Analysis

The Israeli Army Fails to Break Coronavirus Chains of Infection

New contact tracing system should be ready by November 1, but it may not actually work

Amos Harel
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The IDF Home Front Command in Ramle, in central Israel.
The IDF Home Front Command in Ramle, in central Israel.Credit: Tomer Appelbaum
Amos Harel

During the latest meetings of the coronavirus cabinet, on the eve of his trip to the United States, Prime Minister Benjamin Netanyahu repeatedly asked about the system of epidemiological investigations, which is now being run by the Home Front Command. Netanyahu is not pleased with the timetable presented by the Israel Defense Forces, according to which the system will begin to operate fully only on November 1.

But it was the government that he headed that unnecessarily caused the months-long delay in transferring the task to the IDF. And although it looks as though the army will be ready on schedule this time, the increase in the number of identified carriers will make it difficult to conduct effective tests. The ability to break chains of infection will be very limited if the rate of illness continues to be about 5,000 or more cases a day.

The task was handed over to the IDF on August 11 and the coronavirus task force, headed by Brig. Gen. Nissan Davidi, is now in its fifth week of operation. Along with the investigations and breaking the chains, the task force also handles assistance to the coronavirus testing system, the operation of the coronavirus hotels for those who are quarantined or sick, as well as several other tasks. About 1,400 people are now engaged in the investigations, and the plan is to increase that number to 2,000 and then probably to 2,500 in the coming months.

About 700 investigators are Health Ministry personnel, another 300 come from the IDF (soldier-students who completed their studies this summer and whose integration into the army was postponed, and about another 50 female soldier-teachers). Gradually joining them are another 500 students and security inspectors from the Israel Airports Authority, who will later be joined by 500 to 1,000 investigators to be employed by local governments. A new investigator undergoes a week of training and then gains experience under supervision for another week.

Today the investigation system conducts about 2,500 to 3,000 investigations a day – fewer than the daily number of new carriers. The burden will become greater in light of the increase in the incidence of illness. The task force’s objective is to reach 10 “contacts” within about 30 hours from identification of a coronavirus patient. These are people who are known to have been in contact with the patient in the days preceding his identification, who are then ordered to quarantine themselves for two weeks from the day they met with the patient.

In effect, the present average rate is only 5.5 contacts. One reason for the low result is the absence of cooperation from the identified patients. During investigations about 40 percent of them report on three or fewer contacts. The reasons for that are varied: an unwillingness to send other people into isolation, forgetfulness, or embarrassment. The IDF recommends the introduction of a broad information campaign, in order to increase cooperation with the investigations.

The target of 30 hours to break an infection chain is based on the following calculation: two hours from the time a patient tests positive until the investigator’s phone call to him, four hours for the investigation itself and another 24 hours for finding and isolating the “contacts.” This number is very far from the present situation – the average time it takes is at least 90 hours. During this period, we can reasonably assume that the contagion is continuing, with the new carriers still asymptomatic, and unaware that they are likely to infect more people.

In addition, there is a target of 18 hours for evacuating a patient from their home to a hotel, if necessary. Here there are fewer difficulties and the hotel evacuation system is relatively effective, although the increase in illness is likely to present a more difficult challenge. The IDF is trying to learn from the experience of countries that were successful at establishing effective mechanisms for breaking infection chains, such as South Korea and Germany. In both countries the level of illness from coronavirus has been relatively under control in recent months, after a more serious first wave (mainly in Germany).

At present there is no cross-checking between the location data of the Shin Bet security service, which is based on cellphones, and the information emerging from the epidemiological investigations. On reason for that is a fear of invasion of privacy, along with problems of synchronizing the work of the IDF and the Shin Bet. The result is that people get instructions to isolate themselves based on the patient’s testimony, or Shin Bet data. But there’s no attempt to “fuse” the data together in order to reach more potential patients.

On Monday there was a new record for coronavirus diagnoses: 4,973 people. The high number reflects the huge number of positive tests, about 11 percent, but it is also related to the constant increase in the total number of tests. On weekdays there are now more than 45,000 tests a day, while the maximum daily capacity is about 55,000, about 20,000 of them in the MyHeritage national genetic laboratory.

The intention is to reach a daily capacity of 100,000 tests by the end of the year, one of the highest numbers in the world relative to the size of the population. Part of the increase in capacity stems from the opening of drive-in testing stations in cities with a high incidence of illness, where one can be tested without an advance referral.

The work of the new task force is still suffering from a large number of bottlenecks. Even now there is still no sufficiently effective system of gathering and coordinating information, despite the intensive involvement of experts from the Military Intelligence and Teleprocessing directorates in the IDF General Staff in attempts to improve the work procedures.

Another tough problem is related to enforcing the quarantines. The police system for supervising quarantined people is barely functioning in light of the workload. The police manage to reach only about 1 percent of those quarantined a day to ensure that they are at home. The impression is that many people are simply ignoring the directives and leaving their homes, without any fear of the consequences – whether punishment or infecting other people.

The IDF expects to meet its timetable and will receive full responsibility for the tests by November 1. However, the task force will accumulate additional capabilities and manpower later in the year as well. At present about 250 officers and soldiers are working in the context of the task force command center, including reservists. About another 1,000 military personnel are deployed in the field, 300 of them uniformed investigators.

The army admits that there is no point in developing unrealistic expectations regarding the effectiveness of breaking the chains of infection, as long as the daily number of identified carriers is so high. The assumption is that the system will be effective and will meet the timetables for locating and breaking a chain of infection if there are about 200 to 400 new cases a day. At the moment that seems like a distant dream, even if a lockdown is imposed, which based on recent days is expected to include many exceptions, to arouse complaints of inequality and to make it even more difficult to obtain the public’s cooperation.

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