In Tel Aviv’s Rabin Square, there’s a walk-in coronavirus testing station set up by the municipality. In approximately 45 similar facilities, people can be tested for free and without a referral.
Security guards keep the line moving quickly as four Magen David Adom booths conduct tests. A few soldiers from the Home Front Command take the ID numbers of those tested and send the details by smartphone directly to the right health maintenance organization. Each test takes half a minute to complete and 18 hours later you get the results.
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We’ve become accustomed to sights like this, forgetting how far Israel has come in managing the pandemic. Who can still recall the days when Prime Minister Benjamin Netanyahu promised every evening that Israel would soon be conducting 10,000 tests daily, only to see the goal pushed back time after time. Results were lost and the single testing lab collapsed under the pressure. The Health Ministry would only allow people showing obvious symptoms to be tested.
From the onset of the coronavirus in March through the end of May, Israel struggled to reach 10,000 tests a day. Only from June did the daily rate increase, reaching 70,000 by the time the second lockdown began in September. Today the number is about 60,000 a day.
Without question, the rise in testing is Israel’s greatest success to date in the war against COVID-19. Prof. Ronni Gamzu, the first coronavirus czar, says that testing is the key to coping with the pandemic. “Testing is the bulletproof vest for the coronavirus. If we did 100,000 tests a day, we’d be able to identify carriers earlier and there’d be no need for another lockdown,” Gamzu said.
At about 5,500 tests daily per million population, Israel has among the highest testing rates in the world. A graph prepared by the IDF Military Intelligence shows Israel is leaving other developed countries in the dust in testing. The fact that we achieved this after such a slow start isn’t a miracle – it’s good management and leveraging Israel’s strongest assets.
To Israel’s credit, with the eruption of the coronavirus, we had three organizations with the skills and experience to deal with it – the National Emergency Authority, the Home Front Command and the HMOs. They should have been given authority to manage the crisis. But Netanyahu’s desire not to share credit with then-Health Minister Naftali Bennett and to concentrate power in his own hands meant that none of the three were involved at the start. The National Emergency Authority to this day has never been activated.
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Fortunately, the testing crisis was so big that Netanyahu eventually gave up and let the two responsible bodies take over. “The HMOs in ordinary times conduct tens of thousands of tests daily and the great majority of results are delivered to the patient the same day,” says the head of one of the HMOs. “Our testing system is among the best in the world – the error rate in Israel is 0.03%, compared with 1% in the U.S. We believed that what worked in normal times would work well in the coronavirus crisis.”
He is right, of course. The most important decision taken during the coronavirus crisis was to take management out of the hands of the prime minister, the National Security Council and the Health Ministry. Giving it to the Home Front Command, the HMOs and to the local authorities has proven itself.
The HMOs have repurposed their labs for COVID-19 testing and can complete 42,000 tests daily. Four private labs that were established can do another 23,000. Hospital labs – the ones that the Health Ministry had insisted at the start would do all the testing – now do 5,000 tests daily. All told, Israel has the capacity for 80,000 daily tests.
The Home Front Command’s role was to expand nationwide testing capacity. Forty-five mobile testing units were set up offering drive-thru or walk-in access in close coordination with local authorities and the MDA, the national emergency service. Private sector firms deliver the tests to HMO and private labs.
All this is done through a computer interface that ensures seamless connections between all the parties involved. Today, from the time a person is tested it takes an average of 11.7 hours for HMO labs and 16.2 hours for private labs to provide results.
Israeli HMOs already had experience in providing medical-test results rapidly when they themselves are conducting them. What is surprising is that they can do this so quickly and without errors when the tests are coming from the outside. The Home Front Command, which coordinates the activities of the HMOs, the labs and the firms delivering tests to the labs, is doing its job well.
There is still room for improvement. Gamzu, for example, says the rate of testing is still insufficient; the correct way to measure success is not tests per million people but tests per rate of contagion. By that latter measure, countries like New Zealand, Australia and Singapore are the world leaders.
Israel is only slightly ahead of most European countries. “The positive rate is 2 percent. If we are going to rein in the coronavirus, it needs to drop to 1 percent, in other words we need to double from 50,000 to 100,000 the number of daily tests at the current rate of morbidity,” he says.
Nevertheless, Israel has chalked up a success as a result of decentralization and the leveraging of our assets. The Israeli government is a weak organization, whose capabilities are poor. That's why powerful forces developed that can fill in for it when needed.
If we’re going to succeed in the fight against the coronavirus and avoid a third lockdown, we need to learn the lessons from testing: Avoid concentrating power in the hands of the prime minister and the Health Ministry and let a decentralized network do the work it has the knowledge and experience to carry out.