Israeli Watchdog Releases Report on COVID-19 Handling. Here's What's Missing

Ido Efrati
Ido Efrati
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Medical staff dealing with the coronavirus at Shaare Zedek Medical Center, Jerusalem, September 21, 2020.
Medical staff dealing with the coronavirus at Shaare Zedek Medical Center, Jerusalem, September 21, 2020.Credit: Emil Salman
Ido Efrati
Ido Efrati

State Comptroller Matanyahu Englman is releasing his interim report on the handling of the coronavirus pandemic on Monday. Englman is calling it a “special” report and an essential tool for correcting the mistakes “as soon as possible.” But the report does not even expose major failures in managing the crisis – it presents a picture of the situation as of two months ago – so that many of its findings are no longer relevant. In addition, the comptroller focuses only on implementation of the measures to fight the pandemic – and has avoided any criticism of the way the crisis was managed or on the decision-making processes in the government and professional forums.

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Neither does the report supply answers to important questions concerning the staff work in the health and other government ministries in handling the crisis – including the Prime Minister’s Office. For example, it is not possible to find any comments in the report on the forums where decisions were made – not about how these decisions were made, the logic behind the decisions or who was involved in them. Moreover, the report relates only in a general manner to the organizations that were examined, does not allocate responsibility to specific units and does not deal with the functioning of the officials responsible for the duties that were examined in the report.

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Further, it did not examine why professional groups, such as the Health Ministry’s epidemics management team or the national center for disease control, were not involved in the decision-making process. Englman did not provide an answer to why the minutes of the meetings on the pandemic were not released to the public, and why critical information on the spread of COVID-19 in Israel – neither the raw data nor an analysis of it – was not provided to the public or to scientists outside the Health Ministry during most of this period.

The report does not contain any explanations or criticism concerning the factors that influenced the most important decisions – such as the continued delays in deciding to stop flights from the United States. This delay, it turns out, was disastrous and led to most of the cases of coronavirus infection in May. The report also fails to examine the processes that led to the cancellation of the decision in September to impose a full lockdown on a number of “red” cities, in an attempt to avoid a national lockdown.

A closed restaurant during the nationwide lockdown, October 8, 2020.Credit: Tomer Appelbaum

The report’s findings leave in the dark the matter of the billions of shekels in public funds spent on procurement for the pandemic. For example, Englman did not examine if it was justified to contract with private companies, without competitive bidding, for tens and hundreds of millions of shekels. Neither does it examine the government’s communications on the disease and crisis, or the violations of guidelines or the failure to present a personal example on the part of politicians and public figures, and their implications for the public’s trust.

Delay in breaking chains of infection

The report devotes a great deal of space to the testing and breaking of the chains of infection. According to the report, at the end of August a large gap existed between the goal for testing set by the Health Ministry and the actual preparations of the HMOs for carrying out those tests during the winter. The report states that Israel does not have enough kits for carrying out the testing in the labs. But since then, the Health Ministry has purchased hundreds of millions of shekels worth of laboratory materials, and the number of tests that can be conducted in a day has risen to 70,000. This number is expected to reach 100,000 next month.

Englman also examined the waiting times for receiving coronavirus test results. This issue is critical because the earlier the results are received, the more effectively the system for stopping the chain of infection can operate. According to the findings in the report, which are up to date as of the end of August, 74 percent of those tested received their results after more than 36 hours from the time they were referred for a test, and 33 percent of those tested received their results after more than 72 hours.

During the time the tests were conducted, the epidemiological system based itself on the small public health services in the district health offices. This service was composed at first of a small number of public health doctors and nurses, who were joined by nurses from other sectors of the public health field, mostly from Well Baby clinics. The report notes that the number of researchers was small, so the epidemiological investigations system did not operate effectively enough. For example, a sample examined by the comptroller of 76 epidemiological investigations carried out in the Jerusalem district in June and July showed that in 64 percent of the cases, the investigation began after more than four days after a positive test result was received.

Englman also criticized the way the investigations were documented, which was done with forms filled out by hand in some of the districts. Even after the investigators began using computers to document their investigations, they did so using a “slow, inefficient and unsupervised” method that required double the amount of staffers and had a “great potential for mistakes.” In addition, he pointed out that sometimes investigations of a number of family members are conducted at the same time by different investigators – without them knowing they are dealing with a single family. This is how information on infection from within the family is sometimes not collected.

These findings are relevant for the period before the establishment of the Alon headquarters of the Home Front Command for stopping the chains of infection – which began operations during August. The Home Front Command significantly expanded the number of epidemiological investigators, which is now more than 2,000. As a result, according to the Home Front Command, the average time today for the entire process of cutting off the chain of infection is 36 hours. This process includes locating the person who was quite possibly infected, conducting the test, receiving the results, providing the patient with the information, isolating the patient and locating the people who came into contact with the patient. Officials in the Home Front Command said recently that the process will be shortened to 30 hours in a few weeks.

Serological testing

The Health Ministry planned to carry out serological surveys to locate coronavirus antibodies in the blood. These surveys were planned to be conducted a few months after the pandemic broke out, with the goal of providing complementary information on the spread of COVID-19 and the real level of exposure to the virus, the cumulative extent of infection and the population’s immunity to the virus.

To conduct these tests, the Health Ministry purchased 2.4 million test kits at a cost of 112 million shekels ($33 million). But the report states that as of the time it was written, the ministry planned to use only 300,000 of the kits. As for the remaining 2.1 million kits, there was still no plan. In practice, only 250,000 of the testing kits have arrived in Israel as of now, and only about 60,000 had been used as of the beginning of September.

Israel Prime Minister Benjamin Netanyahu on a visit to Shaare Zedek Medical Center, Jerusalem, 6 August, 2020. Credit: Emil Salman

The Health Ministry’s original plan was to conduct a nationwide serological survey including at least 150,000 tests, and a few other surveys in Bnei Brak, using 7,500 kits. But in practice the numbers were much smaller. Only 55,000 people participated in the nationwide testing, and 4,500 in Bnei Brak. This month the Health Ministry presented the results of the serological surveys conducted from June through August – whose effectiveness was damaged because of the delay in releasing the results – and said that they intended on carrying out additional serological testing later.

36% of deaths in old-age homes

Englman also criticized the way the 71,000 elderly people living in nursing homes and assisted living facilities were treated. He pointed out that 36 percent of those who died from COVID-19 at the beginning of October were elderly persons from these institutions – 619 out of 1,710. After the levels of infection and mortality in nursing homes became clear, the Health Ministry established a unit in April for dealing with these people. But this unit did not make sure that all workers who came into contact with the residents were tested for the virus, and they did not have an overall picture of the situation, said Englman.

During the period when the report was written, there were only 440 beds in geriatric institutions allocated for the residents infected with COVID-19. This was true even though the Health Ministry set a goal of 1,000 such beds. Englman said that this shortage of beds prevented hospitals from releasing elderly people who had been hospitalized. An examination conducted by comptroller’s office staff in August found an average of 45 elderly people hospitalized per day in general hospitals – even though the medical staff thought it possible to transfer them to a geriatric hospital. “If those same senior citizens had been transferred for hospitalization in the coronavirus wards in geriatric hospitals, it would have been possible to make available beds in the general hospitals for hospitalizing coronavirus patients from the general population,” states the report. But Health Ministry officials said that today there are more than 1,000 beds for such purposes, and today some are not being used.

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