“Israel is ranked first in the world for the quality of its blood testing, which it has been doing quickly and without errors. We’re 20 times better than the Americans,” boasted Ran Saar, CEO of the Maccabi Healthcare Services in an interview with TheMarker last week.
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Saar’s claim inadvertently raises an interesting point about how Israel has contended with the coronavirus pandemic. The crisis has exposed the country’s shortcomings – the insufficient number of hospital beds, the scientific illiteracy of Haredi society, discrimination against Arabs, red tape, the difficulties of working with 257 different local authorities and the lack of organization. But equally frustrating has been Israel’s failures to capitalize on its strengths.
We have two of them. One is the experience we have developed over the years to manage emergencies with economic bodies and the Defense Ministry’s National Emergency Authority. Prime Minister Benjamin Netanyahu has stubbornly refused to allow either to play a role.
Our other strength is the proven efficacy of community medicine, namely the HMOs, which are considered among the best of their kind in the world.
The Gertner Institute, the research arm of the Health Ministry, said in a report it issued before Passover that the heart of the problem in Israel’s war on the coronavirus isn’t the lockdown but the management of the spread of the disease. It found that it takes 11 days on average between the time a person first becomes infected until he or she is put into quarantine. In the meantime, the virus he or she is carrying can get passed on three or even four times.
Those 11 days can be divided into two phases. The first five days, before symptoms begin to emerge, is a difficult one in which to identify carriers – difficult but not impossible, Gertner says. South Korea, by undertaking systematic testing, has succeeded in identifying most such carriers.
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The second phase, which lasts six days on average, constitutes an embarrassing failure on the part of Israeli health authorities. The sufferer is already showing symptoms, but the system is far too slow in identifying him or her. Gertner asserts that if those six days could be cut to one, the pandemic could be brought to a halt in Israel.
Why does it take six days even after somebody who is ill is showing symptoms?
The answer is management. There is a shortage of testing kits and laboratories to perform the tests. The latter shortage means that Magen David Adom, which is charged with conducting the tests, ends up storing samples from test kits in refrigerators for several days until they can be examined.
Officials at Israel’s HMOs said over the weekend that until the country reaches a testing rate of 30,000 a day, the delays will continue. Until then, there’s no chance of closing the “contagion chain,” as Gertner call it, to a gap of 24-48 hours.
The low rate of testing is a chronic failure that the Health Ministry is not doing nearly enough to solve. Take the case of Tel Aviv University, which raised 2 million shekels ($560,000) to build a lab capable of conducting 2,000 tests a day. The ministry has approved it, but due to red tape the laboratory has still not been cleared to begin operations.
The ministry has compounded the problem by taking control of the testing system itself through the MDA and the ministry’s own labs. The efficient and experienced labs operated by the HMOs conduct millions of tests annually and in most cases deliver the results by app or their websites within half a day, but they are not being used.
Instead, the Health Ministry has created its own chaotic system. Approval for someone to be tested is given to the MDA after approval by local Health Ministry doctors. The tests are administrated by the MDA at the homes of suspected carriers and the results examined by ministry labs, mainly the central one at Sheba Medical Center. The HMOs aren’t involved in the process at all.
Because there is no computer link between the MDA, the central lab and the Health Ministry, the results are put into Excel files compiled manually by the ministry. Patients are then notified of the result by the ministry – in the early days sometimes personally by the minister or director general.
Not surprisingly, the entire process takes 5-7 days and many mistakes are made along the way. Samples and results get lost, people who were never tested are told they are carriers and those who have been tested often have to come back a second time when the file is lost. It’s a miracle that the process doesn’t take even longer.
“The HMOs have not been in the thinking and planning loop for the coronavirus,” said one senior HMO executive.”The Health Ministry managed everything itself over our heads. We didn’t even know that our members were going to be tested whether they were sick or healthy. Because we weren’t in the loop, it took time for us to realize that things weren’t functioning the way they should.”
He says the Health Ministry had good intentions but failed in the execution. It didn’t consult with the HMOs and so it wasn’t aware that they had the necessary equipment and facilities. It wanted to control the testing process from start to finish.
The biggest mistake was to give the testing to the MDA. “The MDA has to train people that it didn’t have and then sent the tests to 21 different laboratories that aren’t connected to a single central computer system. The result was a terrible mess,” he said.
In addition to their experienced and efficient testing system, patients would be able to communicate with their personal physician who would be better able than an MDA medic to decide whether someone’s symptoms merit him or her being tested.
HMOs left out
The decision to not include the HMOs almost certainly had a lot to do with Israel’s inability over the past six weeks not to get control over the pandemic’s spread.
HMO officials are confident they could have cut the time between test and result to the 24-48 hours the Gertner Institute said is critical for containing the pandemic. That would have made Israel another South Korea in terms of getting the situation under control.
To the Health Ministry’s credit, director general Moshe Bar Siman Tov has come to understand that mistakes were made. In the last two weeks he has authorized the HMOs to begin testing their members. In the first phase, they have been given responsibility for testing and for releasing from quarantine in so-called coronavirus hotels those who have recovered. Gradually they will get to decide who needs to be tested. The tests are then done by either the MDA or the HMOs themselves.
There still remains the problem of the rate of testing because, apart from Leumit, none of the HMOs can conduct tests for all their members. As a result, they are working the 31 labs in Israel processing coronavirus tests. The HMOs get the results and ensure they are transmitted to the patient quickly, efficiently and accurately.
In another 7-10 days, the system should be up and running, and that’s when Israel should overcome most but unfortunately not all the problems the system has been plagued with until now.