Katy Graddy:
Welcome, everyone and thank you very much for joining us at lunch today for this event. I'm Katy Graddy. I'm the dean of the Brandeis International Business School. I'd like to start first by thanking our co-sponsors of this event, the Israel Initiative at the International Business School, and especially the donors that support this initiative, and the Perlmutter Institute for Global Business Leadership at the Brandeis International Business School. So today's event is a webinar, and we will take questions later on in the program.
Katy Graddy:
We are certainly living in turbulent, uncertain times due to the continuing global COVID-19 pandemic. As you probably know, we moved at Brandeis, all undergraduate and graduate courses online back in March to ensure everyone's health and safety. But beginning earlier this month, we started a scaling-up process with the reopening and repopulating of our science labs with researchers. Right now, we're in the midst of planning with our COVID-19 task force, putting together a plan for the upcoming fall semester that ensures a positive learning experience for everyone and their safety.
Katy Graddy:
Today, we'll talk a little bit more about the steps that are being taken, not here, but in Israel, as the global community all sets very different paths to end the quarantine, and return to normal daily life.
Katy Graddy:
So, I'm pleased today to be joined by our International Business School professor, Blake LeBaron, who will be moderating this discussion. Professor LeBaron is the Abram L. and Thelma Sachar Chair of International Economics, and he's also our director of the Master of Science in Business Analytics Program. He is a renowned researcher in the field of agent-based modeling, and time series econometrics, especially as applied to finance.
Katy Graddy:
I'm also very honored today, to have a member of the International Business School's Board of Advisors, Doctor Orna Berry. Dr. Berry is known for her efforts to promote excellence in entrepreneurship and innovation with a focus on Israeli society. She's been a researcher, entrepreneur, policymaker, and corporate executive. Recently, she chaired the research infrastructure, TELEM Committee, which was established by the Israeli Academy of Sciences, building the national program for quantum science and technology. She is currently chairing the TELEM committee defining the national program for research and development in artificial intelligence. She has also, in the past, served as a chief scientist and head of the industrial R&D operation for the Israeli Ministry of Industry, Trade and Labor. Thank you, Orna, for being here today and for your significant support of the International Business School including being the architect behind this event.
Katy Graddy:
I now want to hand it off to you to introduce Professor Waxman, our featured speaker.
Orna Berry:
Thank you very much, Katy. I want to introduce our guest speaker, Professor Eli Waxman, who was born in Israel. He earned Bachelor of Science in Mathematics and Physics and Master in Science in Physics, both summa cum laude and a doctorate in physics all from the Hebrew University of Jerusalem. During his graduate studies, he served as research physicist in the Israel's Negev Nuclear Research Center. From 1994 to 1998, he served as a member of the Institute of Advanced Study in Princeton, New Jersey. In 1998, he joined the staff of the Weizmann Institute of Science. He served as the head of the Particle Physics and Astrophysics Department and the chief scientist of the Israeli Atomic Energy Commission on leave from the Weizmann Institute. Currently, he serves as the director of the Benoziyo Center for Astrophysics, as director for the Schwartz/Reisman Institute for Theoretical Physics and Chairman of the Board of the Pazy Research Foundation.
Orna Berry:
As an Israeli leader, Eli applied based scientific practices to mitigate and halt the spread of COVID-19 in Israel. Eli has built an expert group to advise the National Security Council and the prime minister on measures to contain the spread of the virus. We are honored to hosting in our event today. Eli, thank you very much for speaking to us. The Zoom is all yours.
Blake LeBaron:
I'll do a quick intro very fast. Thank you. This is Blake LeBaron again. Thank you Dean Graddy and Dr. Berry and Professor Waxman, I think that we are all just very happy to have. Thank you again for coming and we are just thrilled. We want to hear what you have to tell us about how you and your team have been handling this most critical global crisis that we're facing, unfortunately facing today. So, the floor is... The Zoom window is yours.
