Israeli officials representing several ministries, the Israel Defense Forces and the health system met on Tuesday for a “war game” exercise at the headquarters of the military’s Alon coronavirus task force in Ramle, ahead of a winter in which the medical community is predicting coinciding waves of flu and COVID-19.

Health officials said that flu came early and hit hard in the Southern Hemisphere, and Omicron cases rose simultaneously, putting an unexpected strain on local health systems.

Israeli officials conduct a COVID-19 “war game” exercise at the headquarters of the military’s Alon coronavirus task force in Ramle. Credit: Maayan Hoffman.

Australia, for example, has had its worst influenza season in five years, the country’s Department of Health and Aged Care reported. To date, around 218,000 people have been diagnosed with the flu, 1,708 people hospitalized—including 6.5% who were admitted directly to intensive care units—and 288 people have died.

There were an unusually low number of flu cases in most countries over the past two years of the COVID-19 pandemic, but Israel’s coronavirus czar professor Salman Zarka told reporters that if Australia is an indication, Israel, the United States and other countries in the Northern Hemisphere are likely to experience a difficult winter. And with COVID-19 expected to spike, too, he said health officials have raised a red flag.

In Israel, Zarka said that hospitals are already overburdened following the previous waves of the pandemic. Many people who failed to seek proper preventative screenings or other care during the COVID period are coming in sicker as a result. Multiple lockdowns led to an increase in demand for mental health care. And thousands of Israelis are suffering from long COVID, which medical professionals are still struggling to define and treat.

Zarka said that if another intense wave of COVID-19 together with flu, a “twindemic,” sends hundreds of patients to Ziv Medical Center in Tzfat, where he serves as director-general, “I would have to close the elective surgery and other departments and only deal with the most pressing patients.”

Worst-Case Scenario
According to the worst-case scenario discussed by participants on Tuesday, as many as 100 people could be hooked up to extracorporeal membrane oxygenation (ECMO) machines, which require 24/7 surveillance by highly trained ICU staff.

At the peak, Israel handled around 80 ECMO patients and 1,250 people in serious condition. But Hagar Mizrachi, head of the Health Ministry’s General Medicine Division, told reporters, “We know we did not treat those patients as well as we could have because there was just not enough staff to deal with them.”

At the same time, head of Public Health Services Dr. Sharon Alroy-Preis said that the war games were meant to define how in such an extreme scenario, kids could stay in school and the economy could stay open.

“We do not want to take the easy route and day, ‘OK, we’ll close the schools,’” said Alroy-Preis. “No, we want to keep schools open. We don’t want to tell people not to go places. We want to allow them to go, but to tell them how to protect themselves.”

The war games resulted in a series of recommendations that were passed on to Health Ministry Director-General Nachman Ash.

These included: requiring patients and staff to wear masks in hospitals in the winter; an increasing focus on good hygiene; considering obligating and enforcing isolation of people who test positive for COVID and defining for how long that isolation should be; expanding the availability of registered antigen tests; and embarking on an education campaign to ensure members of the high-risk population get their flu shots and COVID boosters.

At least two-thirds of participants said they would push for masking in public spaces and at large gatherings and for requiring people to test for COVID before entering a geriatric center—both policies that were in effect during previous waves of the virus.

Omicron-Specific Vaccines
Millions of Omicron-specific COVID-19 vaccines are set to arrive in Israel by the end of September or early October, said Zarka.

Zarka told reporters that Omicron-specific Pfizer vaccines, newly approved by the U.S. Food and Drug Administration, have been purchased and will be available for anyone who wants one. He said that the ministry would likely not require vaccination, but rather recommend the booster shot to the highest-risk populations, such as the elderly, people with underlying medical conditions and medical personnel.

However, he added, “There is no question that if a young person wants to come and get a vaccine to try to prevent infection that the individual will not have a problem getting the jab.”

Protecting The Public
The new vaccines provide an updated formula, which scientists say will help stop infection by the Omicron variant. They are considered a booster shot, meaning that only people who took the first three doses of the original Pfizer or another coronavirus vaccine can receive the updated inoculations.

Anyone else would have to first receive the triple-shot baseline regimen, even though the boosters contain two messenger RNA (mRNA) components of the COVID-19 virus: one of the original strain and one of the Omicron variant strain.

Zarka said that the ministry plans to embark on a new information campaign, encouraging the at-risk population to come out and get both their flu and coronavirus jabs simultaneously.

“It’s not one shot,” he said. “It is one in each arm taken at the same time. Logistically, it is easier to get both doses at once.”

Zarka added that the ministry is vetting antigen tests that screen for flu and COVID simultaneously that could be used in the country’s geriatric centers or used by health funds for high-risk patients. These rapid results would allow for faster treatment, with Pfizer’s Paxlovid for COVID patients or with Tamiflu for influenza.

“At the end of this wave, I want to be able to say that Omicron is like the flu and it’s time to break down the coronavirus headquarters and return to routine, to stop counting waves,” Zarka said. “For now, it is my responsibility to take the necessary steps to protect the public.”