COVID-19 testing may have reached an unprecedented height of some 120,000 daily tests last week, but several health care sources have slammed the testing policy as out of touch with the needs of the current infection situation, claiming that they constitute an unjustified waste of public funds.
The Health Ministry set itself the ambitious goal of 100,000 tests per day, which it has managed to reach and even exceed. As COVID swiftly spreads in Israel, the tests produce a huge number of confirmed new cases, and have forced a quarter of a million people into quarantine. However, there is a growing amount of voices in the health care system claiming that testing is increasingly detached from the overall goals of the fight against the virus.
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There is no doubt that testing is critical on both the individual and the wider epidemiological level, but it is also a complicated landscape. The testing system comprises of numerous components, among them establishing testing centers, supplying personal protective equipment and testing kits, sending the tests to laboratories, documentation and digitalization and reporting to health maintenance organizations. There also many entities involved: medical facilities, government ministries, local government, and the army and private companies, which must all work in concert. The complexity of these operations requires a wise use of testing that is attuned to the changing reality of the pandemic in Israel.
When COVID-19 is suspected, tests are also done on groups considered at risk, such as hospitalized patients and medical teams, residents and staff in nursing homes, teachers and yeshiva students. People returning from abroad are also tested, and until recently, so were people who entered the areas known as “tourism green islands.”
The shorter isolation periods, cut to 10 days after suspected exposure, requires the patient to take two tests, one on the second day in isolation and one on the ninth, despite the high level of infection and overburdened laboratories. A brief isolation time may make things easier for the individual, but impedes breaking the chain of infection.
“It’s good that there are many tests, but they should be treated like a costly resource and not as if there’s no financial significance, because there is,” a senior lab official said. He instead encouraged the health system to focus on “practical goals, like reducing secondary exposure in the chain of infection. In my opinion, it is illogical to waste some of this resource on getting out of isolation two days earlier.”
The average cost of a test is 200 shekels (about $61), while testing at home raises the price by a few hundred shekels, according to sources in the HMOs. At the current rate of testing, daily costs can be as high as 25 million shekels, which amounts to 600–700 million shekels a month.
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The spread of highly contagious coronavirus mutations are another cause for concern. “The system is stretched to the maximum,” said Leumit HMO CEO Haim Fernendes. “We are very worried. We see that between 40 and 50 percent of our members who are testing positive are carrying the British variant, and the rate has climbed within a short time,” said Fernandes.
To exacerbate matters, about a week and a half ago, the Health Ministry announced it was ending its policy of allowing people who were not experiencing symptoms to be tested in an effort to ease the burden on the testing system.
However, mayors are still inviting residents of their cities for testing without a referral. Last week, for example, a text message was sent to Ramat Gan residents inviting them to come for testing without any type of referral. “The tests have become a populist tool,” the senior official in the laboratory system said. “Mayors are trying to show that they are working for their residents, but in fact they are taking a bite out of a national resource at a time when infections are soaring, after the Health Ministry specified that open testing would end.” IDF soldiers can also get tested without referral.
Losing the bigger picture
At the moment, testing is taking longer than usual, which is blunting the effectiveness of its main purpose: breaking the chain of infection.
The IDF Home Front Command, for example, carries out almost half of the tests, with the assistance of four private laboratories: MyHeritage, Electra, ILEXD and AID, which are having great difficulty keeping up. While private labs take a single day to process tests, the waiting time in the MyHeritage laboratory is between two to four days, according to Home Front Command sources. They also claim that this is part of the reason that some of their labs are shutting. Meanwhile, HMO labs, which conduct some 40 percent of the tests, are faster, but still fall short of the speed of private labs.
Contact tracing is also falling behind. At most it can reach two-thirds of newly confirmed carriers every day to question them on their contacts, with thousands falling through the net. According to the Health Ministry, from the moment contact tracing is started until it identifies another carrier, 34 hours pass – 10 hours more than the goal set.
These figures all demonstrate that the headline figure of tests does not necessarily serve the broader fight against the virus.
According to sources in the health care system, the situation requires greater dynamism and focus. One suggestion was to forego the second test to shorten isolation, but then it emerged that 5–10 percent of those tested the second time were positive. Another idea was to shorten isolation for certain groups, such as essential workers.
Suggestions have also been made for “smart tracing” – focusing contact tracing on super-spreaders and those with a high viral load – someone who sheds more virus particles and is therefore more contagious. Others are calling for an increase in testing in hospital labs, which now focus mainly on testing patients and staff.
As the infection rate continues to spiral, more doubts are likely to emerge regarding the benefits of Israel’s approach, which is proving that testing isn’t everything.