Eli Waxman:
Okay. Thank you all for joining this event and thank you for inviting me to talk to you. I will share my screen to start the presentation. During the past few months, I had the privilege to lead a team of experts that advised the Israel's National Security Council. I'll try to enumerate some of the main aspects of Israel's response to the pandemic.
Eli Waxman:
We started working during the middle of March. This time, there was a very rapid rise in the numbers in Israel. The very new cases rose from about 4,200 to 15 in four days and the government therefore decided to apply the lockdown, severe restrictions on social distancing reducing the activity of the economy to about 30%. At the background, there were grossly contradicting assessments by various experts both from the academia and from the health administration.
Eli Waxman:
For example, regarding the risks, some arguing that the risk is very low, that corona is just a flu with manipulations. And some argue that the risk is very high, that we are facing thousands of deaths, tens of thousands of ICU, intensive care unit patients. Another major argument was about the number of unidentified carriers. Some people, some experts said that most of the various carriers are identified by our PCR test infrastructure while others out here, there are tens of thousands of unidentified carriers within the general population.
Eli Waxman:
These contradicting assessments lead to contradicting recommendations of action of course starting with the lockdown. Some arguing that it is crucial for the suppression of the pandemic while others argue that it is redundant either because there is no risk or because many people are already affected and identified, a large number identified, people are already infected, so maybe we should just let a much larger parts of the population get infected and develop antibodies and therefore achieve herd immunity.
Eli Waxman:
There were arguments about the healthcare system providers. Some argue that we need to prepare for tens of thousands of ICU patients while other arguing that we should take no special steps. And there were arguments about the PCR test policy. Our policy was to test the symptomatic carriers. The goal was to identify the carriers, to trace their contacts and isolate them and hence to cut off the infection chains. Thus, contain the pandemic. If the number of unidentified carriers is large, this methodology would not be successful and those who argue that there are many unidentified carriers were supporting random survey PCR testing of the general population in order to identify the true prevalence that they argue is much higher than we think.
Eli Waxman:
In view of this form of work, I proposed to the NSC to construct a team that would be able to provide reliable status assessments and forecasts to assess the possible effectiveness of various actions. Based on that, we recommend the preferred action policy and also to identify gaps in our ability to implement the policy, and the steps that are required to close these gaps. We have constructed tools for quantitative assessments of the situation that enabled us to make, to suggest decisions with a high level of confidence.
Eli Waxman:
Fairly quickly, we analyzed that we should not rely on models. I'm sorry here, Blake, but we decided that all the models are based on rather unsubstantiated assumptions and they include many unknown parameters and our choice and strategy was to rely on data analysis of available or more data and I will say more about this momentarily.
Eli Waxman:
We formed the team very, very rapidly in order to, in time for the required decisions and we based it on the extensive, their long experience with analyzing complex systems based on the noisy data which is the crucial part of the program.
Eli Waxman:
We first described our status assessment, forecast and recommendations of March 25th and then I will explain how we reached these conclusions and conditions. So, the first point that we clarified is that the number of carriers in Israel were in the thousands, not in the tens of thousands and that most of them are actually identified. This implied that the pandemic is under control both in terms of the number of the carriers, in terms of our PCR test capacity and in terms of our ICU capability. We predicted that social distancing would lead to significant and clear decline in the growth rate by the end of March and that the daily number of new cases is suspected to start declining about seven days later. And based on this, we also estimated the total number of infected people at the end of the confinement phase which would be about 10,000 and we also predicted that the number of ICU patients would be well below 1,000.
Eli Waxman:
The inclined recommendations were that we should maintain the lockdown until early April to see the decline in cases. We estimated the capacity which is necessary for testing based on the numbers of carriers that we estimated and recommended to maintain the focus on symptomatic, tested symptomatic carriers for the cutoff of infection chains and avoid surveys.
Eli Waxman:
The main gap that we have identified is that the time for us required for completing the testing and contact tracing phase was too long, too long to be ineffective to enable the chain cutoff and recommended to immediately increase the contact tracing capacity. We emphasized that we should avoid all the variants of herd immunity which will bring catastrophic results and we also commented about the public communication aspect which is crucial for handling the pandemic which largely lacking or are very few.
