The Novel Coronavirus - Israel Ministry of Health

The coronavirus belongs to a large family of viruses identified as the cause of certain animal diseases and it can cause disease in humans, too.

The name 'coronavirus' refers to their resemblance to a crown (corona in Latin) when viewed in an electron microscope. The severity of human illness depends on the particular virus strand of this family and ranges between mild ailment, such as a cold, up to a serious disease that can negatively affect the lungs and lead to multiple organ failure, such as the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

The novel coronavirus had not been previously identified as a cause of disease in humans.

In December 2019, it was identified as the pathogen causing a cluster of pneumonia cases in Wuhan City, Hubei province, central mainland China, and later on, it was found to spread to all provinces of mainland China as well as internationally.

In terms of its genetic makeup, the SARS virus, which was the cause of severe morbidity in 2003/4, is the most similar to the novel virus in China among all other coronaviruses that cause human morbidity.

On 11.2.20, the World Health Organization decided on an official name for the virus - SARS-CoV-2, and the disease it causes - COVID-19.

The vast majority of the first patients in this event either worked in the livestock and seafood market in Wuhan or visited it. Hence the hypothesis, that the virus spread from animals to human beings, but thus far, it was impossible to identify with certainty which animal.
Currently, the transmission of the virus is from person to person. The virus can exit the body from a sick person's respiratory tracts, mainly when sneezing or coughing. The dispersed droplets can be inhaled by other people or land on surfaces. People who shortly after that touch these surfaces and subsequently touch their mouth, nose, or eyes may become infected. It has yet to be determined how infectious this disease is, but at this stage, it seems that its level of infection is at least similar to that of the influenza virus. It is possible to become infected from patients displaying very light symptoms.

A significant part of all people infected with Coronavirus do not develop symptoms at all. Among the sick, the symptoms of the disease are similar to those of influenza. As a matter of fact, it is usually impossible to differentiate in clinical tests between infection with the Coronavirus and many other respiratory illnesses.

The most common symptoms are fever, fatigue, and dry coughing. One in six patients will develop severe symptoms manifested in labored breathing. Older adults, people with chronic diseases such as heart condition or diabetes, and people with compromised immune systems tend to develop severe symptoms. In the most extreme cases, the infection may cause acute pneumonia, severe respiratory syndrome, renal insufficiency, and even death.

The disease's mortality rate is estimated at about 2% of the patients. Still, since many do not develop any symptoms, it may be assumed that the mortality rate among those infected is lower, although it is too soon to estimate it.

Information is still partial, and knowledge is based on a handful of accounts and on what is known from similar viral disease:

1. There is no information yet on harm to fetuses or newborns either in the short term or the long term, as a result of the mother's infection with the virus during her pregnancy. In other viruses from the Corona family, miscarriages during the mother's pregnancy were described.
2. Infants born to mothers who were sick with Coronavirus at the time of delivery did not carry the virus, and the virus was not found in the amniotic fluid.
3. So far, the coronavirus was not found in breast milk, and therefore it is apparently not transmitted through breastfeeding. It should be noted that breastfeeding is close contact, which may transmit the virus through exposure to respiratory excretions or contact. (Recommendations for the breastfeeding mother in home quarantine are detailed below under guidance for the person in home quarantine).

The infection is diagnosed with a laboratory test of respiratory droplets. Only people suspected of exposure to the virus, who show symptoms, are tested. The medical center attending physician can send specimens for testing only after the Ministry of Health District Physician permits such a test.

There is currently no specific treatment for the novel coronavirus infection. People infected with the coronavirus receive supportive care; medical care is given according to the patient's medical condition.

No, it is not possible to get tested at your own expense.

There is no antiviral vaccine. Several groups across the world are attempting to develop a vaccine, yet an effective vaccine is not expected any time soon.

