Surveillance of COVID-19 in Israel 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, Tzur Natan Bnei Brak, Givat 2-6-2020 18 176 159 Shmuel, Ramat Gan, Kiryat Ono Kfar Sava, Ra'anana, 7-6-2020 13 31 29 Tzofit, Hod Hasharon, Sde Warburg, Kefar Malal, Gan Haim 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 Mazor, Nofekh, Nehalim, 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.