Eli Waxman:
Let me explain how we reached these conclusions. The first question we had to address was the fraction of asymptomatic carriers. If the fraction of asymptomatic carriers is large, this implies that there is a large number of unidentified carriers because we only test the asymptomatic ones. This would imply as I just mentioned that cutting off chains, the infection chains would not be efficient and maybe that we should move towards herd immunity course.
Eli Waxman:
We've shown that the asymptomatic fraction is small. It's less than about 25%. At the time of the report, this was based mainly on two large evidence. One, the exhaustive test that were carried for the passengers of the Diamond Princess cruise ship. We've shown 18% asymptomatic and more important even by the successful containment of the pandemic in South Korea. You can see that they reduced their numbers of daily new cases by more than all of... by applying this chain cut of policy without major lockdown. Had there been a large population of unidentified carriers, this would not have worked.
Eli Waxman:
Today, we have much supported evidence and we know the asymptomatic fraction to be low. For example, based on the testing of the cruise of the Theodore Roosevelt and Charles de Gaulle aircraft carriers and other evidence but at the time, this was a debatable issue and because it's an important goal to get the correct answer.
Eli Waxman:
Then we asked, is it possible that we're maybe missing most or many of the most asymptomatic carriers because our test capacity is insufficient and we don't reach all of them or many of them or we reached them too late? In this case, we would also be missing a large number of unidentified carriers. The answer to this question is no and how do we know this? So, the point is that during an outbreak, the total number of carriers can be quite reliably inferred from the number of the ICU patients and deceased. This is because the numbers of the people reaching ICUs is large during an outbreak and measuring this number which is not missed because these people will go to hospitals and get tested. So, taking this number and the fraction of the infected that gets into ICU hospitalization that can be reliably estimated independently provide you with an estimate of the total number of infected people.
Eli Waxman:
There is a small description here of the simple calculation that can be done. I would not go for it for the sake of time. You can all go through it after the presentation but applying these simple rules to Israel, at the time, we concluded that at March 25th, we had about 9,000 carriers, most carriers are identified and the prevalence in the general population is low also around 0.1%.
Eli Waxman:
Next, I want to say a few words about making predictions without reliable models. We have looked at the evolution of the pandemic in many regions in the world and concluded that the evolution is quite similar across the globe when you look at it properly.
Eli Waxman:
Our advantage was that Israel was several steps behind many other states in terms of the evolution of the pandemic and this implied that we can assess our situation and make predictions simply by an empirical analysis of the data that we collected from other places. Of course, this required constructing the data base and checking the vulnerability of the data in removing contradictions and so on and of course, it provides some clever analysis of the data but this is possible and I show you one simple example. This is the cumulative number of identified carriers in Spain, Germany and the US and you see that prior to adding social distancing measures, the evolution is similar with an exponential growth. This is doubling also the number every three days for a daily increase of about 30% and once social distancing measures are applied, a clear suppression in the growth is seen within seven to nine days.
Eli Waxman:
Another, a bit more complicated example, this is the evolution this time of the daily increase factors resulting 30% here in different regions in Italy and the time shifted in such that the zero is the time of lockdown in all the places. As you can see, this daily increase factor begins to decrease after the lockdown and five to 10 days after lockdown, it seems that all the carriers are approaching some universal behavior which is the independent of the differences between these regions. So, using these tools, we were able to make predictions for Israel and that database predictions proves to be accurate.
Eli Waxman:
Here is a significant example. What you see here is the cumulative number of ICU patients and deceased as a function of time in Israel from the time of school closure and this is the lockdown. Initially, you will see the exponential growth this line is doubling every three days and you see that the worry was that this line is crossing Israel ICU capacity fairly quickly.
Eli Waxman:
So, we were here and we made the prediction that this is not going to happen, that by March 31st, this line here, we would only reach 100 ICU patients instead of 300 as the exponential growth continued and that eventually we could find that outbreak much less than 1, 000 ICU. You see that both of these predictions are now to be accurate.
