TrialSite recently covered reports of disturbing COVID-19 Delta-variant-driven breakthrough infections in Israel, centering on a television interview of the head of Herzog Medical Center in that nation. Recently, the leadership of Herzog Medical Center, an internationally known academic medical center focusing on aging and behavioral health, reported important updates on the unfolding situation as the country experiences a surge in cases. Notably, the hospital’s President, Yehezkel Caine, M.D., M.Sc., shared with TrialSite national Israeli data as of August 25 revealing that those unvaccinated aged 60 and above have an 11 fold increase of COVID-19 infection as compared to individuals that received the recent Pfizer-BioNTech booster dose.
The Delta Surge in Israel
By August 25, the daily new case 7-day average grew to 7,947 in Israel based on data from the COVID-19 Data Repository, Center for Systems Science and Engineering (CSSE), Johns Hopkins University. Disturbingly, the average daily number of new deaths climbed to 26 in one of the most vaccinated nations. However, as discussed below, early signs indicate a booster program here already produces dramatic results, especially for the high-risk aged 60 and above cohort.
Combatting the Pandemic
According to hospital officials, the largest continuously operating COVID-19 treatment center in the country, Herzog Medical Center, serves the nation as a SARS-CoV-2 referral center. Academic medical centers are strategically positioned in this part of Israel to care for the highest risk group in this pandemic—the elderly.
Thus, Herzog Medical Center has been front and center in the war against COVID-19, with intense media coverage, numerous newspaper and television interviews with many interpretations of the Israeli hospital leaderships’ position on critical matters such as vaccination. The team at Herzog Medical Center recently shared with TrialSite the importance they place on the vaccine-centric strategy to ultimately overcome the virus.
Waning Vaccine Effectiveness
Herzog Medical Center’s President, Yehezkel Caine, M.D., M.Sc., contacted TrialSite’s founder, Daniel O’Connor, to clarify what they believe was an incorrect perception created from a recent Israeli television interview.That was the Channel 13 interview of Dr. Koby Haviv, Director of the Jerusalem-based hospital, who discussed the high number of breakthrough infections and hospitalizations associated with vaccinated individuals. With the Delta outbreak, all data points to waning vaccine effectiveness but not the Herzog Medical Center team’s commitment to the vaccine-centric strategy—which remains steadfast.
Dr. Caine communicated to TrialSite’s foundervia email, emphasizing that the waning effectiveness of the vaccine was expected given the confluence of unfolding factors such as the highly transmissible and virally loaded Delta variant. Dr. Caine reports that the data collected at this important health care hub points to a decrease in the effectiveness of the Pfizer-BioNTech vaccine and possibly the Moderna product. He emphasized that at least based on the data observed at the hospital, the mRNA-based vaccine’s effectiveness “…decreased from 95% initially two weeks post second dose…down to around 40% prevention of infection at 5 to 6 months.”
Importantly, Dr. Caine clarified for the TrialSite reader the powerful preventative features of the vaccine. The Israeli academic medical center specializing in elderly care supports vaccination as a fundamental move to fight off the novel coronavirus.
Caine shared that the Pfizer-BioNTech vaccine was up to 99% effective in preventing severe disease upon administration of the second dose at 5 to 6 months. Even with the Delta variant in circulation, the vaccine remains 80% effective at preventing severe disease, indicating highly protective strengths during the pandemic even a half year after vaccine administration.
Israel represents a critically important place to understand how the COVID-19 vaccines work in the bid to protect society from this ongoing pandemic. Why? Because the nation moved faster than most others to accelerate COVID-19 vaccination programs. This means that, worldwide, the Israeli population was the first to benefit from the vaccines. Of course, they are among the first to experience the waning effectiveness, which is to be expected of most vaccines.
Dr. Caine shared that segmenting vaccine effectiveness by important cohorts such as age points to key discussion points. Presently, 92% of the Israeli population aged 65 and above have been vaccinated with two (2) doses, and most of that cohort received the last dose approximately 7 to 8 months ago. Thus the hospital staff was among the first to experience the rise in breakthrough infections in the elderly population.
Israel Vaccination Data
Herzog Medical Center provided the most recent vaccination numbers in Israel by age cohort:
|Age Group||% Dose First||% Dose Second||% Dose Third|
Herzog Medical Center has cared for about 200 patients during this latest Delta variant-driven pandemic surge, with about 40 in the hospital as of today, which is down from 80 a couple of weeks ago. Of the total, Dr. Caine reports 26% were not vaccinated, representing a higher number than their proportion in the population which stands at 8%.
