Anxiety interferes with decision making

How Anxiety Interferes With Decision-Making – And How to Stop it Intruding

Anxiety tends to rule decisions by presenting us with all of the possible outcomes, particularly the bad ones. Decisions are then made around avoiding what we don’t want, rather than chasing what we do want.

Posted by Karen Young, Hey Sigmund

Anxiety has many ways of injecting itself into life and causing trouble. One of ways anxiety interferes is by leading decision-making astray.

When it’s there, anxiety tends to direct behavior towards the safest option. Sometimes moving cautiously is definitely the best way to go. Sometimes it’s not. Given too much say-so, anxiety can stand in the way of a lot of life.

Scientists at the University of Pittsburgh have discovered what happens when anxiety rules a heavy hand over decision-making and persuades decisions that aren’t the best ones.

Research published in The Journal of Neuroscience explains how anxiety works to disengage the part of the brain that is essential for making good decisions. The area is the pre-frontal cortex (PFC), at the front of the brain, and it is the area that brings flexibility into decision-making.

The PFC is the part of the brain that gets involved in weighing up consequences, planning, and processing thoughts in a logical, rational way. It helps to take the emotional steam out of a decision by calming the amygdala, the part of the brain that runs on instinct, impulse and raw emotion (such as fear).

The research. What they did.

Researchers looked at the activity of brain cells in the PFC of anxious rats while those rats were encouraged to make a decision about which behaviour would get them a sweet reward. Rats share many physiological and biological similarities to humans which is why they are often used in these sort of studies. The researchers compared the behaviour and brain activity of two groups of rats – one that received a placebo and one that received a low dose of a drug that induced anxiety. Both groups of rats were able to make sound decisions, but the anxious rats made a lot more mistakes when there were more distractions in their way.

How Anxiety Interferes. What the research means.

Anxiety rolls good decision-making by reducing the brain’s capacity to screen out distractions. Distractions can be physical, as in things in the environment, or they can take the form of thoughts and worries. Anxiety interrupts the brain’s capacity to ignore these distractions by numbing a group of neurons in the pre-frontal cortex that are specifically involved in making choices.

‘We have had a simplistic approach to studying and treating anxiety. We have equated it with fear and have mostly assumed that it over-engages entire brain circuits. But this study shows that anxiety disengages brain cells in a highly specialized manner.’ Bita Moghaddam, lead author and professor in the Department of Neuroscience, University of Pittsburgh.

This new finding challenges the conventional theories that anxiety intrudes on life by overstimulating circuits within the brain. It seems that when it comes to making decisions at least, anxiety selectively shuts down certain connections, making it more difficult for the brain to screen out irrelevant information and make better decisions.

How to Stop Anxiety Intruding on Decisions

  1. Strengthen your brain against anxiety.

    Be mindful. Mindfulness strengthens the pre-frontal cortex, which is the part of the brain that can be sent offline by anxiety. Without the full capacity of the pre-frontal cortex to weigh in on decision-making, decisions are more likely to become fixed and rigid and driven by intrusive emotions that don’t deserve the influence. Mindfulness strengthens the brain’s capacity to filter out distractions to make more grounded, relevant decisions. It limits the influence of the things that don’t matter, so you can focus on the things that do. (Here you go – this articles explains it in more detail.)

  2. Understand where the anxiety is really coming from.

    Work stress or day-to-day life stress (such as having an argument or being stuck in bad traffic) can trigger enough emotion and intrusive thoughts to influence important, unrelated decisions. Anxiety can also stem from past incidents. The emotion may have been justified then, but now it might be just getting in the way. Unwarranted anxiety can lead to overly safe decision making. By looking for where the anxiety has come from, its influence on behavior can be reduced.

  3. Slow it down.

    Slowing down sounds like it should be easy, but nope – life is rarely that simple. Slowing down involves a deliberate shift away from automatic thoughts and feelings and towards what is actually happening, what you are actually feeling, and what might be behind it. So much of the way we feel and our response to a situation happens automatically, but it doesn’t have to be this way. The greater awareness we have around what we are doing or feeling, the more power we have to change it.

  4. Don’t buy into the idea that thoughts, feelings and behaviour are a package deal. They’re not.

    Just because you feel a certain way or think a certain thought, doesn’t mean you have to act a certain way. This involves being more deliberate about behaviour and pushing against the automatic, habitual response. Thoughts, feelings and behaviour are interrelated. They influence each other, often without us even realising it. Change one and the other two will eventually catch up. You don’t have to believe this – just try it and watch it happen.

  5. Act as if. (Yes, really. Just try it.)

    When there is an important decision to be made, it’s really normal to feel panicked or anxious, but you don’t have to rush your decision. Anxiety is there to protect you from danger but just because it’s raising the alarm, it doesn’t mean there is any danger about. Try challenging the presence and influence of anxiety by ‘acting as if’ there is nothing to be worried about. This might feel difficult, but the more you do it, the easier it will come. Stay with the moment. Right now, you’re okay, and you’ll keep being okay. Even if it doesn’t feel true for you, act as if it is. The point is reducing anxiety enough so that it doesn’t force itself into decisions where it isn’t needed.

  6. Just because there are choices, doesn’t mean there is a wrong one.

    What decision would you make if you knew there wasn’t a wrong one? Often, the way anxiety makes decision-making all the harder is by tricking us into believing that there will be a right choice and a wrong one, a good one and a bad one. If you are feeling really stuck between two decisions, it’s very likely that neither decision will be the wrong one. Once you have made the decision – whichever one that might be – you’ll start organising the environment around you, including your own behaviour and responses, to make sure things work out. Your resilience, creativity and resourcefulness will rise up to support you and propel you forward.

