antibodies to Covid-19. If so, and if a future wave of the virus resulted in the same proportions of Israelis becoming critically ill or dying as have occurred so far, that would mean about 2,300 people would need intensive care, Dr. Schindel said. That would be well within the capacity of the country’s health system. |
But in a bleaker scenario, the survey would reveal that only 1 percent of Israelis have antibodies, in which case the number of people needing intensive-care beds in a future wave could exceed 12,000 — well beyond Israel’s capacity, he said. | But in a bleaker scenario, the survey would reveal that only 1 percent of Israelis have antibodies, in which case the number of people needing intensive-care beds in a future wave could exceed 12,000 — well beyond Israel’s capacity, he said. |
“It’s quite an exercise in epidemiology — so critical that it’s really important to do,” said Dr. Schindel, a co-founder of aMoon, an Israeli venture fund that invests in life-sciences start-ups. | “It’s quite an exercise in epidemiology — so critical that it’s really important to do,” said Dr. Schindel, a co-founder of aMoon, an Israeli venture fund that invests in life-sciences start-ups. |
Israel spent nearly $40 million to obtain 2.4 million antibody tests from two suppliers that have received Emergency Use Authorization from the Food and Drug Administration: Abbott Laboratories in the United States, and DiaSorin in Italy. | Israel spent nearly $40 million to obtain 2.4 million antibody tests from two suppliers that have received Emergency Use Authorization from the Food and Drug Administration: Abbott Laboratories in the United States, and DiaSorin in Italy. |
One potential pitfall: If the coronavirus mutates, the blood tests might not be able to identify it, Dr. Schindel said. Another is that not all antibody tests approved by the F.D.A. have proved reliable. | One potential pitfall: If the coronavirus mutates, the blood tests might not be able to identify it, Dr. Schindel said. Another is that not all antibody tests approved by the F.D.A. have proved reliable. |
The blood tests check plasma for specific iterations of Immunoglobulin-M, or IgM, and Immunoglobulin-G, or IgG, that are created by the immune system in response to Covid-19. While IgM is created quickly as part of the body’s response to infection and dissipates soon, IgG lingers in the body and “represents our memory of our immunity,” Dr. Schindel said. | The blood tests check plasma for specific iterations of Immunoglobulin-M, or IgM, and Immunoglobulin-G, or IgG, that are created by the immune system in response to Covid-19. While IgM is created quickly as part of the body’s response to infection and dissipates soon, IgG lingers in the body and “represents our memory of our immunity,” Dr. Schindel said. |
Patients visiting their clinics for blood tests for ordinary reasons will be asked to allow their samples to also be tested for coronavirus. | Patients visiting their clinics for blood tests for ordinary reasons will be asked to allow their samples to also be tested for coronavirus. |
They will also be asked to complete questionnaires about whether and when they experienced symptoms, whether they were isolated at home or hospitalized, who among their friends and relatives contracted the virus, and so on. | They will also be asked to complete questionnaires about whether and when they experienced symptoms, whether they were isolated at home or hospitalized, who among their friends and relatives contracted the virus, and so on. |
Those whose blood tests show the presence of coronavirus antibodies will be called back for a standard polymerase chain reaction, or P.C.R., test for the virus, to determine the correlation between viral load and antibody levels, Mr. Bar-Siman-Tov said. | Those whose blood tests show the presence of coronavirus antibodies will be called back for a standard polymerase chain reaction, or P.C.R., test for the virus, to determine the correlation between viral load and antibody levels, Mr. Bar-Siman-Tov said. |
Updated June 5, 2020 | Updated June 5, 2020 |
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | |
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
“There are so many things that we can learn and research, if we plan it correctly,” he said. | “There are so many things that we can learn and research, if we plan it correctly,” he said. |
Asking so many citizens to submit to something as invasive as a blood test could seem a tall order in a country where a digital-surveillance initiative to identify coronavirus patients using smartphone location data set off political protests and lawsuits. Many Israelis, citing privacy concerns, also declined to download a government-sponsored app that was designed to help them avoid fellow citizens who had tested positive. | Asking so many citizens to submit to something as invasive as a blood test could seem a tall order in a country where a digital-surveillance initiative to identify coronavirus patients using smartphone location data set off political protests and lawsuits. Many Israelis, citing privacy concerns, also declined to download a government-sponsored app that was designed to help them avoid fellow citizens who had tested positive. |
