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Israel's Mismanagement of Coronavirus Testing Clouds Exit Strategy Talk

Officials have been imprudently pushing lockdowns instead of ramping up testing, ignoring efforts by Defense Minister Naftali Bennett

Amos Harel
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Paramedics in a coronavirus testing center in Bnei Brak, April 1, 2020.
Paramedics in a coronavirus testing center in Bnei Brak, April 1, 2020. Credit: Nir Keidar
Amos Harel

Israel won’t ever be New Zealand, where one person has died of COVID-19 out of some 1,300 infected people so far and only 50 new patients a day, an infection rate that the government says means the virus has been contained there. But compared to other Western countries, from Italy and Spain – which are beginning to see the infection curve slowly flatten – to the United States and Britain, where the virus is still taking the lives of thousands, Israel’s situation is reasonable.

Wise decisions at the beginning of the crisis are helping keep the mortality rate low, about 0.8 percent of all diagnosed patients. This rate is apparently connected to the relatively low average age in Israel.

The number of ventilators is still in a relatively safe place, away from the red line the Health Ministry has set. Avoiding that line depends on a prudent policy over the next few weeks until a climax in hospital capacity is reached, expected during May.

Precisely because of this, Israel’s slow response on the critical issue of coronavirus testing stands out. The goal of 10,000 tests per day that was promised at the end of March has not yet been reached (on Monday only 5,500 tests were performed). Prime Minister Benjamin Netanyahu’s more ambitious goal of 30,000 tests a day remains distant, even though the two deadlines set for this target have already passed.

Today, according to the Health Ministry, an average of one to two days elapses between administering a test, generating a result and returning the answer to the patient.  This issue is important not only because a lag causes anxiety to anyone taking the test. To stop the virus, the chain of infection must be identified. In countries that have been successful at this like South Korea and New Zealand, the process has been to locate the patients, isolate them, identify the chain of infection and reach other infected people.

One characteristic that makes the coronavirus a challenge is the long incubation period before symptoms appear (if they ever do). Assuming that the average infected person shows clear symptoms four to five days after infection, precious time has been lost. After that, more time passes before approval is obtained for testing and then an unknown amount of time before the results come in.

A cautious estimate is that between four and eight days pass between the test and the locating of people who were near the patient. By then it might be too late to stop the infection from moving on to others.

A coronavirus testing center in Rahat.
A drive-through coronavirus testing center in the Bedouin town of Rahat.Credit: Eliyahu Hershkovitz

The government has tried to cover up this gap by letting the Shin Bet security service pinpoint the location of anyone in the country, using cellphone data. But actually shortening the delays in testing and obtaining the results would let the health care system catch up in chasing the chain of infection.

If the delays aren’t overcome, the health care system will keep on operating in the dark on two levels: the attempt to locate and isolate new patients, and the attempt to obtain sufficient information on the spread of the virus.

The release of the bottleneck is not impossible. According to the South Korean model, tests results can come back in six to nine hours. At that point, an epidemiological research team is sent to the patient, a report is made to others with whom the patient was in contact, and the entire process is completed within 24 hours. As things stand now, Israel is chasing its tail via its ever more severe lockdown measures.

Under these circumstances, the media debate on the possibility of gradually reopening the economy after Passover seems useless. Without faster testing now, without serological testing to find antibodies in the blood after recovery from the disease, it will be very difficult to ease the economic distress.

Concerns about the huge economic fallout are once again triggering demands that the people be let back out, except for the main risk group, the elderly. This approach is based on the “herd immunity” theory, but it’s predicated on infecting 60 to 70 percent of the population.

Such a process would take a long time. And even if people under 50 have a low mortality rate from the virus, half a percent or less of everyone infected, it still means thousands would die. That’s a risk no government is quick to take. Britain considered this for a few days and rejected social distancing, and is now far from flattening the curve.

The ministry and health

On Passover eve, there were actually a few encouraging signs of slight progress in testing. El Al planes brought chemical reagents purchased by the defense establishment, which was to help in the administration of tens of thousands of tests. The health and defense ministries signed an agreement with the Chinese company BGI, which is within a few weeks of carrying out 10,000 tests a day.

Another agreement might be signed with the Chinese through the Israeli DNA testing firm MyHeritage. Researchers from the Weizmann Institute of Science say they have achieved a breakthrough in testing without the need for all the materials (in high demand all over the world) for the usual testing. This method is about to receive approval from the government.

All these initiatives have been pushed by Defense Minister Naftali Bennett, but have been given the cold shoulder by the Health Ministry, and Netanyahu is in no hurry to intervene and lift obstacles.

This is all happening slowly and late. A few days ago, the Health Ministry was still asking a lab at the Weizmann Institute to sign that it would take responsibility for damage incurred by inaccurate results – if it wanted ministry approval.

And now, it’s not enough for a person to show symptoms (fever, sore throat, cough, loss of sense of smell and taste) to receive authorization to be tested. Israelis coming from abroad aren’t methodically tested, family members of infected people are tested late, and in hotels where people with mild coronavirus symptoms are staying, releases (to free up rooms for the next patients) are delayed because there aren’t enough tests to prove that the patients are cured.  