Generally, during this latest wave, vaccinated hospitalized patients are experiencing more mild forms of the illness, but some are more severe—about 35% in total. However, their numbers, as represented by a percentage of the total population, are considerably less.
Herzog Medical Center Booster Tracking—Positive Signals
TrialSite received near real-time updates from Dr. Caine and team, who informed us that 66% of Israelis aged 60 and above recently received their third booster dose, and the numbers look quite promising. According to Caine, the “numbers have dropped drastically, and even those infected are following a much milder course.” The effect appears to be rippling throughout Jerusalem as Cain shared, “As of today, only one patient has been admitted to our hospital with moderate to severe disease following the third vaccine.”
Real-Time National Data Revealing
That the booster has impacted Herzog Medical Center’s patient catchment area positively seems apparent based on the drastic drop in new patient hospitalizations. But what’s going on nationally? Dr. Yehezkel Caine shared that the following data as of August 25th evidencing the major impact of the booster program:
|Age Group||Non-Vaccinated||Vaccinated (2 doses)|
|Infection Rate Under 60||4.1 per 100,000||1.4 per 100,000|
|Infection Rate Age 60 +||244.6 per 100,000||21.1 per 100,000|
The data indicates a stunning 11 fold decrease in infections in the elderly due to the booster program ongoing in Israel. TrialSite acknowledges this notable data point. Herzog Medical Center shared that approximately one million adults and 2.5 million children still are not vaccinated in Israel. Herzog Medical Center shared that children by no means represent a majority of cases, “but they are undoubtedly amongst the carriers.”
TrialSite concurs with Dr. Caine and the Herzog Medical Center team that children are, in fact, carriers. However, the rush to vaccinate children must be tempered by a few considerations, including 1) risks for infection, 2) risks for morbidity and mortality, 3) safety risk associated with the vaccine product, and 4) with the Delta variant, the vaccinated are frequently vectors, thus diminishing the argument that children should be vaccinated to mitigate transmission.
With the Channel 13 interview, many here at Herzog Medical Center felt some twisted it with an anti-vaccination point of view. The opposite is true. They argue here that the vaccination program has saved many lives and, at least to date, indicates a dramatic decrease in risks of infection for those aged 60 and above.
TrialSite commends the heroes at Herzog Medical Center, a major nexus of COVID-19 care in Israel. Dr. Caine is at the forefront of combating the pandemic, who shared that thanks to the Israeli booster program, prospects for a slowdown in cases feel imminent. He declared: “So, I think that we are in for a busy summer in the hospital but hopefully, with the third dose for the over 60s (and now also for the 30s and above) we should start seeing an effect within two weeks. As mentioned, we are already seeing a slight drop in the over 60s.”
TrialSite Point of View
The data points out of Israel are significant, indicating a powerful benefit of vaccination. TrialSite raises concerns about more intermediate to long-term ramifications of depending solely on vaccine-centric strategies, not factoring in early treatment and other public health measures. For example, what happens if another variant emerges in six months that is even stronger and more infectious than Delta? The costs and potential health implications of vaccines must be better understood. These products remain novel, and little to nothing is known about longer-term impacts. Objective, unbiased, patient-centric research and associated data monitoring remain a vital function driven by health care institutions such as Herzog Medical Center.
Herzog Medical Center
Based in Jerusalem, Herzog Medical Center traditionally specialized in nursing care for the elderly, and its origins date back to 1894 as a psychiatric hospital. Today, the hospital continues its important work in psychiatry. Still, with almost 400 beds (excluding COVID beds), it has become one of the largest centers for respiratory care, with over 200 patients of all ages (from infants through the very elderly) dependent on ventilators, the largest rehabilitation center in the Jerusalem area, and a place for acute geriatric care.
Also an academic medical center, Herzog maintains a teaching hospital providing student and residency training in Geriatrics and Psychiatry, Psychology, and Social work in affiliation with Hebrew University-Hadassah Medical School.
Call to Action: Herzog Medical Center also suggested TrialSite call attention to a recently published study titled “Safety of the BNT162b2 RNA Covid-19 Vaccine in a Nationwide Setting.” It originated from Israel’s largest HMO – Clalit – and looked at a large, population-based cohort of approximately 2 million members of the HMO to study the vaccine’s safety profile. The study was peer-reviewed, published in the New England Journal of Medicine, and can be accessed here.