Eli Waxman:
Another important point to exercise is what would have happened have we delayed the decision on the lockdown? So, this not a nice example but a good example. What you see here is Lombardy which is a region in Italy with a population similar to that of Israel, 10 million roughly. This is the cumulative number of the infected people and the time shifted such that the zero is when both in Israel and Lombardy, we had 400 carriers. In Israel initially, the growth is similar. This is doubling every three days. Now, Lombardy had delayed compared to Israel its lockdown by about 15 days and the result was that they accumulated 10,000 dead compared to 300 in Israel.
Eli Waxman:
Also you can see, at the bottom graph, the healthcare system collapsed. What you see here, the red here is the number of people in ICUs and it saturated a thousand. This is simply the capacity that they had. On the other hand, you see the blue line, these are the deceased and the number of death crosses the ICU and continues to rise exponentially. So, all the severely ill simply died because they were not treated and this leads to a significant increase also in the rate of mortality which was about 3% instead of 0.7 when the healthcare system is properly functional.
Eli Waxman:
Last point for this first phase is the issue of herd immunity. So, why should we avoid herd immunity at all cost? In order to achieve herd immunity, about 80% of the population should be infected. For population of Israel, this comprise about 50,000 dead and more than 200,000 ICU patients which implies of course the collapse of the healthcare system. Now, it is true that the mortality is higher for older ages. So, one of the suggestions was to isolate all the 65 year old people, older people of about 65 years of age. This is of course impossible because you need to isolate them for many years. So, it's not practical. But even if something like this is possible, it would soon end up with more than 7,000 dead and 130,000 ICU patients and again the collapse of the healthcare system.
Eli Waxman:
Now, it is important to exercise that this cost is not unavoidable. It is possible to resume nearly full economic and social activity, managing the pandemic over a long time, keeping the prevalence low for several years until a vaccine is readily available and all this, at the cost which would be orders of magnitude lower than these numbers and I will explain how to do this in the next part of the talk. Now, this herd immunity policy was forwarded today to the government by leading scientists, physicians, ministers and one of the important contributions of our team was to remove this danger from the table.
Eli Waxman:
Let us move to the second chapter. By the beginning of April, it was clear that the pandemic is being contained. We were here around this curve and we started discussing our long term goals. So, where should we be in the weeks and months for managing the long term battle with this pandemic?
Eli Waxman:
So, I will explain first what the long term goals are and then I will discuss briefly our suggestions for the transition phase relieving social distancing measures towards this steady state long term pandemic management.
Eli Waxman:
As before, I will first summarize our recommendations and conclusions and I will then explain it. Our long term goal is to have a nearly fully functioning economy and society in the presence of the virus because the virus is not going anywhere, while avoiding the necessity of applying lockdowns that caused severe damages to the economy and society. Now, relieving social distancing measures will lead unavoidably to renewed outbreaks. There is no way to avoid this. So, how would we ensure that we can handle these outbreaks without lockdowns?
Eli Waxman:
So, the key is to maintain a very low prevalence. This means, the number of daily new cases should be at the few 10s or less per population of 10 million. Such low prevalence allows several things. First, it provides a safe environment for all parts of the population those risk and without risk factors. Second, it enables a rapid suppression of the low well before a new lockdown should be applied. The key to being able to maintain a functioning society and economy without resulting to a lockdowns in the presence of the virus was to achieve very low prevalence. So, the rate of daily new cases should be a few 10s per day or less for a population of 10 million and this would provide several things. One, a safe environment for all parts of the population, those with risk factors and those without risk factors. It would enable an efficient rapid suppression of outbreaks without resulting to lockdowns and it would provide a high level of confidence for the healthcare system being well away from the danger of being overwhelmed.
Eli Waxman:
I would like to now explain why and how these other conclusions but first I want to show you that this goal is achievable and it is also guiding the policy of states that had coped successfully with COVID-19. It's mainly in Southeast Asia and countries we see in South Korea, Taiwan and Singapore, you see the numbers, the very new infected in those states and you see that they're all, they keep them below 10 per million per day.
