Israel's Health Ministry Delayed Random Sampling to Monitor Coronavirus Spread

The Israel Center for Disease Control asked to begin sampling when there were only 15 coronavirus cases in the country. Now there are more than 900

A Magen David Adom paramedic performing a coronavirus test exercise on a volunteer, February 26, 2020.
Jack Guez/AFP

The Israel Center for Disease Control warned Health Ministry management two weeks ago about the need for a system to monitor the spread of the coronavirus in Israel – but ministry management refused to approve such a step. The ministry has been closely monitoring the spread from one individual diagnosed to the next, but the monitoring system would provide random sampling of patients around the country in an effort to gauge situation among the wider population.

When the disease control center asked for permission to track the contagion, only 15 people had been diagnosed with the disease in Israel, a medical system source said. The monitoring system will begin operating in the next several days – after the number of Israelis diagnosed with the coronavirus has surpassed the 900 mark.

The Center for Disease Control, which is a research institute under the auspices of the Health Ministry, approached ministry management on the matter on the assumption that the pace of the spread of the coronavirus would accelerate over time. Health sector sources said the ministry ignored the request at first, and later rejected it without providing an explanation.

The Health Ministry approved establishing the tracking system about a week ago, but then getting it up and running was delayed by the closure of its national laboratory at the Sheba Medical Center at Tel Hashomer when the lab’s deputy director was diagnosed with corona. “The right time to start operating such a system was two or three weeks ago,” a medical official who is involved in the issue said. “It could be that at the beginning, they wouldn’t have found anything, but today we are already in a situation in which every three days, the number of patients doubles, while the criteria for testing are still very narrow. And we have no idea what the presence of the disease is in the community,” he added.

‘Sentry clinics’

The monitoring system will operate through 35 already existing sentry” clinics: health maintenance organization clinics around the country, which in addition to their regular work, will conduct sample testing of the population. The doctors at the clinics will randomly choose patients with symptoms characteristic of the coronavirus in an effort to gauge the extent of the presence of the infection among the country’s population.

These clinics already routinely monitor infectious diseases, but because of the unique profile of the coronavirus, which has caused a particularly low rate of infection among children and higher levels among adults, the staff of the clinics have to approach the sampling of patients differently – because it involves a more complex and hazardous procedure than regular sampling for the flu.

Initially only about 300 to 350 tests will be conducted each week, a number that health officials describe as very low. According to health care system sources, this is due to a shortage of the swabs used to obtain the samples from patients. Experts say such a small number of tests will not supply the critical information needed, but it is expected that the pace of testing will increase, giving the sentry clinics more information on the presence of the infection among the general population.

An Israeli firefighter sprays disinfectant in the Hayarkon Park's Rokach blvd parking lot in the Israeli coastal city of Tel Aviv on March 20, 2020.
JACK GUEZ/AFP

For now, the strict criteria for carrying out coronavirus testing among most patients have not changed. Other than at the sentry clinics, tests will only be administered to patients with coronavirus symptoms who have recently visited a country where the disease is widespread or who have been exposed to a confirmed coronavirus patient. Hospitals are also carrying out tests on pneumonia patients with symptoms of the virus, but many more people among the broader population have the same symptoms and are not being tested, or monitored.

At this stage, no priority has been given to testing medical staff, even though they are on the front lines of the fight against the epidemic, are being exposed to infection – and may be infecting others.

Getting the fuller picture

The testing done at hospitals does not reflect the situation in the Israeli population as a whole, a source in the field of epidemiology said. “To understand what is happening, we need to step back and ask who has been tested. The situation is that in the community, there is a large group of patients with symptoms, but without a background [risk for corona]. If some of them have actually been infected, this is only the tip of the iceberg of the disease in the community.”

With regard to the delay in establishing the monitoring system, the official said: “Whether it was because of a shortage of swabs or for another reason, the tests in the community are coming with a significant delay.”

Other health officials agreed that random testing beyond the sentry clinics should also be carried out. That would provide the opportunity for in-depth study of the nature of the outbreak in Israel and help spot the outbreaks as they occur.

“The numbers that we have for now are skewed due to the very strict criteria for testing,” an expert in tracking infectious disease told Haaretz. “What we need to sample is the percentage of carriers of the virus in the population. We need to learn the differences between people who are infected with the virus and who are asymptomatic, and those who are sick – and to understand the mortality rates ....”

And mortality rates need to be compared to the population of those who tested positive for the virus, not only those who have had symptoms, he said. “Such a system, which would conduct about 2,000 tests a week, for instance, could provide very important information on the spread of the virus and how to deal with it in Israel.”