First and foremost, avoid arriving in places where it is known that the virus is locally transmitted.
Beyond that, it is recommended that you maintain the same rules of hygiene which help prevent infection with other respiratory viruses such as influenza, namely:

• Wash your hands frequently with water and soap or with alcohol-based sanitizer (especially after coughing and sneezing and after contact with a sick person or his or her surroundings).
• Avoid close contact with people suffering from acute respiratory disease; keep a distance of at least one meter from people who are sick, coughing, or sneezing.
• Avoid shaking hands.
• Avoid contact with the mouth, nose, and eyes.
• Make sure to cough or sneeze into your elbow or into a disposable handkerchief and toss it into the garbage.
• Avoid using common utensils in the same meal.
• Avoid public places when you feel sick.

• Crowds in one space should be avoided as much as possible.
• If gatherings are held, they should be as limited as possible, and in any case, no more than 100 people. This guideline includes religious events, performances, cultural events and movie theaters.
• Private events such as weddings, bar mitzvahs and celebrations can be attended by up to 100 people.
• In light of the complexity of the guidelines, exceptions will be set in order to allow for a normal routine.
• Sporting events will be held without spectators.
• If players or judges from abroad participate, follow the instructions of the Ministry of Health designated for the field of sport.
• There is a complete prohibition on holding and attending international gatherings and conferences in Israel, regardless of the number of participants and where they come from.

For the elderly population, and especially those with chronic illnesses or a weak immune system, it is advisable to reduce social contact whenever possible while maintaining an active routine.

For those aged 60 and over, it is advisable not to attend gatherings, avoid contact with people returning from any destination abroad, and avoid contact with people with symptoms, and those who are suspected of being infected.

Visits to welfare, nursing or healthcare establishments (where those residents live) are not permitted, except a single caregiver, preferably the same person for each visit.

Any person with symptoms is not permitted to provide care for patients or visit establishments for the elderly.

As a general rule, it is advisable to avoid visits to hospitals and senior institutions, and to suffice with only one designated visitor. Institutions have been instructed to prevent multiple visitors from entering for the benefit of resident health.

Avoid entering the city of Bethlehem and the towns of Beit Jala and Beit Sahur.

According to the recommendations by the Ministry of Health and the Ministry of Foreign Affairs, traveling to mainland China, South Korea, Egypt or Italy should be avoided. Reconsider all nonessential international travel.

If, however, you do decide to travel, be sure to practice strict hygiene during your stay. Furthermore, it is recommended that you avoid contact with either living or dead animals, stay away from livestock markets, and avoid unnecessary visits in healthcare establishments.

In any case, due to the highly dynamic nature of the situation, it is recommended that you keep yourself up-to-date on the reports on the situation in your local region and the guidance by the Ministry of Health, the Ministry of Foreign Affairs and local authorities at each destination.

Presently, and until further notice, there is a sweeping ban on healthcare system personnel from leaving Israel.
The Civil Service Commission has issued guidance for state employees to avoid traveling abroad in an official capacity and to reconsider the necessity of traveling in a private capacity.

Avoid travel to international conferences, events and congregate settings, including religious events.

This table tells you what you need to do if you returned to Israel from abroad, depending on your health condition and time elapsed since your return.

Citizens of Israel who return to Israel from anywhere in the world must be under 14-day home isolation, effective for returns March 9, 2020, 20:00 and later.

If you had returned to Israel in the last 14 days, and were not obligated in home isolation according to Ministry of Health guidance, you are not required to be placed under home isolation. If symptoms develop, you must immediately be under home isolation and call the 101 MDA Emergency Services hotline for medical advice.

People that are under home isolation following the Ministry of Health guidance must complete the 14-day home isolation counting from the date they returned to Israel.

Those who have been in close contact with a confirmed patient must be placed under home isolation in line with given guidance and the law requires them to notify the Ministry of Health of their status by sending the online report or calling the Ministry of Health Hotline *5400. Furthermore, they must call their physician or HMO Hotline to be advised. If it is determined they indeed had close contact, they must follow the guidance for travelers from mainland China (see the table above).