Eli Waxman:
So, do we understand why this is the policy that they have adopted? The answer is yes. So, let's us try to explain this. One of the main goals is to avoid overwhelming the healthcare system. And one of the key parameters that we should look at, so the only parameter but the key parameter is the ICU capacity. So, let's take, Israel is about 1,000 ICU beds capacity and by the way, the bottle neck here is not the ventilators. It's rather the medical staff required.
Eli Waxman:
Okay, now, since an ICU patient typically stays there for 15 days, this implies that we should not cross the line of 65 new ICU patients daily because this would get us to about 1,000 overall. Since about 3% of carriers reach ICU hospitalizations, we should avoid 2,000 new cases. We should avoid 2, 000 new cases daily.
Eli Waxman:
Now, from our experience and from the experience of other places, you have rapid outbreak. Once lockdown is imposed, the number of daily new cases rises by a matter of fact of 20 before saturating. This implies that you will need to apply strong measures once we cross hundreds new cases daily. Now, if we want to ensure that we identified with high confidence such interaction crossing 100, we should stabilize at the same range which is well below this. So, with rate of a few 10s per day and no more.
Eli Waxman:
These considerations also leads to two additional important conclusions. One where we cross this number of 100 new cases daily, you will need to apply social distancing measures. This would be local measures just like in the case for the eruption, the outbreak is local. It would need to be state-wide constraints if the outbreak is not confined in a well-defined region. A second important conclusion is related to our ability to make sure that we don't have runaways. How to ensure that with this level of 10 new cases per day? We don't have divergent chain of infections that very quickly get us to the 100s. The times here for the evolution of this pandemic is that for days, this is the typical infection type. This implies that we need to have the capacity to suppress any such outbreak, new outbreak in a time scale of about 48 hours, in two days.
Eli Waxman:
Let me say a few more words about this. So, it is crucial training capability to suppress any eruption, any new divergent chain of infections within 48 hours. In order to do this, this means that we need to be able to test suspected carriers, confirm that they are carriers, trace their contacts and isolate them, all these within 48 hours. From symptoms to first circle isolation in 48 hours. This will ensure that the chains would be suppressed and that we will be able to avoid runaways from the 10s to the 100s.
Eli Waxman:
On April 14th, we proposed to the NSC our long term management goals and also our recommendations for the transition phase for the phase of relieving the restrictions. I would say this very briefly only, our guidelines, whatever, to carry out the relief gradually with two weeks intervals between successive steps and this is because it takes about two weeks to assess the impact of steps that you have taken. Second, we emphasized that we should weigh risk versus the gains for the economy of each of these steps. In particular, we should be careful about allowing the activities involving gatherings of 10s of people in closed spaces which usually have little contribution to the economy. We're set what we've coined as a purple standard. These are regulations or guidelines, regulations for conduct at work and public places that will help reducing the infection probabilities and recommended to allow full resumption of activity to places that meet the purple standard requirements and we recommended using self-regulation rather than full government regulation.
Eli Waxman:
Finally, we emphasized that we must complete the construction of this capability of rapid test-trace-isolate within 48 hours in order to make sure that we have the tools required to suppress new outbreaks without resulting to lockdowns and we stressed that it should be completed before resuming high risk activities like commerce and full-scale education system operation.
Eli Waxman:
What is the current status in Israel? On April 16, the government adopted our recommendations. This is the announcement of the Prime Minister's office adopting the recommendations. So, this all seems fine. The problem is that the implementation was and is lacking. Restrictions were relieved too fast, not according to the value versus risk consideration and the test-trace-isolate unit was indeed constructed but it was not given the authority that it needs to manage the process and therefore, will not have this required capability even today. The results came after successfully suppressing the rates to the goal of about 10, 20 new cases daily in mid March. We see a rise back to about 300 cases per day already today, the rise is slower than it used to be in March but if the strength continues, we would face another lockdown in three to four weeks. So, we must take action now in order to prevent this issue.
