SARS-CoV-2 Epidemic in the Israeli Defense Force-Lessons Learned From Our rt-PCR Screening Policy.

BACKGROUND: During the SARS-CoV-2 pandemic, multiple preventative measures were used to prevent the virus from spreading in the population. The Israeli defense force deployed further means to contain the disease, including putting units in quarantine, physical distancing and using masks, gowns and disinfectants when in contact with suspected patients. METHODS: We used reverse transcriptase-polymerase chain reaction (rt-PCR) tests to screen for patients among asymptomatic soldiers within units participating in civilian aid or in close contact with known patients, using personal protective equipment. Positive results were repeated and followed with serological testing to verify the nature of results. RESULTS: Between April and May 2020, we screened a total of 1,453 soldiers in 13 different units. We found 11 false positive results, leading to unnecessary measures until resolution, and three true positive results (0.2%). All true positive results had unreported symptoms concomitant with SARS-CoV-2 disease. These results led to the resolution of this screening policy. CONCLUSION: Screening asymptomatic army personnel in this setting with rt-PCR test for SARS-CoV-2 is not warranted and leads to unnecessary false positive results. Efforts should be directed at identifying symptomatic patients.

Socioeconomic disparities and COVID-19 vaccination acceptance: a nationwide ecologic study.

OBJECTIVE: To analyse the correlation between COVID-19 vaccination percentage and socioeconomic status (SES). METHODS: A nationwide ecologic study based on open-sourced, anonymized, aggregated data provided by the Israel Ministry of Health. The correlations between municipal SES, vaccination percentage and active COVID-19 cases during the vaccination campaign were analysed by using weighted Pearson correlations. To assess the adequacy of first dose vaccination rollout relative to the municipality COVID-19 disease burden, a metric termed the vaccination need ratio was devised by dividing the total number of active cases (per 10 000 people) by the vaccination percentage of the population over 60 in each municipality, and its correlation with the SES was examined. RESULTS: 23 days after initiation of the vaccination campaign, 760 916 (56.8%) individuals over the age of 60 were vaccinated in Israel with the first dose of the BNT162b2 COVID-19 vaccine. A negative correlation was found between the COVID-19 active case burden and the vaccination percentage of the study population in each municipality (r = -0.47, 95% CI -0.59 to -0.30). The vaccination percentage significantly correlated with the municipal SES (r = 0.83, 95% CI 0.79 to 0.87). This finding persisted but was attenuated over a 5-week period. A negative correlation between the vaccination need ratio and municipal SES (r = -0.80, 95% CI -0.88 to -0.66) was found. DISCUSSION: Lower COVID-19 vaccination percentage was associated with lower SES and high active disease burden. Vaccination efforts should focus on areas with lower SES and high disease burden to assure equality of vaccine allocation and potentially provide a more diligent disease mitigation.

The Effectiveness of the Two-Dose BNT162b2 Vaccine: Analysis of Real-World Data.

BACKGROUND: Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were shown to be highly efficacious in preventing the disease in randomized controlled trials; nonetheless, evidence on the real-world effectiveness of this vaccine is limited. Study objective was to evaluate the effectiveness of BNT162b2 vaccine in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19-related hospitalization and mortality. METHODS: This historical cohort study included members of a large health provider in Israel that were vaccinated with at least 1 dose of BNT162b2. The primary outcome was incidence rate of a SARS-CoV-2 infection confirmed with real-time polymerase chain reaction (rt-PCR), between 7 and 27 days after second dose (protection-period), as compared to days 1-7 after the first dose, where no protection by the vaccine is assumed (reference-period). RESULTS: Data of 1 178 597 individuals vaccinated with BNT162b2 were analyzed (mean age 47.7 years [SD = 18.1], 48.4% males) of whom 872 454 (74.0%) reached the protection period. Overall, 4514 infections occurred during the reference period compared to 728 during the protection period, yielding a weighted mean daily incidence of 54.8 per 100 000 (95% confidence interval [CI]: 26.1-115.0 per 100 000) and 5.4 per 100 000 (95% CI: 3.5-8.4 per 100 000), respectively. The vaccine effectiveness in preventing infection was 90% (95% CI: 79%-95%) and 94% (95% CI: 88%-97%) against COVID-19. Among immunosuppressed patients, vaccine effectiveness against infection was 71% (95% CI: 37%-87%). The adjusted hazard ratios for hospitalization in those infected were 0.82 (95% CI: .36-1.88), 0.45 (95% CI: .23-.90), and 0.56 (95% CI: .36-.89) in the age groups 16-44, 45-64. and ≥75 years, respectively. CONCLUSIONS: The effectiveness of the BNT162b2 vaccine is comparable to the one reported in the phase III clinical trial.

Short Communication: Combining Ethics With Efficiency-Israel Defense Forces' Experience in Clinical Trials During the Coronavirus Disease 2019 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic, first reported in China, soon spread worldwide, has evolved into one of the most complex global public health crises the world has encountered in the last several decades. Conducting military medical research is vital to study the unique influences of military service conditions on soldiers' health and to improve the medical response in various emergency periods. The Israel Defense Forces (IDF) Medical Corps maintains an Institutional Review Board (IRB) which reviews clinical studies conducted within the IDF. During the COVID-19 pandemic, the IRB of the IDF had to rapidly implement procedural modifications in order to comply with expanding urgent demands for research without compromising ethical standards. The ethical dilemmas and the IDF policy and perspective are outlined in this article.

Self-reported symptoms in healthy young adults to predict potential coronavirus disease 2019.

OBJECTIVE: To assess the utility of self-reported symptoms in identifying positive coronavirus disease 2019 (COVID-19) cases among predominantly healthy young adults in a military setting. METHODS: A questionnaire regarding COVID-19 symptoms and exposure history was administered to all individuals contacting the Israeli Defence Forces Corona call-centre, before PCR testing. Surveyed symptoms included cough, fever, sore throat, rhinorrhoea, loss of taste or smell, chest pain and gastrointestinal symptoms. Factors were compared between positive and negative cases based on confirmatory test results, and positive likelihood ratios (LR) were calculated. Results were stratified by sex, body mass index, previous medical history and dates of questioning, and a multivariable analysis for association with positive test was conducted. RESULTS: Of 24 362 respondents, 59.1% were men with a median age of 20.5 years (interquartile range 19.6-22.4 years). Significant positive LRs were associated with loss of taste or smell (LR 3.38, 95% CI 3.01-3.79), suspected exposure (LR 1.33, 95% CI 1.28-1.39) and fever (LR 1.26, 95% CI 1.17-1.36). Those factors were also associated with positive PCR result in a multivariable analysis (OR 3.51, 95% CI 3.04-4.06; OR 1.86, 95% CI 1.65-2.09; and OR 1.34, 95% CI 1.19-1.51, respectively). Reports of loss of taste or smell increased gradually over time and were significantly more frequent during the late period of the study (63/5231, 1.21%; 156/7941, 1.96%; and 1505/11 190, 13.45%: p < 0.001). CONCLUSION: Loss of taste or smell, report of a suspicious exposure and fever (>37.5°C) were consistently associated with positive LRs for a positive SARS-CoV-2 PCR test result, in a population of predominantly young and healthy adults.

Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data.

INTRODUCTION: The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command's (NC) preliminary experience. MATERIALS AND METHODS: We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC). RESULTS: The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18-50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units. CONCLUSIONS: Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.