  7. Be guided by what you want, rather than by what you want to avoid.

    Try shifting your focus. Anxiety tends to rule decisions by presenting us with all of the possible outcomes, particularly the bad ones. Decisions are then made around avoiding what we don’t want, rather than chasing what we do want. What would your decisions look like if they were driven by what you want to happen, rather than by what you don’t want to happen.

And finally …

It is the way of anxiety to prod you from behind then hide in the shadows. By strengthening the brain to filter out distractions and by being aware of the feelings that are driving behaviour or decisions the way is open for wisdom, relevance and clarity – and decisions that will be more enriching ones for you.


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supplements for immunity

Doctor’s Note: Can you boost your immune system?

The immune system relies on a complex integration of various cells, organs, proteins and tissues which work together to recognise and neutralise pathogens. there are numerous nutrients, vitamins and minerals that are required to support the normal functioning of your immune system.


In the current climate, health is on everyone’s minds and we are all thinking “How can I avoid catching the coronavirus?”

We are washing our hands incessantly, standing two metres away from each other and running a mile when someone coughs.

But many of my patients are asking me whether there is a way to boost their immune systems to help protect them.

The short answer is no. No amount of kale or flaxseed will stop you from catching this contagious and serious viral infection. Hand washing, social distancing and self-isolation remain the only current ways we have to actively prevent it. 

Our immune systems do not have an on and off switch that a supplement will flip.

Instead, the immune system relies on a complex integration of various cells, organs, proteins and tissues which work together to recognise and neutralise pathogens.

Furthermore, the immune system is not designed to be “boosted”, and if it were able to work in overdrive it could actually result in us becoming more unwell by damaging our healthy cells and tissue as well, which is what can happen in “autoimmune” conditions.

More Doctor’s Notes:

However, there are numerous nutrients, vitamins and minerals that are required to support the normal functioning of your immune system.

Most of these nutrients, except for vitamin D, can be sourced easily from a well-rounded, healthy diet. While we are aware that malnutrition can impair immune function, providing you have an adequate intake, any product suggesting its pill will “boost” your immunity is likely to be misleading.

It may laud the evidence to support that supplement as one of the factors in the functioning of the immune system, but it is unlikely, in isolation, to be able to do very much for you. 

Vitamin D

Vitamin D is often associated with the healthy development of bones, joints and muscles. However, we are learning more about this humble vitamin, and now understand that it is associated with far more than just our skeleton.

It has been found to adapt our immune responses, and that a deficiency in it can be a trigger in autoimmune conditions and susceptibility to infections.

Vitamin D is primarily made from a reaction of the sun on our skin. During the winter months, when the sun does not often shine through the clouds and is weaker when it does, this can be difficult to achieve.

Some foods, including oily fish, egg yolk, meat and offal, contain vitamin D in small amounts. However, for most of the population, a maintenance dose of vitamin D in the form of a supplement is required over the winter months, recommended by the NHS at a dose of 10mcg Vitamin D3 daily.


Zinc is known to be an important “micronutrient” for the immune system, and a deficiency of it can result in an impaired immune response.

There is even evidence to suggest that by taking a zinc supplement within 24 hours of a cold commencing, it can reduce the severity and duration of the illness.

Zinc can be found in plenty of foods, including seafood, meat, beans and pulses. 

B vitamins

Several members of the B vitamin complex, namely vitamin B6, B12 and B9, have been implicated in the immune response.

Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk and milk products, so where vegans are not adequately supplementing their diets they can develop a deficiency.

Vitamin B6 is needed to absorb vitamin B12 and to make red blood cells and cells of the immune system. It can be found in foods including beef liver, chickpeas, tuna, salmon, rice, cereals and onions.

Most people only ever hear about folic acid (vitamin B9) in pregnancy as women are advised to take it daily in the first three months. Its role in pregnancy is to ensure that your baby does not develop neural tube defects such as spina bifida.

Folic acid is naturally present in a wide variety of foods, including dark green leafy vegetables, fruits, nuts, beans, seafood, eggs and meat.

These B vitamins have been found to have a role in the immune system, and a deficiency in them can alter the response of the immune system. This is by inhibiting the body’s ability to make antibodies, white blood cells and other immune factors it needs to fight off infection.

Vitamin C

Vitamin C has an essential role in normal immune function. It is found most richly in fruit and vegetables and aids the formation of collagen, wound healing and is an antioxidant.

This means that it scavenges free “radicals”, which are charged particles that can damage cells, tissues and genetic material, which can affect your immunity.

Most of us can achieve the recommended daily amount of vitamin C by simply eating a large orange, though smokers may need a slightly higher intake as, according to the National Institute of Health, smoking can deplete the body’s vitamin C.

Gut microbiome

The microbiota is the community of trillions of bacteria, fungi and other microorganisms that colonise our bodies, and the microbiome is the collection of them in a particular environment, in this case, the gut.

Not only does the gastrointestinal tract harbour a vast microbiome, but it also contains a large pool of immune cells.

The gut microbiome has been found to communicate with these immune cells, thus controlling how your immune system works and responds to infection.

As such, keeping these bacteria healthy with prebiotics and probiotics may also keep your immune system functioning normally.

Again, supplements are not required for this as there are plenty of foods that contain these properties. Pre-biotics are essentially the non-digestible fibre that the bacteria ‘feed’ off, and probiotics are the beneficial bacteria themselves, and can be found in yoghurts, artisan cheeses and many fermented goods including kimchi, sauerkraut, kefir, miso and kombucha. 

Omega 3

Omega 3s are integral parts of the membranes that surround each cell in your body.