1. The Ministry of Health is investigating each and every case of close contact. If a person had close contact, this person must be placed under home quarantine in line with given guidance and the law requires the person to send an online home quarantine report to the Ministry of Health or to call the Ministry of Health Hotline *5400. If symptoms show, seek medical care in accordance with the Ministry of Health guidance. If you are not sure whether there was close contact, call the MDA Hotline - dial 101 for advice.
2. Any person who does not satisfy the definition of close contact with a confirmed patient or group is not required to be placed under home quarantine, but must monitor their health (fever 38C (100.4F) or higher, cough or other respiratory symptoms). If such symptoms develop, seek medical care in accordance with the Ministry of Health guidance. If you are not sure whether there was close contact, call the MDA Hotline - dial 101 for advice.

The risk of becoming infected with the novel coronavirus as a result of contact with a healthy person who had contact with a confirmed patient is very low. You may resume normal daily activities, and you do not need to be placed under home isolation.

The purpose of home isolation is to slow the spread of the disease into Israel and to prevent infection. For this purpose avoid public places and protect household members. The Ministry of Health Director General Decree mandates a 14-day home isolation from the time you returned to Israel or from the last contact with a confirmed patient. The law requires you to notify the Ministry of Health that you were placed under home isolation by sending the online report or by calling the Ministry of Health Hotline *5400.

Guidance for the person under isolation:

• Stay indoors;
• Stay in a separate, well-ventilated room with a closed door. Exit the room if necessary, for very short periods only, cover your mouth and nose with a facemask. Several individuals of the same household can be isolated in the same room. If all household members require isolation, there is no restriction within the home;
• Wash hands with soap and water or clean them with an alcohol-based sanitizer before and after food preparation, before eating, and before and after using the toilet.
• Soap and water should be used if hands are visibly dirty. It is preferable to use disposable paper for hand drying;
• If available, use a separate bathroom;
• Keep mouth and nose covered while sneezing or coughing, cough or sneeze into a disposable tissue or sleeve. This is to prevent the virus from spreading. Immediately afterwards, wash hands with soap and water or disinfect them with alcohol-based sanitizer;
• If breastfeeding, wash hands before touching the infant, wear a face mask or any other cloth while feeding at the breast. If expressing breast milk with a breast pump, wash hands before touching any pump or bottle parts, and if possible, consider having someone who is well feed breast milk to the infant.
• If fever or respiratory symptoms develop, or any other medical condition, call the 101 MDA Emergency Services Hotline.

General guidance:

• There should be only one person who enters and exits the room of the isolated person, this person should be a healthy person with no other diseases which might further increase their risk;
• No home visitors are allowed;
• Check that the common areas in the home such as the kitchen and the bathroom are well ventilated;
• Upon entering the isolation space, cover your mouth and nose, preferably with a face mask, cloth is also possible. Do not touch face mask while wearing it;
• Use disposable products such as gloves when exposed to the isolated person and the home isolation space, including dirty surfaces, clothes or beddings;
• Avoid direct contact with body fluids, especially oral secretions, airway secretions, urine and feces of the isolated person;
• Wash hands with soap and water or disinfect them with appropriate alcohol-based sanitizer after every contact with the isolated person, the person's belongings, or immediate environment, before eating, and after using the toilet. There is a preference to wash with soap and water over sanitizer if the hands have visible dirt;
• Surfaces should be cleaned and disinfected at least once a day, such as handles, light switches, toilets and showers, bedside tables, bed frame and other furniture in the suspected patient room, with standard household disinfectant (soap or alcohol based- at least 70%). If possible, clean with 1000 ml of chlorine solution (eg "bleach" containing sodium chlorite - take 40 ml bleach and dilute in 1 liter of water) until the surfaces / items are dried. Gloves and a gown or apron should be used during the cleaning processes.
• Bed linen and laundry must be changed at least twice a week. All laundry of the isolated person must be stored separately in the isolation room until the time of washing. Care should be taken to avoid dirty laundry from coming into contact with other items, including clean laundry. Washing must be done separately, on a washing program of at least 65 ° C with regular laundry soap.
• Disposable products such as gloves, tissues, masks and other waste associated with the care of the isolated person must be disposed of in a dedicated bag in the patient's room and sealed tightly before being disposed of in an external garbage can;
• Avoid the sharing of common objects that could transmit the virus with the isolated person, such as: toothbrush, cigarettes, dishes and utensils, towels, beddings, etc. You can wash dishes and utensils with water and dish soap; and
• It is best do dishes in a dishwasher with a temperature of at least 65 ° C. If no dishwasher is available, dishes can be washed in hot water and dish soap and to ensure they fully dry in the drying rack. The utensils (plates, cups, cutlery and trays) of the people in isolation will be separate from those of other occupants, or they should use disposable utensils.
• All other household members must wash hands frequently.
• Practice strict hygiene

