An emergency response team that recently visited a young man who had returned from Thailand and reported symptoms suggesting he was infected with the new coronavirus was in for a surprise: The man who was supposed to be under home quarantine was not alone.
“The team entered the apartment fully equipped with protective gear from head to toe, only to find that 20 people were there with him,” says a senior official in the health system who deals with emergency preparedness. “They came to hear stories about Thailand and visit their friend in isolation. They laughed when they saw the medical team.”
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This example is not representative of most Israelis who are under home quarantine, and tests showed that this particular man was not infected, but the incident shows the risks associated with being quarantined at home, which the Ministry of Health views as essential in the case of COVID-19, the disease caused by the coronavirus.
In the absence of a vaccine or treatment, the main tools at the disposal of the health care systems in its attempts to contain and limit the outbreak of an epidemic are closure and quarantine. “The quarantine strategy will be with us for the duration of this event in order to prevent the spread of the virus – it’s the best one we have,” said Prof. Siegal Sadetzki, the Health Ministry’s head of public health services. But not everyone in Israel understands the significance.
Many people view the quarantine order as exaggerated, even after the arrival of COVID-19 in Israel. Quarantine requires people to cut themselves off physically from the world for two weeks. In some cases, even people who understand the significance of isolation and the risks of breaking it are unwilling to suspend their routine, even if it endangers public health and could result in jail time.
In Or Yehuda, Yehud and surrounding areas southwest of Tel Aviv, hundreds of people went into home quarantine after having visited the Red Pirate toy store. They had come into contact with the store’s owner, who had just returned from Italy and had tested positive for the virus. His wife was later found to also be infected. A Health Ministry team disinfected the store over the weekend.
The exposure of multiple people to a store owner with a virus is something that is inevitable during an outbreak. However, the owner of Red Pirate and his family impeded his immediate quarantine and attempts to identify the people who had come in contact with him by lying about the places family members had visited. The truth came out after police intervention, when testimony from store employees reached the Health Ministry.
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Over the weekend it turned out that family members were in the store for a day longer than previously believed, which expanded the circle of people who now have to be quarantined. The delays encountered by the Health Ministry in conducting tests caused the number of potential infections to expand. “In such cases, epidemiological investigation is a race against time,” explains a ministry official. “Every passing moment, with more cases of contact that are unidentified and isolated, increases the risks for the spread of this disease.”
The case of the toy store owner is not the first instance in which the ministry had to turn to the police. Several complaints were recently filed against people who had violated home quarantine – a criminal offense which carries a sentence of up to seven years in jail – refusing to stay in isolation even after ministry inspectors visited their homes. In one case, a 40-year-old man in the Sharon area was arrested for violating quarantine after returning from Thailand. He cursed and deliberately sneezed at the inspectors.
The ministry has dealt with hundreds of reported violations in the last two weeks. Some cases were resolved after a phone call or a home visit, when inspectors explained the importance of the quarantine.
“These cases are marginal,” says a ministry official. “Most people understand the significance of quarantine and take instructions seriously. We’ve even had reports of violations by family members, such as a father who reported that his son had returned from Thailand but refused to go into quarantine. He asked that we intervene.”
The need to isolate and remove potentially infected people from clinics and hospitals has been a heavy burden on emergency response teams who must in some cases come to a person’s house and take a sample for testing. The number of test kits in the ministry’s national laboratory is limited; 1,000 samples have been tested since the crisis began.
But it turns out that some people in isolation find it hard to wait the full two weeks. According to ministry sources, some people have given false or incomplete reports about their symptoms so medical teams would come and test them to rule out COVID-19, thus setting them free. When teams arrive, they find that what the person reported on the phone doesn’t not match what they encounter on the scene. However, since only one symptom from a list, such as a dry cough, is sufficient to raise suspicions, they cannot definitively rule out a case and must perform an unnecessary test.
In recent days, the coronavirus dam has burst in Israel, with seven people testing positive so far, three of them diagnosed since Thursday. Health Ministry officials tackle each case as best as they can, reconstructing the locations visited by the afflicted person and trying to isolate and test every individual who came in contact with them. But at some point they won’t be able to keep up the pace, and responsibility will fall to the public.
“Dismissing isolation instructions is like dismissing safety regulations, which can cost lives and harm public health,” explains Prof. Hagai Levine, head of the Public Health Physicians Association. “We all have to internalize that this is a public health emergency, so that every person who has fever or respiratory difficulties must avoid infecting others. It is a test not just for the health system but for each of us.”