There are three forms of omega 3 fatty acids – EPA, DHA and ALA. ALA is what we call an “essential” fatty acid, which means that it must be consumed via our diet and cannot be made by the body.

A number of studies have shown that omega 3 is associated with boosted B-cell activity which is a vital part of our immune system. 

We can make a only small amount of EPA and DHA from ALA, so it is still important to get it from our diet too. ALA can mainly be found in plant oils, nuts and seeds; and DHA and EPA, in oily fish.


In addition to dietary measures that support your immune system, exercise may also play a role.

It has been found to enhance the body’s immune response and improve its defence activity. Regular, habitual exercise resets the immune system, something known as “immunoregulation”.

While the extent of this will clearly depend on the amount and type of exercise you do, the NHS guidelines are to incorporate at least 150 minutes of moderate-intensity activity a week or 75 minutes of vigorous-intensity activity a week into your routine.


While acute stress has been shown to be potentially beneficial for the immune system, chronic stress has been associated with the suppression of immunity.

Evolutionarily it is thought that an acute “fight or flight” type of stress caused a beneficial response in the immune system to prepare it for infections as a result of cuts, scrapes and bites.

Chronic stress, however, is associated with consistently raised cortisol production which is a hormone that suppresses the immune system to a degree.

Little is known about the psychological and biological pathways that link stress and the immune response, but the results of a large study have supported the association of stress and a decrease in immune measures.

Moderate your drinking

We are well aware that alcohol can have a damaging effect on many of our organs, leading to liver disease, and can also increase the risks for heart disease as well as a number of cancers.

But alcohol misuse can also weaken your immune system, making you more vulnerable to infections. If you are drinking more than the recommended limit of 14 units per week, perhaps consider trying to cut back.

Ultimately, in addition to our genetics, our immune system is made up of the interplay between our diet, stress, lifestyle and environment. While there are likely to be many more micronutrients and factors not mentioned above involved in the healthy functioning of our immune systems, there is no one elixir to optimise it, just the symbiotic relationship of all these factors acting together.

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Remdesivir for COVID-19

Mechanism of action revealed for remdesivir, potential coronavirus drug

3 March 2020

Researchers have demonstrated how the drug known as remdesivir works, presenting the viral RNA polymerase of coronaviruses as a target for these conditions.

Coronavirus cells

A team of academic and industry researchers has reported new findings on how exactly an investigational antiviral drug stops coronaviruses. The paper was published the same day that the US National Institutes of Health (NIH) announced that the drug in question, remdesivir, is being used in the country’s first clinical trial of an experimental treatment for COVID-19, the illness caused by the SARS-CoV-2 virus.

Previous research in cell cultures and animal models has shown that remdesivir can block replication of a variety of coronaviruses, but until now it has not been clear how it does so. The researchers, from the University of Alberta, US, and Gilead, studied the drug’s effects on the coronavirus that causes Middle East Respiratory Syndrome (MERS). They found that remdesivir blocks a particular enzyme that is required for viral replication.

Coronaviruses replicate by copying their genetic material using an enzyme known as the RNA-dependent RNA polymerase. Until now, it has been difficult to get the polymerase complex that contains multiple proteins to work in a test tube.

“It hasn’t been easy to work with these viral polymerases,” Matthias Götte, a virologist and professor at the University of Alberta who led the study. He explained that this has slowed research into new drugs’ function.

Using polymerase enzymes from the coronavirus that causes MERS, scientists in Götte’s lab found that the enzymes can incorporate remdesivir, which resembles an RNA building block, into new RNA strands. Shortly after adding remdesivir, the enzyme stops being able to add more RNA subunits. This halts genome replication.

The scientists hypothesise that this might happen because RNA containing remdesivir takes on a strange shape that does not fit into the enzyme. To find out for certain, they would need to collect structural data on the enzyme and newly synthesised RNA. Such data could also help researchers design future drugs to have even greater activity against the polymerase. They suggest the viral RNA polymerase of coronaviruses as a target.

The study was published in the Journal of Biological Chemistry.

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Middle East copes with COVID-19

The Calm before the Storm? Coping with Corona in the Middle East | INSS

Itai Brun, Sarah J. Feuer

INSS Insight No. 1284, March 26, 2020

The coronavirus is making its way across the Middle East, forcing states to prepare for the possible collapse of governing systems. The virus struck a region already buckling under the weight of armed conflicts, social upheaval, severe economic distress, and identity-related clashes. The data on corona’s spread is far from precise or reliable, given the lack of testing, lagging policies, and likely efforts at concealment on the part of certain regimes. But it is safe to assume that the number of infections is far greater than what is reported. Every regime seeks to mitigate corona’s consequences, and for the moment governments across the region appear to enjoy support from the public in doing so. Still, the region could suffer an uncontrollable outbreak, given high population density in certain cities and the sizable clusters of refugees and displaced persons scattered throughout the area. Such an outbreak could spell a humanitarian disaster, exacerbating the region’s endemic problems and in some cases leading to a level of chaos that regimes would be hard-pressed to manage. Israel must prepare for the possibility of serious instability on its borders stemming from the outbreak, principally in the West Bank and Gaza.

The corona crisis is in its early days, and the available data reflecting its impact across the Middle East and North Africa is incomplete and largely unreliable. The figures below are drawn from state reporting and independent sources as of March 25, 2020. The number of infections is likely far greater than what is reported due to the lack of adequate testing, difficulties associated with containment, and regime efforts to conceal the true extent of the virus’s spread.

