Health Ministry Is Only Seeing the Tip of Israel's Coronavirus Iceberg

Its testing policy has been too limited to gauge the real size of the pandemic

Meirav Arlosoroff
Meirav Arlosoroff
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Students and staff from the Jerusalem’s Gymnasia high school get tested in the parking of Teddy Stadium in Jerusalem, June 2020.
Students and staff from the Jerusalem’s Gymnasia high school get tested in the parking of Teddy Stadium in Jerusalem, June 2020.Credit: Ohad Zwigenberg
Meirav Arlosoroff
Meirav Arlosoroff

Thirty years as a business journalist has taught us that when a spokesperson doesn’t respond to a request for comment, it can only mean one of two things: He or she is avoiding us because the questions we’re asking are too challenging, or ignoring us because he or she has no idea how to respond.

You can guess which of the two applies after we failed to elicit a response from the Health Ministry to the following simple questions: How many coronavirus tests were conducted at Jerusalem’s Gymnasia high school? How many of these tests came back positive? How many of the people who tested positive for the virus had no symptoms? 

It could be that the Health Ministry doesn’t like us and that’s why it didn’t respond. That’s OK. We’re not offended. We’ll just engage in some public shaming for their failure to do their the job correctly. But it is more likely that it isn’t about liking us and more about not having the data to begin with. Or that it does have the data but is embarrassed to release it because it would show that the ministry’s entire testing philosophy is wrong.

Gymnasium Rehavia high school in Jerusalem, May 20, 2020
Gymnasium Rehavia high school in Jerusalem, May 20, 2020Credit: Ohad Zwigenberg

From what we were able to find out, from unverified data, some 2,000 people connected to the Gymnasia were tested, and 173 of them tested positive for the coronavirus. It is believed that most people who are infected with the virus show no symptoms.

The mass testing, which included not only students and staff members but also the people they live with, was the first implementation of the ministry’s new policy of testing everyone connected with a COVID-19 outbreak. Until now, the ministry had refused to do this and had limited testing only to people who came into contact with a confirmed carrier or who have known symptoms of the disease.

The new policy was introduced in response to pressure from the Jerusalem municipality. City officials were worried about the large number of cases found at the school and demanded comprehensive testing. The Health Ministry agreed and the results showed that close to 10 per cent of the people who were tested population had been infected, in most cases without experiencing any symptoms.

Israel's recently appointed Health Minister Yuli Edelstein.
Israel's recently appointed Health Minister Yuli Edelstein.Credit: Ohad Zwigenberg

These are the so-called silent carriers, who are considered dangerous precisely because they have not been identified and as a result are not in isolation or quarantine. It is crucial to find these individuals, who are much more numerous than the people who have been diagnosed with COVID-19.

This week we got a sense of the great scope of the problem. The first Israeli study based on a representative sample of serological (antibody) blood tests found that about 2.5 per cent of the population had contracted the coronavirus, at least 10 times more than the number of confirmed cases. 

If anyone thought otherwise, we’ve learned that the coronavirus is here to stay. There’s no way to fight it because there’s no drug to cure it, no vaccine to prevent it, few have developed resistance to the disease because it’s so new and we are far from reaching the point of herd immunity. If 2.5 per cent of Israelis have been exposed to the virus it means that means 97.5 per cent have not.

We have no solution for the coronavirus; we have to learn to live in its shadow and nip it in the bud when it emerges in one place or another. The way to do that is through constant testing. 

That’s the Health Ministry goal, but it’s having a hard time reaching it. Until a week ago, its policy was mainly only to test those with symptoms known to have been in contact with a confirmed carrier. People, like those at the Jerusalem Gymnasia, who may have been near a carrier but hadn’t developed symptoms weren’t tested. Likewise, those who have symptoms but were not known to have been near a carrier.

In short, the ministry was dealing with the tip of the coronavirus iceberg, not the iceberg itself. Its policy, since the onset of the pandemic, was to test only those who were deemed likely to have the virus.

The ministry had good professional reasons for its policy: The rate of false positives on the tests is very high. But then, look what happened at the Gymnasia: As of last Wednesday, before the city got the ministry to conduct more testing, there had been only six confirmed cases. The wider testing revealed the real number was 173, most of them silent carriers we would never have known about.

That day, the ministry has told health maintenance organization doctors that they may now test anyone who is sick whether or not they are believed to have been in contact with a known carrier. The following Monday, Yuli Edelstein, the new health minister, widened the directive to include everyone suspected of being in contact with a carrier even if they show no symptoms.

This is a big step forward in the space of less than a week, but it’s not a breakthrough. The ministry still lacks a policy for how often tests should be administered for the entire population or a systematic process for testing those who work in public places, such as teachers and bus drivers, and are the most vulnerable to contagion. 

Somewhat late in the game, the Health Ministry now recognizes that it erred. Most of the iceberg remains hidden. A situation in which a small group of ministry officials make decisions unilaterally, without consulting the experts in the ministry itself much less those outside it, is irresponsible and intolerable. How much longer must we pay for their mistakes?