Only at the beginning of the week, after it had been clear for a long time that assisted living facilities are coronavirus hotbeds, did the Health Ministry deign to change its policy. The ministry announced that in any closed facility where a coronavirus patient is found, all residents and staff will be tested. That’s too late for the Mishan assisted living facility in Be’er Sheva, where 11 residents died.

A paramedic of Israel's Magen David Adom handles a swab to test for coronavirus at a drive-thru testing site in Tamra, March 31, 2020.
A paramedic of Israel's Magen David Adom handles a swab to test for coronavirus at a drive-thru testing site in Tamra, March 31, 2020.Credit: Ahmad GHARABLI / AFP

The leaders of the Health Ministry are making decisions under difficult, unprecedented conditions. And yet we must recall the declarations and promises by Health Ministry officials last month. As Prof. Siegal Sadetzki, head of the ministry’s public health services, explained on March 18: “Too much testing will increase complacence.”

Other officials expressed this more diplomatically, but it’s hard to avoid the feeling that the Health Ministry is underestimating the importance of testing and considers Bennett’s insistence, which has gained the support of most of Israel’s scientific community, a buzzing nuisance.

The economy, army and innovation

Discussions on the economic implications of the coronavirus are focusing on two issues. The first is the huge damage: an estimated loss of a billion shekels ($277 million) a day, more than a million unemployed, and small businesses going under. The second is a possible exit from the crisis by a gradual return to work. But longer- term implications must also be considered.

A possible comparison may be made with the 1973 Yom Kippur War.  Israel was surprised by the Arab countries, almost lost the war, and then, under the influence of the trauma, invested huge sums in defense for more than a decade. Thus a decade was “lost” in the economy, the height of which was raging inflation under Prime Minister Menachem Begin.

This time, major investments will be needed to rehabilitate the health care system and prepare for other emergencies. In the meantime, people might lose confidence in the economy and investors might be scared off.

Regarding the army, when the extent of damage by the coronavirus became clear in mid-March, the army announced it was taking steps to prevent the infection of soldiers and maintain its battle readiness. For example, soldiers would have to remain on base so as not to create new chains of infection.

Throughout this time, reports were coming in from parents and the soldiers themselves that the army was having a hard time enforcing its orders on furloughs and social distancing. Even photos released by the army’s spokespeople show officers standing close together, flouting the rules.

A paramedic of Israel's Magen David Adom handles a swab to test for coronavirus at a drive-thru testing site in Tamra, March 31, 2020.
A paramedic of Israel's Magen David Adom handles a swab to test for coronavirus at a drive-thru testing site in Tamra, March 31, 2020.Credit: Ahmad GHARABLI / AFP

The height of this came on Passover eve, when the army announced it was letting some soldiers  go on holiday leave “while observing medical guidelines.” In other words, the army was making its own rules and sending hundreds of soldiers home.

Regarding innovations in industry, the global crisis brings with it major involvement by the scientific and technological community in an attempt to reach breakthroughs in two areas: a coronavirus vaccine and drugs to help recovery, as well as solutions to ease the burden on medical teams.

In Israel, in addition to scientists, high-tech companies and the defense industry have joined the efforts. It can’t be ignored that these efforts also involve good public relations and perhaps economic opportunities.

But the involvement of industry in hard times is a positive point. What was true when companies tried to meet the challenge of incendiary kites and balloons from Gaza that set fire to Israeli fields nearby is even truer in the fight against the coronavirus.

Two good examples of this are developments by the defense electronics firm Elbit Systems. In three hospitals, beginning with Rambam Medical Center in Haifa, a digital command and control center normally used by the army and installed in command headquarters and vehicles has been adopted for use by medical teams.

The system lets medical personnel, who have to don heavy protective suits that impede communication, know via a cellphone app the location of all team members, and of all patients and their condition. A special microphone can also break into the communications network to quickly deliver urgent messages to anyone connected to it.

Another innovation is equipment to monitor patients’ vital signs by remote control – fever, pulse, breathing rate and changes in breathing. The system was approved for use at the beginning of the week and is now in operation at Beilinson Hospital, Rabin Medical Center in Petah Tikva. Such monitoring streamlines the work of the medical teams and reduces the risk of infection on the team, one of the issues most worrying the Health Ministry as the numbers of coronavirus patients increases.

On Thursday evening, Bennett publicly demanded for the first time that the Defense Ministry and the military take responsibility for coronavirus testing. According to Bennett, putting testing in their hands would be the only way to streamline the process. The Health Ministry opposed Bennett’s suggestion.

A Defense Ministry official told Haaretz Thursday night that "at the moment, due to the shortage in reagents that has necessitated a change in the testing plan, there is a rift between sampling and processing of results. I agree completely that there is a need for improvement. There is a concerted effort on everyone's part, including the IDF, the Intelligence Directorate and Sayeret Matkal. I hope we can improve in the span of ten days and meet our mark in the end. Many efforts are being made in a few directions. If just a few aspects come to fruition, it will be a new step forward for testing." 

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