War in the Time of Corona

In Syria (population 17 million), the regime of Bashar al-Assad only acknowledged the first, and thus far only, instance of corona on March 22 after weeks of strenuously denying the virus’s presence in the country. Independent estimates place the likely number of infections at 2,500, many reportedly stemming from contact with Iranians returning in recent weeks to join the Shiite militias fighting in Idlib and eastern Syria. The regime postponed parliamentary elections originally scheduled for April 13, partially sealed its borders (though flights from Iran continue), closed schools, banned pilgrimages to holy sites, and canceled Friday prayers in the mosques. Since March 24 a curfew in major cities has been in effect from 6 AM to 6 PM.

In Yemen (pop. 29 million), officials on both sides of the conflict insist the virus has not yet reached the country, where an estimated 15 million people were already facing starvation prior to corona and roughly 70 percent of the population lacks access to basic healthcare. Still, both the internationally recognized government and the Houthi rebels seeking to overthrow it announced the suspension of flights, closure of schools, and establishment of quarantine zones.

In divided Libya (pop. 6 million), a lone case has been formally acknowledged, but the internationally recognized government in Tripoli suspended flights, closed border crossings, canceled sporting events and weddings, closed cafes and schools, and suspended prayers in mosques. The eastern-based (unrecognized) government of Khalifa Haftar imposed a nightly curfew and announced it would be closing its borders with Chad, Niger, Algeria, and Sudan. Despite statements from Western and Arab countries calling on the rival parties to cease hostilities in order to combat the virus, clashes reportedly continue in and around Tripoli.

Protests on Pause                                         

Iran (pop. 83 million) appears to be the hardest hit country in the region. The country has officially confirmed more than 25,000 infections and a death toll of 1,800, but there is likely a great discrepancy between official and actual cases. The government, widely criticized at home for its lack of transparency in publicizing the risks associated with the virus’s spread, suspended Friday prayers for three consecutive weeks but only shut down shrines and holy sites last week, and as late as March 18 the Associated Press was reporting that markets in Tehran remained packed with people. The government has turned to the International Monetary Fund for a $5 billion emergency loan to assist in combating the virus, blaming United States sanctions for hampering the country’s ability to adequately stem the epidemic.

Iran’s regional footprint has been linked to the corona outbreak in Lebanon (pop. 6 million), where the first confirmed case in February was thought to emanate from the visit of a high-level Iranian delegation there. The official number of infections has risen to over 300, with 4 deaths. The government declared a “medical state of emergency” and closed schools, universities, and airports (except to allow flights bringing citizens home). Supermarkets and pharmacies remain open, but banks have closed, causing widespread panic given the country’s precarious fiscal situation.

In Iraq (pop. 39 million), where activists leading demonstrations against the government since October were forced to suspend their protests, the number of reported infections has reached 316, alongside 27 related deaths. Airports are closed, Baghdad has imposed a curfew, and a number of provinces have enforced lockdowns. Corona landed in Iraq at a politically fragile moment, with the recent nomination (as yet unconfirmed) of a new Prime Minister, Adnan al-Zurfi. Zurfi faces opposition from Iran-backed militias, some of which recently launched a series of missile and rocket attacks on US and coalition forces stationed at military bases outside Baghdad. Those attacks drew American retaliatory strikes, heightening prospects of an escalation between the US and Iran on Iraqi soil. Meanwhile, Iraq sealed its border to Iranians wishing to enter, but it has continued to permit Iraqi citizens to return home, despite widespread concerns they are likely bringing additional cases of corona into the country.

In Algeria (pop. 41 million), where a widespread protest movement demanding an overhaul of the political system recently reached its one-year mark, the government banned all public protests, shuttered mosques, canceled flights to and from Europe, and announced an upcoming suspension of domestic flights. The country has reported 264 infections and 19 deaths.

Official figures are much lower in Sudan (pop. 40 million), with only 2 acknowledged infections and 1 death, but the government has nonetheless closed schools and religious institutions, shut down airports, sealed off sea and inland borders, and reportedly begun preparing isolation centers near the border with Egypt.

Calm before the Storm?

In the West Bank and Gaza, authorities have largely copied Israel’s approach to handling the outbreak, imposing severe restrictions in an effort to contain the virus.

In the West Bank (pop. 2.5 million), there have been 60 confirmed infections, mostly in and around Bethlehem, where the outbreak originated. The Palestinian Authority has implemented a full lockdown, and coordination between Israel and the PA has continued, including work permits issued to Palestinians on condition they remain in Israel for two months to prevent the virus from traversing the territories. Thus far, 50,000 Palestinians have accepted the offer. Israel has also provided several thousand corona test kits to the PA. In the event the PA is unable to continue controlling the situation, an outbreak of the virus could spill over into Israel. Restrictions on the movement of people and goods between Israel and the West Bank, which are slated to continue for several months, will increase the chances of a major economic crisis, heightening prospects of the PA’s collapse and widening chaos in the West Bank.

The relative quiet from Gaza (pop. 2 million) in recent weeks has stemmed from Hamas’s preoccupation in trying to prevent an outbreak there, and from Israeli relief measures vis-à-vis the Strip. There have been two reported cases in Gaza, where Hamas has closed schools, opened makeshift quarantine facilities, and required Palestinians returning to the Strip through the Rafah and Erez crossings to remain in quarantine for 14 days. Meanwhile, Israel facilitated the delivery of 500 corona test kits to authorities in the Strip. A reduction in such relief measures or more generally in the scope of cooperation surrounding the virus could bring an end to the quiet and increase the chances of escalation or even a resumption of the mass protests along the border fence with Israel.

In Egypt (pop. 98 million), the government has confirmed 402 infections and 20 deaths (among them two military generals), but reports in international media outlets have suggested the true extent of the virus’s spread is far more severe, leading the Sisi regime to revoke the credentials of several Western journalists in the country. The government closed schools, universities, and tourist sites, instituted a nightly curfew, reduced work in the public sector, shuttered nightclubs and cinemas, suspended prayers in mosques, and imposed quarantines for workers in the tourism sector.

