Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices

Abstract

Background Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making. Methods PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed. Results Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location. Conclusions Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.

The Israeli health system’s rapid responses during the COVID-19 pandemic

“…One striking example is the leadership provided by the United States in promoting the rapid development of several novel COVID-19 vaccines [ 38 – 40 ]. At the same time, the rapidity of Israel's response was remarkable regarding procuring vaccines and vaccinating the population, a variety of mitigation policies [ 13 ], and surveillance measures. We present ten such areas, starting with those that are vaccine-related, followed by those that are not vaccine-related.…”

“…There is a large and growing literature comparing COVID-19 responses across countries [ 13 – 19 ]. The creation of this literature was facilitated by the establishment of several databases that tracked a broad range of relevant government policies over the course of the pandemic in many countries [ 20 – 22 ].…”

“…For example, Turkey, Italy, and the USA were the first OECD countries to announce selective border entry restrictions. Hong Kong, South Korea, and Switzerland imposed physical distancing measures such as restrictions to mass events more than a week before the declaration of a state of pandemic by the WHO [ 13 ]. Several small countries such as Malta were also fast in rolling out mass vaccinations [ 23 ].…”

“…Several small countries such as Malta were also fast in rolling out mass vaccinations [ 23 ]. Rwanda and Taiwan were rapid responders in many measures, including closure of schools, limitations to mass events and public life, and border closure [ 13 ].…”

“…A recent IJHPR article by Ginzburg et al systematically compared mitigation policies implemented by Israel and their timing— during the first wave of the pandemic —to those of other OECD countries [ 13 ]. They found that Israel ranked in the upper third of OECD countries in swiftness of implementation for eight of the ten measures compared.…”