The army’s Operations Directorate head, Maj. Gen. Aharon Haliva, warned the Health Ministry this week that the current system used for breaking the chain of the coronavirus infection is flawed, and that the ministry must stop relying on the “public’s good will.”
“Testing for the virus at this stage is not done in a manner that employs basic capabilities for processing and integrating information, which significantly hampers the location of contacts of infected people and the obtaining of a full picture of the spread of COVID-19, beyond the fact that testing requires goodwill and cooperation on the part of citizens. This requires a change of paradigm,” Haliva wrote in a letter he sent to Health Ministry’s director-general and other senior ministry officials, as well as to the head of the National Security Council and the army’s chief of staff.
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Haliva was in charge of handling the first wave of the coronavirus and continues to be involved. He presented his thoughts on breaking the chain of infection, analyzing fault points in managing the crisis and in conducting epidemiological investigations. He offered a rapid-action plan, formulated together with military intelligence and members of the academic community.
“The solution does not lie in improving existing methods but in changing paradigms,” wrote Haliva, noting that epidemiological tests are the key in battling the spread of the virus.
The spirit of these words and the major points he raises are similar to those heard from other experts, including the National Security Council’s advisory panel. It is agreed by all that the rapid rise in infections requires a quick, accurate and coordinated effort to break the chain of infection.
Currently, the Ministry of Health is responsible for testing, which is carried out by teams at its district offices. The ministry has a new crisis management center which includes a team that can carry out rapid investigations, which in practice has not yet been given the required authority. Thus, its presence is not yet felt. The process is still complicated and cumbersome and takes too long compared to the speed of the virus’ spread.
“The time it takes from the moment a person starts to feel ill and contacts his clinic or the emergency medical services, and the time when the attempt to break the chain of infection is implemented, is several days to two weeks,” writes Haliva.
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He also notes that despite efforts by health maintenance organizations, several days pass from the time infection is suspected until a sample is taken. There is no transparent documentation of this, making it difficult to measure the exact duration. The difference between laboratories and the absence of a unified database leads to lost time between the arrival of test results and the questioning of an infected person.
“There is a significant gap between the investigative arm, with a lack of information infrastructure, manpower shortages, methods of operation that are incompatible with the challenge and an absence of using technological knowhow” writes Haliva, highlighting the absence of coordination and synchronization between the various agencies involved.
A major flaw is the difficulty in relying on the public’s goodwill in epidemiological investigations. “As long as isolation is self-reported, relying on a person’s goodwill with no orderly monitoring, infections will not be halted effectively” says Haliva. This is a major flaw, since “one can assume that people do not make sufficient efforts to retrace their movements, often preferring not to share this information for various reasons. This non-compliance adversely affects the ability to break chains of infection.” Haliva believes that punitive measures are required.
The plan he proposes includes a list of steps, chiefly a more coordinated and centralized management of the process. He envisages a national command center which combines using databases and technology in order to expand the means available for locating contacts, as well employing monitoring and enforcement of guidelines.
The agency he suggests resembles one that already exists, comprising 200 people working for the Ministry of Health. It’s unclear how the ministry is currently using this agency. Haliva proposes using a centralized database, with centralized control of testing that will be done through the ministry’s district offices. Field investigative teams will be used when there is non-compliance and an infected person balks at providing information about his or her contacts.