After a delay of several weeks, random nationwide coronavirus antibody testing started on Monday in 191 communities in Israel, including 13 virus hot spots, as the government attempts to get a full picture of the outbreak.
Unlike swab tests, which are designed to diagnose patients currently infected, antibody testing should be able to show how far the virus has spread within the general population, whether or not those that have contracted it have developed symptoms.
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It will also provide further data to determine how much specific groups, including children and people with underlying medical conditions, have been infected, the degree to which they may have developed a measure of immunity to the virus and the extent to which they may have infected others.
The program will last several days, during which 75,000 tests will be carried out at health maintenance organization community clinics around the country. Designed by the Health Ministry, it is meant to be random in order to obtain a representative sample based on geographic location, size, socio-economic status and ethnic or religious background.
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On Monday morning, some of the country’s four HMOs already reported that they were turning down many people seeking testing, eager to find out whether they had been infected.
A similar but separate survey is being carried out independently in the Tel Aviv suburb of Bnei Brak, which went into total lockdown as one of the most affected communities in Israel earlier this year. An initial phase involving targeted testing has been completed, officials said, and now random tests are being performed among the population. In all, 7,500 people are expected to be tested.
Lab staff sound the alarm
On Sunday, Esther Admon, who chairs the Association of Biochemists, Microbiologists and Laboratory Workers, warned that the rush to conduct the tests now put undue pressure on the laboratories, which lack sufficient personnel to process the blood test results, putting other crucial tests in jeopardy.
Last week, Kan, Israel’s public broadcaster, reported that testing supplies for the survey would be expiring within three weeks, and that they would go to waste if the survey didn’t start immediately. The Health Ministry said in response that it might be possible to extend the expiration dates of some of those materials, manufactured by Abbott Laboratories, and that they also had access to other supplies with later expiration dates.
“The pressure at the moment is to manage to use the tests before they expire,” Admon said, creating a delay in diagnosing antibodies for other viruses, such as jaundice, measles, German measles and mononucleosis. “The Health Ministry has chosen to ignore ongoing regular work in the system. The labs are close to the point where they won’t be able to receive and process additional routine tests,” Admon said.
The tip of the iceberg?
The survey is based on the ‘tip of the iceberg’ theory, which says that a large number of asymptomatic patients contract the virus. In a recent article, Profs. Isaac Ben-Israel of Tel Aviv University and Doron Lancet of the Weizmann Institute, claim that five to ten times the number of people are being infected than what is reflected in the daily figures from the Health Ministry.
But basing their arguments on data from elsewhere around the world, critics, which include some consultants and researchers working with the body responsible for Israel’s coronavirus response, the National Security Council, posit that the rate of asymptomatic carriers of the virus who have not been diagnosed is actually very small. They also argue that most of those who have been infected (at least 80 percent, depending on the expert and the research involved) are detected within a short time through measures already in place, making the survey unnecessary.
A random survey could also create a dangerous illusion among the public that people that have developed the antibodies have lasting immunity to the coronavirus, some experts note. Some businesses are known to have asked employees to get blood tests as certification of sorts that they are free of the virus, even though there is currently no definite ruling that the presence of antibodies provides protection, or for how long.
Over the weekend, the director of the Central Bureau of Statistics, Prof. Danny Pfeffermann, warned that the project would lead to unrepresentative, slanted results, even though staff from the Central Bureau of Statistics were involved in developing the model used in Bnei Brak.
“Those coming for blood tests [in any event] are not a representative sample of the Israeli population from a medical standpoint, particularly during a period with coronavirus,” Pfeffermann said. “It’s reasonable that at least some of those people coming for blood tests are suffering from some kind of medical problem,” he said, “and they might therefore actually be more careful.”
In at least one of the larger HMOs, some tests will be offered to patients already coming in for a blood test, as long as they fit the Health Ministry sampling criteria.
One of the aims of serological testing, Pfeffermann added, is to look at the interaction among individuals in the same household, but the national sampling that is now being carried out does not make that possible.