Surveillance of COVID-19 in

Report for week 25 ending 20-06-2020

Israel Center for Disease Control

Summary: As of week 25, a slight increase was observed in respiratory morbidity in the

65+ age group.

Clinical: Community clinics: A downward trend was observed in the raw rates of visits

to the clinics due to upper respiratory tract infections in the age groups 0-18 and 19-64,

however, in the age group 65+, a slight increase was observed.

Hospitals (“Clalit Health Services”) There is no material change in the percentage of

visits to the pediatric and internal medicine emergency departments due to pneumonia

is continued.

Laboratory: As of Week 25, one positive case of SARS-CoV-2 was identified out of 100

samples collected at the sentinel clinics.

1 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

2. Visits to Community Clinics due to Upper Respiratory Infections (URI) On Week 25, a slight decrease was observed in the raw rate of visits to "Maccabi Health Services" community clinics due to upper respiratory infections. This decrease is mainly reflected in the age groups 0-18 and 19-64, the slight increase is continued in the 65+ age group (Figures 1 and 2). A similar picture was observed at “Clalit Health Services".

Figure 1: Weelky rate of visits due to the upper respiratory tract infections,2017-2020, compared to multi-annual average

- - - 120

100 000 , 80

10 60 40 cases/ 20 0

week

Figure 2: Weekly rate of visits due to the upper respiratory tract infections by age and year, 2017-2020 - - 160 140

120 000

, 100

10 80 60 cases/ 40 20 0

year & week

2 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

3. Visits to community clinics due to pneumonia On Week 25, no material change was observed in the rates of visits to "Maccabi Health Services" community clinics due to pneumonia continues in all age groups (Figures 3 & 4). A similar picture was observed at “Clalit Health Services".

Figure 3: Weekly rate of visits due to pneumonia, 2017-2020, compared to multi-annual average - - - 16 14

12 000

, 10

10 8 6

cases/ 4 2 0

week

Figure 4: Weekly rate of visits due to pneumonia, by age and year, 2019-2020 - - 30

25

20

000 ,

10 15 10

cases/ 5 0

year & week

3 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

4. Calls to the nurses call center, “Maccabi Health Services” On week 25, the decrease in the number of calls to "Maccabi Health Services’ nurses call center due to fever and respiratoy symptoms was continued (Figure 5).

Fig. 5: Calls to the Nursing Call center due to sore throat and cough, Maccabi Health Services 1200

1000

800

600

400 Number 200

0

year and week

Fever in adults sore throat cough shortness of breath fever in children

5. Visits to hospital Emergency Medicine Departments (ED) due to pneumonia (Based on the Ministry of Health's database managed by the Health Information Division). On week 25, a slight increase was observed in the percentage of visits to the pediatric and internal medicine emergency departments at "Clalit Health Services" hospitals due to pneumonia (Figures 6-7). Also, there was no material change in the number of visits due to pneumonia. At the same time, a decrease was observed in the number of visits to the Emergency Departments due to all causes (Figures 6-9).

4 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

Fig. 6: Percentage of visits to internal medicine ERs due to pneumonia, Clalit hospitals, 2018-2020, compared to multi-annual average

5

4

3

2

percentage 1

0

year & week

Fig. 7: Percentage of visits to pediatric medicine ERs due to pneumonia, Clalit hospitals, 2018-2020, compared to multi-annual average

6 5 4

3

percentage 2

1

0

year & week

5 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

Fig. 8: Number of visits to Clalit ERs due to pneumonia, 2019-2020 pediatric ERs Internal ERs

300

250

200 150

Number 100 50 0

Year & week

Fig. 9: Number of visits to Clalit ERs due to any diagnosis, 2019-2020 pediatric ERs internal ERs 7000 6000

5000 4000 3000 Number 2000 1000 0

Year & week

6 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

6. Clusters of respiratory morbidity Identification of clusters is based on data obtained daily from Maccabi and Clalit Health Services. The clusters are identified by focusing on two diagnostic categories: upper respiratory tract infections and pneumonia. Data analysis is performed based on statistical geographic areas. Furthermore, with respect to clusters that last for over a week, we are checking whether active COVID19 patients were identifies in the area at that time, based on data provided by the Ministry of Health. During week 25 and as of 21/06/2020, the areas with consistency in the presence of the clusters which lasted over 7 days, of the two diagnostic categories and based on data from the two health funds, were:

7 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

Locations where BEGINNING DURATION Number of patient with a distinct clusters have OF THE OF THE positive SARS-CoV-2 sample in been identified that CLUSTER CLUSTER the location and during the persist for over 7 days (Days) cluster period Total New in the number cluster’s period (Prevalence) (Incidence) Atlit, Ein Carmel, Geva 28-5-2020 23 0 0 Carmel Taibeh, Azriel, Tzur 31-5-2020 20 4 4 Yitzhak, Bnei Brak, Givat 2-6-2020 18 176 159 Shmuel, Ramat Gan, Kiryat Ono Kfar Sava, Ra'anana, 7-6-2020 13 31 29 , Hod Hasharon, , Kefar Malal, Shefaram, Adi 8-6-2020 12 8 8

Ahuzat Barak 11-6-2020 9 0 0

Giv'at Ko'ah, Rinatya, 11-6-2020 9 0 0 , , , Be'erot Yitzhak Jadeidi-Makr, Tal Al 12-6-2020 8 1 1

8 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

7. Sentinel clinics in the community Sentinel clinic activity for surveillance of morbidity caused by SARS-CoV-2 began on week 12. As of Week 25, the network includes 48 clinics nationwide.

