The manager of a Health Ministry lab overwhelmed by the demand for coronavirus testing spoke on television Monday. She fumed over the neglect of the laboratory system, over the labs’ unbearable workload, the lack of resources, the health risks to which lab workers are exposed — and over how there are no solutions in sight. “People keep suggesting that all kinds of students come to help, but that’s useless. It takes me a year to train a lab technician,” she said with obvious emotion.
At Israel’s leading academic research institutions, people watching the interview didn’t know whether to laugh or to cry. “A year?” one senior university researcher told TheMarker. “At any given moment, every single doctoral student of mine is doing tests that are much more complicated. The coronavirus test couldn’t be simpler. I could train hundreds of doctoral students who could help in two hours. But the Health Ministry doesn’t want it.”
As of Tuesday, only eight labs in Israel were doing coronavirus tests, at a total rate of less than 1,000 per day. The daily testing rate fell below 1,000 after the main lab — the one at Sheba Medical Center — closed down after a worker there was diagnosed with the coronavirus. But even this number is a huge leap. Earlier in the week, only five labs were doing testing, with a total capacity of just a few hundred tests per day. Yesterday, the main lab of Clalit became the first lab at any of the health maintenance organizations to do coronavirus tests. The other HMOs have yet to be approved to do these tests, nor has any academic institution.
Israel’s universities have hundreds of labs, many of which are much more advanced than the Health Ministry labs (including some that are robotic), that could conduct testing at great speed. Top university researchers estimate that the research labs within the medical and life sciences faculties of all the universities could reach a capacity of 10,000 tests per day. The directors of the HMO labs say they could also get up to 3,000-5,000 tests per day.
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So why in God’s name is Israel still doing fewer than a 1,000 tests a day now that three weeks have passed since the coronavirus crisis erupted?
Everyone we spoke to about this complained about a major managerial lapse on the part of the Health Ministry. The testing capability is there, but no order has been given to start testing. Even the simplest move – boosting the ranks of the Health Ministry labs with doctoral students who are experienced with research in the life sciences so the labs could operate 24/7 – has encountered stiff resistance, as evidenced by the remarks of the lab director in that interview.
As far as is known, the laboratory of Ein Kerem Hospital, Hadassah Medical Center is the only one that has agreed to accept students, from the Hebrew University, to do testing on night shifts. Soroka Hospital in Be’er Sheva may also soon accept such assistance. Yet all of the universities have offered volunteers to all of the Health Ministry labs.
Why isn’t the Health Ministry taking advantage of these resources to increase the pace of coronavirus testing? The ministry cites bureaucratic barriers. For example, the Health Ministry has to comply with strict regulation for approval of laboratories. This includes safety rules meant to protect the health of lab workers as well as public health, and validation rules to ensure the lab is performing tests correctly.
All the labs we spoke with at the universities and the HMOs understand the need for regulation, but all insist they could meet the regulation standards within 48 hours at most, “if only the Health Ministry bureaucrats could be troubled to move a piece of paper from one side of the desk to the other.”
“The World Health Organization issued safety regulations to labs that are testing for corona. My lab meets these standards,” one senior university researcher says. “We routinely conduct studies of pathogens that are just as dangerous as the coronavirus and all of the researchers in my lab adhere to the safety rules. The problem is that the Health Ministry invented regulation that is specific to Israel. The ministry demands even stricter safety rules than the WHO does, and thereby is reducing the supply of coronavirus testing labs from thousands to dozens at most.”
Certificate of good conduct
This isn’t the only constraint the Health Ministry imposes. It also demanded that all volunteers – including medical students who wished to help Magen David Adom personnel in taking samples from people at risk in home quarantine – have insurance, vaccinations and suitable protective gear. And at first, the Health Ministry was also insisting on a certificate of good conduct (attesting to no criminal record), though it has since dropped this requirement. But it is not being flexible on any of the other conditions.
“It’s fine that they want to maintain safety,” said a researcher, “but we’re at war, and this is the time to be flexible. Even when I was a commander in the army, in wartime I took soldiers who hadn’t completed their training with me to the front line because there was no choice. The Health Ministry had to shut down its main laboratory, at Sheba, because the deputy head of the lab was infected with the virus. It’s not clear how she became infected. It may well have been through community infection. That’s the nature of an epidemic. People are infected everywhere, all the time, and that’s why the rules need to be relaxed right now. This is not the time to insist on maximum protection.”
The HMOs make similar complaints. “We have the capability to do the tests professionally and safely, but we still haven’t received approval to do it,” they say. Officials at the HMOs as well as the universities say it is frustrating “chasing after the Health Ministry” and that they are “literally pleading with them to let us do testing, even for free,” but the ministry has not budged.
There are other reasons for the low number of tests: Delays in collecting samples, a shortage of Magen David Adom workers (their numbers have been bolstered by hundreds of medical students who volunteered to help), a shortage of sample collection kits, and apparently also a shortage of testing materials for the laboratories, among other problems. These are all real issues, but they could be overcome if the Health Ministry would bring all of its weight to bear to fix them.
“It’s hard to complain about the staff in the Health Ministry. They really are collapsing under the incredible workload,” said one official at an HMO. “The problem is a lack of managerial attention, and the lack of a general who decides that the tests are the top priority and that all the barriers blocking them must be removed.”
The logjam that has arisen in sample collection also stems from a policy set by the Health Ministry: that samples may only be collected in people’s homes (not at the HMO clinic or at hospital emergency rooms), only by Magen David Adom personnel, and only according to a narrow set of criteria. This is a bizarre policy that could cause harm, they say at some of the HMOs. “It really seems like the Health Ministry is afraid to test – lest it discover – as we all believe – that there are tens of thousands of carriers, with nowhere to hospitalize them or care for them,” one said.
Many of the experts fear that the harm caused by the dearth of tests done so far may already be irreversible.
All eyes are on South Korea, which, with the aid of a vast amount of general testing (in conjunction with other measures like school closings, tracking carriers’ locations and lockdowns of virus hotspots), has apparently managed halt the virus’s spread.
Even now, it appears that the Health Ministry would prefer to completely shut down the economy, causing colossal economic damage, rather than relax its regulations in order to enable a major increase in testing. The ministry’s unyielding posture may lead to a lockdown being inevitable. A lockdown that lasts for six weeks would cost the Israeli economy 80-90 billion shekels, mainly due to shrinking output and loss of GDP.
The Health Ministry declined to comment.