Provided the home isolation conditions are maintained, household members can continue their normal activities. There are no movement restrictions on students who live with an isolated person.

Work absence during the isolation period shall be considered an absence from work due to illness, on condition that proof is submitted to certify the date of arrival to Israel.

Click for a general statement of illness (Hebrew). Do not ask your physician to issue a statement of illness for this absence.

As far as we know, companion animals such as a dog or a cat cannot be infected from humans and they cannot infect humans with the novel coronavirus. However, since other members of the corona family may infect animals, it is recommended that you take extreme caution and avoid interaction with pets if you have symptoms related to the coronavirus infection; if you cannot avoid contact with animals while you are sick, wear a facemask and wash your hands.

The effectiveness of a face mask in protecting from the novel coronavirus infection is limited. With extended use, it wears out and gets moist. There is no recommendation to routinely use a face mask for protection from respiratory illnesses, including the infection caused by the novel coronavirus, unless a healthcare professional recommends it. People who are showing symptoms or people suspected of a coronavirus infection or confirmed patients should wear a face mask (in order to avoid spreading the infection to others), as well as people who have contact or are taking care of suspected or confirmed patients (in order to protect themselves).

According to information currently available, coronavirus are not transmitted through food or food packaging, and no transmission of the disease in this way has been reported.

However, it is always important to follow good hygiene practices when handling or preparing food: washing hands and surfaces frequently, separating raw meat and cooked foods, and immediately cooling food.

The information currently available suggests that the coronavirus cannot be transmitted via packages or food, and there are no reports that the infection can spread this way.

The Ministry of Health's policy at this time is one of preventing local infection, which includes the isolation of infected and suspected persons and the restriction of gatherings. At the same time, The Ministry continues a policy of "prevention", i.e. reducing the risk of more patients arriving in Israel. Accordingly, the Ministry of Health recommended measures to restrict entry to Israel for non-residents of Israel (as detailed in the question of “who is allowed to enter Israel?”). In addition, the Ministry of Health has ordered home isolation for anyone who enters Israel from anywhere abroad, for 14 days.

The Ministry of Health follows the situation since it started and keeps in touch with the World Health Organization and other Health Ministries across the world. It issues guidelines to the Healthcare System and the general public on how to prepare for the possible spread of the virus to Israel. The healthcare system can identify potential infections, isolate them, diagnose them, and treat them.

View the COVID-19 spread in Israel (Hebrew)

Entry into Israel is permitted to any citizen or resident of Israel, but they are obliged to isolate a house upon their arrival from abroad.

As of 12.3.20 at 20:00, entry to Israel will be refused to non-citizens or residents of Israel arriving from anywhere in the world. In exceptional cases, one may apply for approval of the Foreign Ministry subject to proof of the ability to remain in home isolation for 14 days.

• For medical questions about the disease or possible exposure, call Magen David Adom Emergency Services Hotline - dial 101.
• For questions about home isolation and general questions about the novel coronavirus, call the Ministry of Health Hotline *5400 or HMO Hotlines.