In Jordan (pop. 10 million), where 154 infections have been confirmed but no deaths reported, the regime took a relatively aggressive approach to containing the virus following initial concerns that the public was not heeding advice to remain at home. A state of emergency was declared, and the government imposed a lockdown, closing all government offices (except hospitals), ordering private firms to shut down, closing stores except for those selling food and medicine, sealing its land and sea border crossings, suspending all flights, and forbidding all social and communal religious activities. Several hundred Jordanians have reportedly been arrested for curfew violations, and the government has transformed 34 hotels into makeshift hospitals.

Turkey (pop. 83 million) formally acknowledged the outbreak relatively late, announcing its first infection only on March 11. By March 25, that number stood at 1,872 with 44 reported deaths. The government has closed schools and universities, restricted mosque activity to individual prayer, and suspended flights from over forty-six countries, although flights from Qatar remain operational. Turkish Airways has announced that as of March 27, the airline would only offer flights to Hong Kong, Moscow, Washington, New York, and Addis Ababa. In a speech on March 18, President Recep Tayyip Erdogan called upon citizens to stay at home for three weeks, and soon thereafter the Interior Minister announced a curfew for people over the age of 65 and those with a chronic health condition.

In Morocco (pop. 32 million) and Tunisia (pop. 12 million), a combined 284 infections and 9 deaths have been reported. Both countries scrambled to allow flights to bring tourists back to their home countries, and both have closed mosques, cafes, schools, and universities. In Morocco, authorities have declared a state of emergency, and military personnel are patrolling the streets to ensure people remain in their homes. In Tunisia the government has imposed a curfew and implemented a nationwide lockdown.

Finally, across the six states of the Gulf Cooperation Council – Saudi Arabia, Bahrain, Qatar, Kuwait, the United Arab Emirates, and Oman – 6 deaths and over 2,200 infections have been reported. The hardest hit Gulf state appears to be Qatar, which has registered 526 infections out of a population of 2.8 million (85 percent of whom are foreign workers). All governments have now suspended flights to varying degrees, closed schools and mosques, restricted work in the public and private sectors, and implemented quarantines. In Saudi Arabia (pop. 34 million), where 767 infections have been reported, the regime moved swiftly to seal off the Shiite-majority and oil-rich eastern region of Qatif in a bid to contain an expected spike in cases among citizens returning from the holy city of Qom in Iran.

Implications for Israel: Initial Assessment

Rapidly changing dynamics on the ground, coupled with the more general uncertainty surrounding the virus’s spread, render any assessment of the outbreak’s long term regional implications premature at this stage. Still, a number of considerations warrant attention in Israel

    1. The Middle East is poised to experience a severe outbreak of the virus, given the population density in certain cities and the millions of refugees scattered throughout the region. The outbreak could lead to a severe humanitarian crisis and exacerbate the region’s endemic social and economic problems already threatening the stability of many regimes. The central challenge to these regimes is likely to stem from the collapse of governing systems unable to handle the burdens associated with containing the virus, and from ensuing chaos, rather than from the widespread protests seen in recent years.
    1. On the eve of the outbreak, states in the region figured along a spectrum of stability, ranging from those in the throes of war to those experiencing significant social unrest in the form of mass protests to those enjoying a relative, if fragile, calm. This classification presumably rendered countries more or less vulnerable to damage from the virus, both in terms of human suffering and economic repercussions. Still, a snapshot of the region suggests the virus is likely to severely disrupt even states that enjoyed relative stability prior to corona.
    1. States that were engulfed in armed conflict prior to corona have been the most handicapped, and the least transparent, in responding to the virus. Even as authorities have announced containment measures, the human toll in these countries could be catastrophic. The same can be said for states with large concentrations of refugees, such as Lebanon and Jordan.
    1. In countries that have experienced mass protest movements since last year, corona’s arrival presented a dilemma for protestors, insofar as congregating in large groups suddenly posed a health risk. By now, most protests have dissipated, offering governments a temporary reprieve. For the time being, publics are largely abiding by their governments’ policies, which are perceived as necessary in stemming the virus’s outbreak. If regimes manage to cope with the crisis reasonably well, they could ultimately emerge in a strengthened position.
    1. The relative stability of the remaining states may ultimately make them marginally better equipped to handle the outbreak. Still, in some cases that stability was fragile to begin with, and even in sturdier countries like Turkey and Morocco, the very integration with the global economy facilitating that stability will make them all the more vulnerable to economic shocks reverberating from containment measures.

Corona’s impact across the region may require Israel to deal with the collapse of governing systems in a number of states. The most consequential developments, at least in the near term, will be in territories bordering Israel, first and foremost the West Bank and Gaza. In both territories, deteriorating conditions could even lead large numbers of people to seek entry into Israel. But alongside the challenges presented by the destabilizing effects of the virus, there may emerge opportunities for cooperation with countries similarly struggling to beat back the pandemic. As such, it will be crucial for Israel to advance cooperation with the Palestinian Authority, Egypt, and Jordan surrounding medical knowledge, the provision of medical equipment and available treatments, and border management.

Oded Eran, Yoel Guzansky, Gallia Lindenstrauss, Orna Mizrahi, Kobi Michael, Yohanan Tzoreff, Carmit Valensi, Ofir Winter, Ari Heistein, and Noa Shusterman assisted in the preparation of this article.

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Finally Arabs see benefits of cooperation with Israel

Coronavirus: How are Palestinians coping with COVID-19?