Eli Waxman:
I would like to end with some guidelines for actions in the near future based on our experience which maybe relevant not only for Israel. First, there is no herd immunity solution. As I mentioned, the cost of such policy would be catastrophic, 50,000 dead, 200, 000 ICU patients per 10 million population and the collapse of the healthcare system. Our goal should be to maintain near-normal activity of the colony and of the society in the presence of the virus while avoiding lockdowns due to outbreaks that are bound to occur as we resume normal activity and the virus is still around.
Eli Waxman:
Actually, this goal is possible provided several requirements of it. First, the prevalence should be kept low, less than two daily new ICU cases per population of 10 million. This corresponds to about 50 daily new infected cases per day but I emphasized the daily new ICU cases because this is robust. The ICU cases gets to the hospitals, you can have them reliably. The number of newly infected maybe misleading if you are not doing sufficiently wide testing of the population. Second, you must have the capability for a rapid cut off of infection chains, 48 hours from symptoms to isolation of first circle of contacts and in order to have this capability, you also need an adequate testing capacity of about 10,000 tests per day per 10 million. One of your signs for a properly functioning testing infrastructure would be that the daily new ICU cases will be less than 1% of the daily new confirmed cases because this is sort of the rate that we expect.
Eli Waxman:
Now, before reaching or prior to reaching this low prevalence requirement, you should maintain or strengthen your social distancing measures because it will not be possible to maintain a functioning economy and society with much higher prevalence. And here, I want to emphasize the economic social and health interest are not intention. They are actually aligned. If social distancing measures are indecisive and do not lead to a rapid reduction of the prevalence to this level, this would imply that the economy and the society would be functioning only partially and the accumulated damage would be much, much larger compared to the policy strict measured are applied to rapidly reduce the prevalence to this level. And second, it should be realized that maintaining a normal and functioning with high prevalence is impossible because recurrent lockdowns would bound to occur due to outbreaks that you will not be able to control. Okay? And I will stop here.
Blake LeBaron:
Okay, thank you very much. Actually, Eli could you shake your mic? Your sound was pretty good but there was occasionally some static. You might have a slightly loose wire on your mic. So, just do a little shake there. We could hear you but it's... I think it should be okay with a little jiggle there.
Eli Waxman:
Is it good now?
Blake LeBaron:
I can hear you now. We have to go with that I think. I got a lot of questions coming in on the Q&A lines. So, I'm just going to right there. Thank you very much. It was actually for me totally insightful into what's been going on. It's such a really nice detailed overview of the policy and the responses and the work of your team. So, just excellent. I'm very excited about that. But I want to get right to the questions here. So, I have a couple. This may not be the first one. I'm going to do this in the order they've come in. May not be directly related but you may be able to just tangentially point to it. Someone was asking about Israel's activity on the vaccine side. I think Israel has been active on that. Do you know much about that or is that anything in the realm of your team?
Eli Waxman:
Can you repeat the question? I didn't hear you well.
Blake LeBaron:
Just a very quick comment on the status of research into a vaccine going on in Israel.
Eli Waxman:
This is really far from what I've been... I know there that there a lot being done in most at the universities and the biologists, et cetera but I'm not really the person to ask, to know this.
Blake LeBaron:
Okay. The next question maybe closer back to your realm here because it's about testing and I've heard about this in the US too. I've heard that Israel is working on checking for virus on sewage plants to see where the hotspots are. Do you know about this and if so, can you review your thoughts?
Eli Waxman:
I believe that this is not going to be useful in the society. The level of prevalence that we are talking about is a few 10s or hundreds of people for a population of 10 million. The only way to identify carriers and outbreaks is by going to the carriers, testing them. All the other methods, heat maps and all those things that are proposed are not sensitive enough. They become sensitive when the prevalence is so high that it is already too late. So, the best more sensitive, the fastest indicator is the number of symptomatic cases run through test.
