Analysis |

As Coronavirus Cases Skyrocket, Israel Is Making Decisions in the Dark

Ido Efrati
Ido Efrati
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A woman wearing a face mask walking in Jaffa Street in Jerusalem, June 30, 2020.
A woman wearing a face mask walking in Jaffa Street in Jerusalem, June 30, 2020. Credit: Ohad Zwigenberg
Ido Efrati
Ido Efrati

The coronavirus crisis hit Israel five months ago, but the Health Ministry has not yet managed to build an efficient control network. The severe lack of information and coordination with other government agencies makes it hard to manage the outbreak.

Members of the public are still not receiving vital information from the ministry to reduce infections and stay healthy, and keeping them in the dark does not induce cooperation.

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Finance Ministry officials have criticized their colleagues at the Health Ministry for hogging the data, saying they are not provided with critical figures relating to the management of the economy, unemployment rates and other issues.

They don’t know if the Health Ministry is even collecting data in these areas, the officials add, remarking that the budget division went to great efforts in asking, persuading and even threatening the Health Ministry to give it to them.

Their request to add a question about the place of infection to the epidemiological survey form was not even granted, they say, which directly affects decisions to close various parts of the economy. When they turned to the Gertner Institute for Epidemiology and Health Policy Research, which advises the Health Ministry, for data about transmission rates, the ministry didn’t allow the institute to release the information.

Health Minister Yuli Edelstein and then director general Moshe Bar Siman Tov during a briefing, Jerusalem, May 31, 2020.Credit: Emil Salman

Treasury officials are also highly critical of preparations in the earlier part of the crisis. The Health Ministry asked to lock down the country, costing a billion shekels ($290 million) and putting a million Israelis out of work, in order to prepare for the crisis, they say - why was an efficient system for breaking the chain of infections not completed and is still not functioning?

At the height of the first wave, as Israel was trying to create a plan to restart the economy, the Treasury informed the Bank of Israel and the National Economic Council that every branch of the economy should be assessed by comparing its contribution to the extent of risk in operating it. Officials now warn they might not have the tool to make a similar assessment, and understand the impact of the coronavirus regulations - known as “purple badge” - that businesses were supposed to follow upon reopening.

A Health worker wearing protective gear, Bnei Brak, Israel, April 13, 2020.Credit: Ofer Vaknin

Collecting and sharing data have generally been the Health Ministry’s weak points since the crisis began, with no sign of a promised effective mechanism to identify trends and track important infection indices. The rising number of infections in recent weeks has forced the ministry to present a more detailed epidemiological picture to check the progress of the epidemic, the healthcare system's preparedness, and influence prevention measures. But a lot of vital information on all these subjects is not collected or shared with the public and other government ministries. 

Crucial questions remain unanswered. How many new cases are asymptomatic? What is the rate of infected people with unknown transmission sources? How many tracings are done daily and what is their success rate? How long did the process of breaking the infection chain take and how far is it from the fixed goal? How much does the Shin Bet security service surveillance and telephone tracing contribute to breaking the chain? What is the average length of hospitalization among COVID-19 patients? What are the main places of transmission? What are the dynamics of infection in schools? Who is high risk and what is the risk to family members?

The answers to these questions would allow us to prepare for the second wave of the outbreak by indicating to what degree it is under control. If the infection source is unknown, for example, patients are liable to infect others unwittingly, and the chain of infections won’t be broken. Similarly, data on asymptomatic patients is important for the government to take steps to “flatten the curve”  and prevent the health system and hospitals from crashing. A comeprehensive map of new patients means hospitals and health maintenance organizations can prepare better, while lifting and re-imposing restrictions can be better managed.

Shuttered stores in Jerusalem during the coronavirus pandemic, March 2020.Credit: Ohad Zwigenberg

While the Knesset is hysterically advancing legislation to use Shin Bet surveillance, its effectiveness has never been proven to the public, even though it constitutes an invasion of privacy. How does it work? Who is exposed to the information derived from it, and what is the level of the data’s accuracy? How many patients and people who came into contact with them were located via the surveillance, and are there other ways of producing data on infected people? This data is critical for setting policy and taking informed steps while reducing the economic price involved in each one of them, yet there is no in-depth analysis of the current wave of infections.

A Health Ministry official told Haaretz the raw data exists but processing it takes time. “Mountains of data are pouring in daily,” he said. “but it requires a lengthy and complex epidemiological analysis that can't be done with an automatic algorithm. We’re doing it, but it takes time.” Still, the Health Ministry does not yet have a professional team to analyze the coronavirus data, which is not reconciled in periodic ministry reports. Officials have not requested skilled personnel to produce the relevant reports.

“The lack of data makes it hard to evaluate the infection situation from different perspectives,” Prof. Tammy Shohat, former head of the Israel Center for Disease Control. “Because the report only shows the number of infections without information on the onset of symptoms, it’s impossible to build an epidemiological curve.”

Mounted police enforce coronavirus regulations in the shuttered Carmel market in Tel Aviv, April 10, 2020.Credit: Eyal Toueg

“The fuller the data on epidemiological research, the sounder policy decisions can be," Prof. Eyal Leshem, director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center, Tel Hashomer, adds. "For example, if we know the rate of infections in the educational system compared to workplaces or commercial centers, we’ll be able to argue why it’s worth holding events of limited capacity but keeping schools closed.”

As the infection rate rises, the Health Ministry is already recommending imposing lockdowns on dozens of communities, and some economic activity is likely to be brought to a stop sometime soon. However, it is impossible to know whether the second wave will be identical to the first regarding the profile of people infected, the rate of people on ventilators and the preparedness of the hospitalization system. The full picture – if it exists at all – remains strictly in the Health Ministry’s hands.

In response, the Health Ministry said that data on diagnostic reasons, rate of known infection sources, reasons for quarantine, the number of epidemiological investigations last week and the date of taking samples of testing results will be available in a few days, after it is processed.

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