For the first time in many years, Palestinian officials are not afraid to openly talk about cooperation with Israel.

Palestinian women work in a sanitiser factory amid precautions against the coronavirus, in Hebron in the West Bank March 12, 2020 (photo credit: REUTERS/MUSSA QAWASMA)

Palestinian women work in a sanitiser factory amid precautions against the coronavirus, in Hebron in the West Bank March 12, 2020(photo credit: REUTERS/MUSSA QAWASMA)

“I never imagined in my life that the day would come when I would see Palestinian policemen impose a curfew on a Palestinian village or town,” said Siham Rishmawi, 63, a Palestinian mother of four from Beit Sahur. “I’m old enough to remember the days when Israeli soldiers were the ones to announce curfews in our town, especially during the First Intifada.”
Beit Sahur, south of Bethlehem, has been under lockdown for the past three weeks, when the first cases of coronavirus were discovered in the area. The nearby town of Beit Jala has also been under lockdown since then, with Palestinian policemen patrolling the streets to urge residents to stay indoors to prevent the spread of the virus.
At least 13 security checkpoints have been set up in the area, as part of this effort. All churches and mosques have been ordered shut, as well as wedding halls, restaurants and coffee shops famous for their nargilas – the colorful water pipes used for smoking flavored tobacco.
“Who would have believed a month ago that we would be in this situation, in which people are banned from leaving their homes, and Bethlehem, Beit Sahur and Beit Jala would become ghost towns?” Rishmawi added. “People here are really frightened because no one knows when this crisis will end.”
Rishmawi, however, is not upset with the Palestinian Police for imposing a curfew and strict restrictions on the movement of Palestinians in the Bethlehem area. On the contrary, she and many residents said they support the tough measures announced by the Palestinian Authority government, headed by Prime Minister Mohammed Shtayyeh.
“Although most people are distressed, they understand that the Palestinian government has no choice but to take strict measures to prevent the disease from spreading,” said Marwan Abu Hajlah, a driver with the United Nations Relief and Works Agency for Palestine Refugees.
In addition, many Palestinians do not seem to be bothered by the cooperation between the PA and Israel in the fight against the pandemic.
That cooperation, particularly in the security field, has always been one of the most controversial and sensitive issues among Palestinians. For several years, the PA had faced sharp criticism for conducting security coordination with Israel – an act denounced by many Palestinians as an act of treason.
On the eve of the March election in Israel, the PA leadership came under strong criticism for arranging meetings between Palestinians and Israelis. The criticism reached its peak after the PA invited a group of Israeli journalists to a tour of Ramallah and interviews with senior Palestinian officials. The invitation was in the context of the PA’s attempt to undermine Prime Minister Benjamin Netanyahu and the right-wing bloc by persuading the Israeli public that the Palestinians remain committed to peace and the two-state solution.
The widespread criticism prompted Mohammed al-Madani, head of the Palestinian Committee for Interaction with Israeli Society, to submit his resignation to PA President Mahmoud Abbas.
Madani, who later withdrew his resignation, privately complained that Abbas had failed to defend him and his colleagues against the smear campaign they faced for allegedly promoting normalization with Israel.
The outbreak of the coronavirus pandemic, however, appears, at least for now, to have changed the Palestinians’ views about cooperation with Israel.
For the first time in several years, the Palestinians are no longer condemning the cooperation with Israel as a “treacherous” form of normalization with the “Israeli occupation.” And for the first time in many years, Palestinian officials are not afraid to openly talk about cooperation with Israel.
When the first coronavirus cases were confirmed in the Bethlehem area, the first thing the Palestinian Ministry of Health did was to seek Israel’s assistance in testing samples taken from Palestinians suspected of having contracted the disease. PA Minister of Health Mai Alkailah told Palestinian reporters that the samples were sent to Sheba Medical Center at Tel Hashomer, in coordination with the Israeli Health Ministry.
Israeli and Palestinian health and security officials suddenly found themselves holding several meetings a day to coordinate efforts to prevent the spread of the virus.
A few days later, Israel announced that it had delivered hundreds of coronavirus testing kits and protective medical gear to the Palestinians in both the West Bank and Gaza Strip.
The announcement was followed by a revelation made by Palestinian government spokesman Ibrahim Milhem to the effect that the Palestinians and Israel had set up a joint “operations room” to combat the virus. Israel, meanwhile, announced that it has been holding training session for Palestinian and Israeli medical professionals to coordinate efforts to stem the spread of the virus.

“We are in a state of emergency, and when it comes to health issues, there’s no room for controversy,” said Mohammed Arafeh, an official with the Palestinian Ministry of Health. “It would be foolish and irresponsible for anyone to oppose medical cooperation between the Palestinians and Israel in fighting against the pandemic, which does not recognize borders and does not distinguish between a Palestinian and Israeli. This is the time to lay aside any differences and conflicts and join forces in the battle against coronavirus.”
Some Palestinians emphasized that the current cooperation between the PA and Israel does not have any political implications.