Blake LeBaron:
The next question that came in, I'll read this here. Actually, that incorporates a bunch of geopolitical things too. It said, "Dr. Waxman, thanks for your service to the nation of Israel and to Jews worldwide. Do you attribute the success of these results in part to the country's constant existential threat as opposed to having to succumbed to public opinion political views? Do you think that this reality of existence that our nation lives under contributes to the seriousness of which security, health initiatives get dealt with? Is this a fact or a possibly a variable that could be accounted for in analysis?"
Eli Waxman:
Oh, interesting.
Blake LeBaron:
It's a big question.
Eli Waxman:
Interesting and big question. Okay. So, I think that one of the unique things in Israel was the ability of the establishments to accept the advice in the health and assistance from many, many sources. So, when the outbreak begun, we had many units in the army just going into the Ministry proposing help and being incorporated in the process. The government was ready to listen to our advice and to the advice of other experts. So, this ones I think a very positive aspect. Unfortunately, it is true that we are used to dealing with security crisis but we are not so used to dealing with civilian crisis. So, I think that our infrastructure for dealing with this is not excellent and what was the ability of the system to adjust and accept the help and assistance from a wide-range of individuals. I'm not sure that now that we are going into this long term management phase that we will be doing as well.
Blake LeBaron:
Well, it is interesting. I think you do have a population that maybe more willing to make sacrifices in this than in countries that are less threatened at times. Here's another more direct to compare you to other countries. Here's the question, what do you think about the Swedish approach designed by Dr. Tegnell from the Public Health Agency of Sweden which aims to sort of, at herd immunity?
Eli Waxman:
Okay, yeah, this is what you call an excellent question because I have a slide.
Blake LeBaron:
Sweden is out there obviously. They're doing their thing too.
Eli Waxman:
Yeah. This slide. What about Sweden?
Blake LeBaron:
What about Sweden?
Eli Waxman:
Okay, so here it is in Sweden. First of all, it's not clear what policies Sweden is actually adopting. There is a discussion of herd immunity but they deny that they chose this policy. In reality, there is social distancing being applied in Sweden partly by the government, partly voluntarily and they've reduced their activity by 40% for a long time. Now, what were the results?
Eli Waxman:
So, let's see. This is Stockholm alone. In Stockholm alone which is one million population, we have 1,300 dead, more than 1,300 dead already which is worse than Lombardy. So, 13,000 per 10 million population. The ICU capacity was saturated as you can see here and the worse thing is that there is no end in sight for this because they are not identifying most of the carriers and they would not be able to resume normal activity because there would major outbreaks. So, this is a good example for causing a large damage over a long period of time with heavy cost on the economy and on healthcare system and on the society and not resolving the problem.
Blake LeBaron:
Interesting. I'm juggling my order here but I have a very practical question here. It seems apparent that travel to Israel is unlikely to be possible for many months to come. Can you forecast... I know forecasting is difficult. Can you forecast when it will again be possible to visit?
Eli Waxman:
I heard only the last part of the question.
Blake LeBaron:
I can summarize that more quickly and there must be restrictions there, restrictions on foreigners visiting Israel. When do you think those will get lifted?
Eli Waxman:
So, as you said, it's very difficult to predict. Now, people are required to be quarantined and I think that as long as the prevalence in many places is high, this would still be a limiting factor. I think that as long as... In places where the prevalence is high, we will have to take measures to make sure that we don't import a large number of cases which are uncontrolled.
Blake LeBaron:
There's a question about... This is near and dear to my heart on heterogeneity. You seemed to treat the entire population homogeneously but in reality, the impact is quite different by age. How does that impact the guidelines especially for the young and school aged?
Eli Waxman:
So, I'm not sure what indicator that we are using with treating that up population as a single unit. So, I gave rough numbers of course in this presentation but all the numbers that I get for the number of deceased and ICU patients are taking into account the distribution of age as in the population of Israel. So, based on measurements in many other places and corrected to the age distribution. So, it is true that mortality at a younger age is lower but also, at younger ages, not between zero and 19 but between 20 and 45, the mortality is 0.1%. The fraction of people getting into ICU hospitalization jumps at the age of about 45. So, this is not an old people's disease. It affects the entire population.