Nasopharyngeal samples are taken from patients attending clinics with fever and/or respiratory symptoms with or without a diagnosis of pneumonia and with no known exposure to a confirmed COVID-19 patient or returning from a foreign country in the 14 days prior to onset. In addition, for patients who do not physically come to the clinic but rather consult their physician using digital technology methods, exhibiting respiratory symptoms and/or fever and without an epidemic story, the sample is collected by Magen David Adom (MDA) Emergency Services.

7.1. Samples from sentinel clinics’ subjects (Table 1)

Table 1. Patients that tested positive for SARS-CoV-2 out of the total number of subjects that were tested in the sentinel clinics

Week 25 Accumulated Data from 14/06-20/06/2020 Week 12 15/03-20/06/2020 Positive 1 (1.0%) 28 (1.8%)

Negative 99 (99.0%) 1543 (98.2%)

Total 100 1571

* There may be a retroactive update of the number of samples and their results. * An epidemiological week is calculated according to the sampling date.

9 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

7.2. Patients that tested positive for SARS-CoV-2 in sentinel clinics (Tables 2, 3 and Figure 10).

Table 2. positive patients for SARS-CoV-2 by location during the surveillance period, by week

Week Dates Positive Negative Total

12 15/03-21/03/2020 0 (0%) 33 (100%) 33

13 22/03-28/03/2020 6 (2.3%) 255 (97.7%) 261

14 29/03-04/04/2020 13 (5.7%) 214 (94.3%) 227

15 05/04-11/04/2020 3 (2.9%) 100 (97.1%) 103

16 12/04-18/04/2020 1 (1.4%) 67(98.6%) 68

17 19/04-25/04/2020 1 (1.0%) 97 (98.9%) 98

18 26/04-02/05/2020 0 (0%) 49 (100%) 49

19 03/05-09/05/2020 0 (0%) 73 (100%) 73

20 10/05-16/05/2020 0 (0%) 76 (100%) 76

21 17/05-23/05/2020 1 (1.2%) 79 (98.8%) 80

22 24/05-30/05/2020 0 (0%) 75 (100%) 75

23 31/05-06/06/2020 2 (1%) 192 (99%) 194

24 07/06-13/06/2020 0 (0%) 134 (100%) 134

25 14/06-20/06/2020 1 (1%) 99 (99%) 100

10 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

Table 3. Positive patients for SARS-CoV-2 by location during the surveillance period (Only the localities in which there was at least one positive sample during the surveillance period are specified) Municipality Number of positive Accumulated number of positive samples samples (Total no. of samples) (Total no. of samples) since Week 25 Week 12 14/06-20/06/2020 15/03-20/06/2020

Elad 0 (0) 3 (20) Beit Shemesh 0 (0) 1 (68)

Bnei Brak 0 (0%) 1 (5)

Jerusalem 0 (6) 13 (219)

Acre 0 (1) 1 (38)

Rosh HaAyin 0 (2) 1 (36) Ramat HaSharon 0 (0) 1 (39)

Sderot 0 (0) 2 (11)

Tel Aviv 0 (6) 2 (86)

Ramla 0 (5) 1 (48)

Petach Tikva 0(16) 1 (212)

Or Yehuda 1 (2) 1 (24)

On Week 25, one case was tested positive for SARS-CoV-2 out of the total number of samples sent from the sentinel clinics.

11 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

Fig.10: Specimens positive for SARS-coV-2 out of total specimens collected by sentinel network, 2020

Positive Negative

300 250 200 150

Number 100 50

0

Week

8. Cumulative national SARS-CoV-2 morbidity (the data are updated for the end of Week 25 ending June 20, 2020) (Figure 11) (This figure id based on the official data provided by the Public Health Services)

Fig.11: Number of national cumulate morbidity cases of COVID-19,2020

cases

25000 20664 18997 20000 17745 16366165331665416997 1531016076

13543 15000 10957 8166 Number 10000 3916 5000 1029 0 18 23 42 194 0

Week

12 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

* Slight changes may apply due to retroactive updates. 9. Mortality in Israel 9.1. Mortality of all causes (updated for week 21 ending on May 23, 2020) As of week 21, the death rate is above the multi-annual average (Figure 12).

Fig.12: Overall national mortality rate, 2017-2020, compared to multi-annual average multy weekly mortality rate annual average 2010-2017 14 13

12 000

, 11 10 10

Cases/ 9

8

7

6

------

-

Year and week

13 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881

9.3. Pneumonia mortality (updated for week 23 ending on June 06, 2020) As of Week 23, the percentage of mortality due to pneumonia is within the seasonally expected range (Figure 13).

Fig.13: Deaths from pneumonia as a percentage of all deaths, 2017-2020' compared to multi-annual seasonal prediction

percentage of deaths from pneumonia seasonal prediction epidemic thershold 24

20

16 12 8 4 Percentage 0

Year and week

10. Global COVID-19 snapshot

The upward trend in the number of people contracting SARS-CoV-2 is continued. As of 21/06/20, the total number of confirmed COVID-19 cases was 8,708,008, of which 187,020 were new cases. The total number of deaths is 461,702, of which 4,783 were new deaths. Countries with the highest number of deaths were: USA (118,895), Brazil (48,954), United Kingdom (42,589), Italy (34,610), France (29,565), Spain (28,322), Mexico (20,394), India (13,254), Belgium (9,696), Iran (9,507), Germany (8,882), Canada (8,346) and Russia (8,111). (The data was gathered from the World Health Organization Report - Status Report 153).

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200621-covid-19-sitrep- 153.pdf?sfvrsn=c896464d_2

14 Israel Center for Disease Control ICDC-Israel Center for Disease Control Ministry of Health Ministry of Health Gertner Institute, Chaim Sheba Medical Gertner Institute, Chaim Sheba Medical Center Center, Tel Hashomer 52621 [email protected] [email protected] Tel: 03-7371500 Fax: 03-5349881 Tel: 03-7371500 Fax: 03-5349881