“Palestinians are not going to change their opinion about Israel and the occupation because of the virus,” said Bassem Abdel Haq, a Fatah activist from Ramallah. “We are not opposed to cooperation with anyone who is willing to help us save lives. The cooperation against coronavirus is different than security coordination or political meetings between Palestinians and Israelis.”
Abdel Haq and other Palestinians in Ramallah said they are more concerned about the economic repercussions of the pandemic than any form of cooperation with Israel.
The severe restrictions imposed by the Palestinian government in the past few weeks have effectively paralyzed the economy in the West Bank.
“Until a few weeks ago, businesses in Ramallah, Bethlehem were doing very well,” said Hisham Atallah, an Arab-Israeli accountant who has been living in Ramallah together with his wife and two children for the past five years. “Now the streets are empty and people are afraid to leave their homes. I’ve never seen Ramallah as a ghost town, especially at night. The restaurants and coffee shops, which used to be full at night, are closed, and many workers are on unpaid leave.”
Interestingly, the Palestinian public seems for now to be satisfied with the way Shtayyeh and his government are handling the coronavirus crisis. While many Palestinians are willing to accept their government’s medical cooperation with Israel, they are also praising the performance of Shtayyeh and his government, including the Palestinian security forces.
The 62-year-old Shtayyeh, who next month will mark his first year in office, could emerge as the biggest winner in the war on coronavirus.
The daily briefings by Shtayyeh and his spokesman, Milhem, about the pandemic, as well as strict and swift measures taken by the government and security forces, have been received with deep satisfaction by many Palestinians.
“For the first time, we see Palestinian leaders leading the campaign against the disease in a transparent and professional manner,” noted Suhad Shamali, a social worker from the town of Bir Zeit, north of Ramallah.
“We see daily press conferences by the prime minister and his spokesman to inform the public about the latest developments surrounding the virus. The feeling here is that the government is not hiding anything from the public. We also see many officials, especially the governors of the Palestinian cities, touring many areas and talking to the people. This is a good sign, and I would say that Shtayyeh has scored many points with the Palestinian public.”
Nidal Tayeh, co-owner of a Ramallah-based coffee shop, said he shares the view that Shtayyeh could emerge as the biggest winner from the current crisis.

“There’s a feeling here that Shtayyeh is now the leader,” Tayeh remarked. “While most of our leaders, particularly President Abbas, have been in self-isolation since the beginning of the crisis, Shtayyeh has become the most prominent and public figure in the fight against coronavirus.
“Most of our leaders are in their 80s and 70s and are not in good health. That’s why they are staying at home, leaving Shtayyeh and his government alone to face the pandemic.
“Many people are now praising Shtayyeh for his charisma and transparency in dealing with the crisis. Some are even saying that he should be the next president.”
The battle against coronavirus may have boosted Shtayyeh’s chances of succeeding the 84-year-old Abbas, but it is unlikely to result in any fundamental change in Palestinians’ attitude toward Israel.
In order for Shtayyeh to win the hearts and minds of his people, he needs to talk less about cooperation with Israel. The more he condemns Israel, the more he increases his chances of becoming the next Palestinian rais.

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Optimistic stats from Israel

Jerusalem hospital chief voices cautious optimism over virus statistics

“What we can say in general in Israel, is that the number of patients is doubling every three days, around the same as Europe. But, the number of critically ill patients, especially those dying, is quite low at this time”

25 March 2020,

The Times of Israel

Although there is a sharp rise in the number of coronavirus deaths and diagnoses in Israel, the statistics actually give rise to cautious optimism, a hospital director has suggested.

Ofer Merin, Director General of Shaare Zedek Medical Center, indicated that if hospitals continue along the current trajectory they could see a lower fatality rate from the virus than in some other countries. “I am not sure that in every country it behaves in the same way,” he said, discussing the virus.

Israel didn’t have a single coronavirus fatality before the weekend but has now seen five (two of them since Merin made his comments Tuesday), and doctors expect to see several more this week. The number of diagnosed has risen sharply to 2,369, of which 37 are in serious condition.

“What we can say in general in Israel, is that the number of patients is doubling every three days, around the same as Europe. But, the number of critically ill patients, especially those dying, is quite low at this time,” Merin said.

He stressed that Israel is at “a very early stage,” and his comments should be taken in this context.

Simcha Friedman, a patient at the Shaare Zedek Medical Center who recovered from the coronavirus, seen after her release from the Shaare Zedek Medical Center in Jerusalem, March 24, 2020. (Yonatan Sindel/Flash90)

Merin made his observations in a webinar titled “The Corona Wakeup Call: Innovation and Startups,” organized by the Israel-based investment company Jerusalem Venture Partners.

Eran Zehavy, Chief Innovation Coordinator at the Israel Institute of Biological Research, also voiced optimism in the webinar about research that could combat the virus.

“Major goals are to develop a vaccine and a neutralizing antibody that could be used as a treatment for infected people. We are developing antigens and the like, and already have very encouraging results,” he said.

Zehavy’s institute is believed to have been one of the best-prepared to begin coronavirus research, and according to an Israeli media report received frozen samples of the virus from overseas weeks ago.

Zehavy said that start-ups are being brought in to deliver practical applications for government research as quickly as possible.

“I have personally discussed with at least 50 people — start-ups and the like — to hear from them and work together. We already have three agreements, including with two small start-ups. We are trying as much as possible to collaborate.”

While one of big questions that Israelis are asking about coronavirus is how specialist hospital facilities are coping, Merin said that “the biggest challenge we are facing is not the patients diagnosed with coronavirus.” He said it is actually the worry that patients who arrive at the hospital for matters unrelated to the virus will turn out to be infected — and pass the virus to other patients and staff.

“On a daily basis, we are trying to look at every patient, even the young, to see if they are carrying the disease,” he stated, noting that if infected people enter normal wards, the virus can sweep through staff. “In Spain, almost 15% of the sick population is healthcare providers. So, we have to be quite strict with the regulations.”

“One of the great challenges is to look after the medical staff members. These are people with concerned families and we need to keep safe this crazy environment.”

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Stanford professors: COVID-19 death rates too high

Stanford Professors: Coronavirus Death Rate Estimate Likely ‘Orders Of Magnitude Too High’

On Tuesday, professors of medicine at Stanford University, Dr. Bendavid and Dr. Bhattacharya, released statistical data that shows the estimated death rates of the novel coronavirus, or COVID-19, are likely “orders of magnitude too high.”