Blake LeBaron:
I've got another question that's related so I'm going to jump in around here because it was also asking about schools again. There were some, there were schools led to large increases of people being quarantined. Has there been new policies in school? So, that's back to the school age types as whether they are a sort of something population we need to treat differently because schools... And we're worried about the same thing obviously, opening up schools here. So, we kind of look into your data but I know that's been a reason of that there.
Eli Waxman:
Right. So, we've seen major outbreaks in schools. I believe that we could have avoided some of these especially the older students could have been kept at remote learning and this would have allowed more space for younger grades and therefore would enable reducing the rates of the infections. So, for resumption of schools, it's going to lead to outbreaks and it should be managed carefully. Yes.
Blake LeBaron:
I think I'm going to have to... We only have time for one or two more questions. So, I have to apologize to all... But I have actually, we've been swamped with questions coming in but here is one that's actually, I think the numbers are right. I hope these calculations are correct but as testing at 10 to the fourth per day implies greater than three years to test everyone, is this acceptable? If everyone were tested in seven to 10 days with positive, quarantined and traced as has been shown in other places and all negatives retested in seven to 10 days with positives again quarantined. COVID stopped dead in its tracks. I sort of read that. I think it's...
Eli Waxman:
The capacity of test of about 10,000 per 10 million population per day is meant to enable identify all the symptomatic carriers. So, the policy would be mainly to test all the people with symptoms and identify those that are carriers of the virus. The number of 10,000 or 15,000 is derived from the background that you have when there is a regular few. You need to test all the people with the respiratory symptoms and you need to identify the 10s out of them who are actually coronavirus carriers. This will enable you to do the contact tracing and isolation and suppress the eruption. There is no way to test the entire population and to... There are many problems we try to test the entire population. Just the numbers don't work and the false negative is quite significant. It's 30%. So, it's simply impossible to do this. Test everyone and...
Blake LeBaron:
Let me finish up one last question because it's interesting and it's also relevant to things we've seen in the United States. This has come in, in several forms. What's moving around on my screen? How are Arab citizens doing and particularly though also how are poor neighborhoods, poor maybe more congested neighborhoods? Are there differences in the spread of the disease in these areas? Do you have any information on that?
Eli Waxman:
Yes, so we see a correlation between socioeconomic level and the prevalence of the virus. It is not surprising. I think it is related to several factors. One is that lower income jobs often require people to go out and it's naturally difficult for them to be isolated and also the risk based per person. So, the rate of infection within their neighborhood is higher. So, the correlation is clear. What should be done I believe is to provide a logistics required in these neighborhoods for them to be able to do an effective isolation as required. If we don't provide these logistics, it is very impossible for them to do it and it would fail.
Blake LeBaron:
Okay. Thank you. I have to apologize. I'm on my time schedule. It's time for me to start wrapping up. So, I have to apologize to all the other question askers out there. I can't get to your questions but I would then, I think for all of us, to thank Professor Eli Waxman for just really fascinating thought. Thank you again very much on this. This has been a super interesting way to hear what's going on. Also to Orna Berry, of course, and to Dean Graddy. Also, thank you for putting sort of all of this together. I thank our sponsors, the Israeli Initiative, Perlmutter Institute for Global Business Leadership, the International Business School and I don't know if Gina is going to coordinate. The recording of this event will be made available soon on the Brandeis Alumni Association YouTube channel which that's I'm sure you can find that. That will be posted.
Blake LeBaron:
Beyond the lookout, I'll also give an ad for some other events that are coming. So, just keep checking out that website for other events. If you had joined this webinar, please join the Schusterman Center for Israel Studies on July 21st for Israel Pandemic Economic Impact, Political Response, Social Conclusions. You'll see that link too. Whatever time zone, I know we're all across the globe here. This is what's great about Zoom, stay well. Take care. Again, thank you very much. This is very interesting. I am totally fascinated, so thank you. And thank you to everyone for being part of this.
Eli Waxman:
And stay safe everyone.
Blake LeBaron:
And stay safe.