The call by the Israeli Association of Public Health Physicians to stop testing and isolating those who have been exposed to a verified COVID-19 patient made waves in the health care system and aroused a harsh counteraction.
The Health Ministry and the Israeli Medical Association didn’t interpret the opinion of Israel's public health doctors as an invitation for discussion or an open professional dialogue. Professor Idit Matot of the Tel Aviv Sourasky Medical Center – Ichilov, had a similar proposal, and wrote in a post, “Anyone who doesn’t feel well should stay at home. All the rest – release them and simply do something else – wear masks.”
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At the same time, Israel's health care system is discussing shortening isolation to five days, like in the United States. This issue is particularly crucial for medical staff and the Medical Association is expected to discuss it.
In the past seven days over 282,000 Israelis have been confirmed as coronavirus carriers – an average of 40,000 a day. Each one of these people lead to a long chain reaction from among those they were in contact with and ultimately exposed to the virus – requiring tests and isolation for those who are unvaccinated.
Over 2.6 million tests have been administered (supervised antigen and PCR lab tests) – an increase of 45 percent compared to the previous week.
But apparently, all these tests stop far short of reflecting the entire picture. Professor Eran Segal of the Weizmann Institute of Science estimates that there are about 100,000 infections a day, about 60,000 covert, or untested infected people in addition to the 40,000 verified each day.
Currently, there are 436 seriously ill patients in Israel's hospitals – a significant increase compared to the previous week, but still one third of the record number of cases during the third wave, which was the worst in terms of serious illness and death. With that in mind and given the shortage of medical manpower due to the many staff members in quarantine, it’s worth asking whether it is time to change the approach to dealing with the pandemic.
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Given the widespread overt and covert rate of infection is there a point in pursuing asymptomatic verified patients and their contacts? Are the large investments in infrastructure, manpower and equipment really helping to reduce the burden on the hospitals, and has it translated into saving lives? Will resources be directed at protecting and diagnosing immune-compromised populations and ensuring effective operations within the health care system? That’s an approach that calls for dealing with illness and not with the pandemic.
It’s also worth questioning whether it’s somewhat naive to request that the Israeli public make a personal effort to prevent spread, by asking anyone who doesn’t feel well to stay home – especially without a mechanism of compensation for employees and employers. And should this be a substitute for the existing quarantine policy? Can we distinguish between actual illness and the pandemic, allowing a different track for each, in a situation in which every verified patient infects an average of 2.5 others?
“We have to examine the cost-effectiveness of the regime of testing and quarantining,” says Prof. Nadav Davidovitch head of the School of Public Health at Ben-Gurion University of the Negev, a member of the Association of Public Health Physicians and one of those who wrote the position paper. “Of course anyone who feels unwell should stay home, of course people at risk should protect themselves and the government has to help them to do so, but apparently the present regime of tests and quarantines cannot continue. We can’t quarantine everyone, and in light of omicron we have to rethink things.”
But this call by Matot of Ichilov and Davidovitch and his colleagues is not being viewed as an invitation to an open academic discussion, but instead as irresponsible public relations. The Israel Medical Association quickly announced that it rejects the opinion of the public health physicians, and is planning a special discussion by the COVID-19 forum with representatives of the relevant medical groups.
Prof. Zion Hagai, chairman of the Israel Medical Association, says that the body includes about 200 different associations and professional organizations dealing with the virus. He says that the declaration by the public health physicians “is confusing the public and sending a message that there’s no need to be tested and that if we get infected it’s not so terrible. But sending such a message while the wave is at its height is problematic and irresponsible.
“We don’t know enough yet about the asymptomatic patients, and there is evidence that the patients infect others even a day before they have symptoms,” says Hagai. “We don’t know anything yet about the ‘long COVID’ of omicron. It’s possible that if 50 percent of the country becomes infected, the policy may have to change, but to change it at this point is inconceivable.”
Prof. Galia Rahav, head of the Infectious Disease Unit and Laboratories at Sheba Medical Center in Tel Hashomer, also warned against the recommendations of the public health physicians, calling them “dangerous and irresponsible.” “We’re strongly opposed,” Rahav told Haaretz. “There are so many people who are suffering from immunosuppression. Changing the policy now is unacceptable.”
Professor Ran Balicer, who heads a committee of experts advising the Health Ministry on the pandemic, says the dispute raises the basic question: whether there’s any interest at this point in reducing the number of infected people, especially those in at-risk groups?
“I think we’re very interested in that, and therefore I don’t agree with canceling isolation for the asymptomatic, certainly not now… We know that people infect others even without symptoms. At this point, I don’t find it reasonable to encourage steps that could cause an increase in infection, which could be a heavy burden on the hospitals.”
Prof. Dror Mevorach, head of the COVID-19 department in Hadassah University Hospital, Ein Karem, says this isn’t the right time to examine a change in the policy. “In the course of this week and the beginning of next week we will reach the height of the pandemic, in which every fourth or fifth person could infect you. And that’s the time to give full attention to quarantines and avoiding contact. When the pandemic declines there will be room to ask questions, but not at its height. It’s a strategic mistake.”
Meanwhile, a group of Israeli researchers has sent a plan, proposing new rules, to the prime minister and cabinet. They propose that the vaccinated and those who have recovered from COVID be required to take a home antigen test only after 72 hours of isolation from the time of exposure.
If over 72 hours have elapsed from the time of exposure, antigen tests should still be administered. The rationale behind the plan is that people often test positive only a few days after exposure.
“Had we applied the plan from January 2, one out of three verified patients would not have been infected,” they claim. “And if it’s applied beginning this week it would lead to a reduction of 800 cases of serious illness compared to the forecasts.”
The plan is based on an analysis of an event in Oslo in November when a single omicron patient, who had returned from South Africa, received a negative result 28 hours after being tested, but went on to infect 81 people. That’s because only 17 percent of people develop symptoms within 48 hours of infection, 63 percent after 72 hours, and 89 percent within 120 hours.
“An antigen test wouldn’t have identified most of the ill people less than 72 hours from the time of exposure,” say the Israeli researchers who studied the case.