The doctors conclude by suggesting that “universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health” and urging evaluation of the impact of the current lockdowns.

Models that have been used by government officials project that million of Americans, 2.2-4 million, will perish from COVID-19 if no precautions are taken, peaking in June.

But after looking at data samples from places like Wuhan, China, where the virus originated, hard-hit northeast Italy, Iceland, and the United States, our nation may be looking at a .01 death rate, which is a ten-fold lower death rate than that of the flu and equating to some 20,000-40,000 deaths total, the study found.

“The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases,” the doctors explained in the piece published at The Wall Street Journal on Tuesday. “The latter rate is misleading because of selection bias in testing,” which “could make the difference between an epidemic that kills 20,000 and one that kills two million.”

“If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well,” the duo said. “That’s not only plausible but likely based on what we know so far.”

Focusing on Wuhan data, Dr. Bendavid and Dr. Bhattacharya said that just 0.9% of evacuees were infected from COVID-19.

“If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases,” they summarized, thus making the fatality rate “at least 10-fold lower than estimates based on reported cases.”

Here’s what they found in Northeast Italy, emphasis added:

Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

Looking at the U.S., Dr. Bendavid and Dr. Bhattacharya focused on the NBA to get a better sense of virus prevalence and its fatality rate.

“The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association,” they wrote. “Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%.”

“The NBA isn’t a representative population, and contact among players might have facilitated transmission,” the professors continued. “But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower.”

“These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears,” Dr. Bendavid and Dr. Bhattacharya stated. The discrepancies from highly-cited epidemiological models is due to two factors, they explained:

First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill.

“Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections,” said Dr. Bendavid and Dr. Bhattacharya, while epidemiological modelers have yet to adequately adapt their estimates to reflect these significant factors.

The virus is clearly highly transmissible, they explained, with the number of infections reportedly doubling every three days. “An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected,” the doctors said. But as of March 23, CDC numbers showed there were 499 Covid-19 deaths in the nation.

“If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death,” the doctors noted. “This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.”

COVID-19 is not a “nonissue,” they warned, highlighting the strain it places on our medical system. They also underscore that we do not the true infection rate in the U.S., though recent developments are helping us get closer to accurately determining it.

The doctors conclude by suggesting that “universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health” and urging evaluation of the impact of the current lockdowns.

Related: Prevention Expert: Data Shows Our Fight Against Coronavirus May Be Worse Than The Disease

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We need global data to combat COVID-19

Stanford University Medicine Professor: ‘We Must Treat the Epidemic the Way Twitter Handles News: Make Medical Solutions Real Time and Democratic’

by Elihay Vidal / CTech

Israeli firefighters wearing protective clothes disinfect Ichilov Hospital in Tel Aviv, on March 20, 2020, as part of measures to prevent the spread of the COVID-19 virus. Photo: Flash90.

CTech – Leaders of government, health, technology, and economy from around the world attended a virtual conference Tuesday to address the role of innovation and startups in combating the Covid-19 crisis. The event, led by Erel Margalit, founder and chairman of Jerusalem Venture Partners (JVP), hosted medical and policy experts to discuss and share their best practices and methods for using innovation in diagnostics, prevention, treatment, and more. The participants issued a call for more proactive synergy between governments and world leaders, including the global sharing of data.

“The virus is evolving. This is a 21st century disease and we need to arm ourselves with 21st century tools,” said Dr. Nirav Shah, MD, a professor of medicine at Stanford University, who spoke at the event. “We need to do what Twitter did to the news cycle: make it real time and democratic, so that medical solutions are more widely available and impactful.”

“We are situated in different countries. Let us remember that the only way this is contained is for the leaders to work together to coordinate strategies and best practices between countries,” Margalit said. “It is the only way to be effective.”

“We are facing a situation which has never happened before,” Davide Falasconi, Italy’s chief innovation officer, said of the situation facing his country. “But it is not only an Italian issue. We have some regions which are incredibly under pressure.” Pinpointing some of the technological steps being taken in Italy, he said, “We are enabling digital services to provide their services for free” to benefit companies and residents.

Lindsay Clinton, executive vice president of the industry and innovation group at New York City Economic Development Corporation, outlined the situation in New York, currently the center of the pandemic in the US. “Our priorities are identifying additional hospital and medical space, identifying additional availability of medical supplies and additional staff,” Clinton said. In particular, she described efforts to develop a local ecosystem of decentralized production for much-needed face shields, isolation gowns, ventilators, and other essential items. Clinton described the enthusiasm of local manufacturers: “Within 24 hours of issuing a call, we had prototypes of face shields and other items.”

Dr. Eran Zehavy, chief innovation coordinator at the Israel Institute of Biological Research, outlined the institute’s efforts to develop a vaccine.

“We started to see in early January that this virus would be a serious problem,” Zehavy said. “Luckily, we arranged lots of tools in early January. So, when we received the order to work on vaccine development, we were already somewhat prepared. We started to shift all our research towards that target, and we already have very encouraging results,” he said.

“We are trying as much as possible to collaborate,” Zehavy said, adding that his institute had signed agreements with three companies, including two startups.

Dr. Galia Barkai of Sheba Tel Hashomer Medical Center in central Israel noted that the hospital was the first in the country to treat coronavirus patients.

“This corona crisis made us harness technology. We had to build a facility with minimal physical contact. This is not in our DNA,” Barkai said. “We placed patients inside the facility; the staff was outside in an inflatable tent with all the monitors and other equipment. It enabled physicians to do everything they needed to do while protecting staff from being infected.”

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