But Mr. Bar-Siman-Tov said he did not expect the survey to be a tough sell because participants will be told the results. “I think the people would like to know,” he said. “I mean, I think about myself, and I would like to know.” He added, “I think that we’ll have more demand than supply.” | But Mr. Bar-Siman-Tov said he did not expect the survey to be a tough sell because participants will be told the results. “I think the people would like to know,” he said. “I mean, I think about myself, and I would like to know.” He added, “I think that we’ll have more demand than supply.” |
Moreover, whether out of a tendency toward hypochondria or because their socialized health-care system makes it cheap and easy, as many as 70 to 80 percent of Israelis already have blood drawn in any given year, Mr. Bar-Siman-Tov said. | Moreover, whether out of a tendency toward hypochondria or because their socialized health-care system makes it cheap and easy, as many as 70 to 80 percent of Israelis already have blood drawn in any given year, Mr. Bar-Siman-Tov said. |
“Israelis are addicted to health services,” he said, laughing. | “Israelis are addicted to health services,” he said, laughing. |
In addition to the broad nationwide sample, Mr. Bar-Siman-Tov said the ministry planned to test greater concentrations of subjects in cities that have experienced major outbreaks, like Bnei Brak and Jerusalem. Health-care workers will also be tested as a group. The remaining antibody tests will be made available to researchers for further studies, he said. | In addition to the broad nationwide sample, Mr. Bar-Siman-Tov said the ministry planned to test greater concentrations of subjects in cities that have experienced major outbreaks, like Bnei Brak and Jerusalem. Health-care workers will also be tested as a group. The remaining antibody tests will be made available to researchers for further studies, he said. |
If the nationwide survey shows a large portion of the population has gained immunity, that could prompt the government to ease remaining restrictions faster, Mr. Bar-Siman-Tov said. But he said there was no going back to a stricter lockdown based on the serological tests alone. | If the nationwide survey shows a large portion of the population has gained immunity, that could prompt the government to ease remaining restrictions faster, Mr. Bar-Siman-Tov said. But he said there was no going back to a stricter lockdown based on the serological tests alone. |
Though Israelis have complained about chaos and inconsistency in the way the rules have been developed and enforced, the country has fared relatively well, with only 237 dead and 16,268 cases as of Tuesday afternoon. Fatalities per million of population are 27 in Israel, compared to 213 in the United States. | Though Israelis have complained about chaos and inconsistency in the way the rules have been developed and enforced, the country has fared relatively well, with only 237 dead and 16,268 cases as of Tuesday afternoon. Fatalities per million of population are 27 in Israel, compared to 213 in the United States. |
Mr. Bar-Siman-Tov said Israel’s experience had shown that “to be pre-emptive, that was the key.” | Mr. Bar-Siman-Tov said Israel’s experience had shown that “to be pre-emptive, that was the key.” |
“The time to take action, or to take the measures that you want to take during pandemics, is when you think it’s too early,” he said, recalling decisions beginning with the cancellation of airline flights from China in early February. | “The time to take action, or to take the measures that you want to take during pandemics, is when you think it’s too early,” he said, recalling decisions beginning with the cancellation of airline flights from China in early February. |
“Everybody thought we were being too aggressive about it, or just exaggerating the threat, that nothing is going to happen, we’re just ruining Israeli foreign affairs, or being hysterical, or ruining the economy,” he said. “It usually took a day for us to feel that we did the right thing, and about two to three days for others.” | “Everybody thought we were being too aggressive about it, or just exaggerating the threat, that nothing is going to happen, we’re just ruining Israeli foreign affairs, or being hysterical, or ruining the economy,” he said. “It usually took a day for us to feel that we did the right thing, and about two to three days for others.” |