The Israeli public, like its decision makers, has come to the critical early point of exit from the coronavirus crisis without clear objectives, timelines or milestones for implementation. The fog covering Israel’s battle against the virus at this stage is the result of a lack of necessary information and an inability to access what information does exist, as part of what looks like a policy of ambiguity and fear of criticism over the handling of the crisis or of the inability to deal with its challenges.
The race after Health Ministry information has become an integral part of the crisis. Researchers, doctors, journalists and mere ordinary citizens want to know more. But the information being published is partial and heavily processed. Those very few who seem to have access to additional information, like journalists or experts interviewed in broadcast studios, hint that such a thing indeed exists, but is only released under certain circumstances that dovetail with the line being promoted by the ministry.
People in the health system have the feeling that everything relating to the COVID-19 crisis is being treated as a “security” issue, as if the information was connected to national defense and must be kept secret.
On the decision makers’ desks are all kinds of reports and models for an exit strategy. But they were drawn up by a very select group of people who were granted access to the raw data collected by the Health Ministry, and which isn’t accessible to the public, health system officials or researchers.
In an epidemiological event of this nature, the data required by those coping with the crisis includes information on the global situation, data and academic research from other countries, and the valuable local data that has been accumulated as the crisis continues – about the pace of infection, hot spots, medical characteristics of the virus, risk groups and other statistics. All this is crucial for making decisions and planning what comes next.
But of the few people given access to this information, most have nothing to do with the Health Ministry or the healthcare system, and some of the strategy-planning teams don’t include any medical officials or public health officials, epidemiologists or experts on contagions; they are mathematicians, physicists, computer experts and economists. They include teams from the National Security Council, the Gertner Institute (which is partly funded by the Health Ministry but doesn’t answer to it) and the Weizmann Institute of Science.
The lack of transparency and access is so extreme that information is often denied to the senior professional echelons of the Health Ministry itself.
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“We get the information like all Israelis, through Telegram or WhatsApp,” said a Health Ministry official whose job is highly relevant to the coronavirus battle. “We get processed information in the form of reports, not raw information. And what’s absurd is that the ministry’s computers can’t even download Telegram or WhatsApp because of the computer security system, so we can’t even read that information properly. Recently, some ministry employees got special access to these materials, but only for the corona crisis period.” Only a select number of public health officials and ministry computer people have access to any of the raw data.
“There’s no reason not to reveal this information; it’s not secret or private. It’s a database that could serve many research groups seeking to create models or segmentations, as they do in U.S. Centers for Disease Control,” this same official said. “The feeling is that releasing the information might lead to various interpretations and so it’s best to grant only certain people access to the information.”
The information is stored in a computer system set up for this purpose, which, according to Health Ministry officials, suffers from plenty of bugs that aren’t fixed in a timely fashion. In recent days, for example, there were several daily updates that lowered the number of new cases reported to the public and the press. On Wednesday morning, the data showed a spike of 300 new cases, but ministry sources said this was the result of a bug in the way information is merged from various sources, and the real number was around 220.
Health Ministry director-general Moshe Bar Siman Tov likes to stress the importance of transparency and sharing of information, when in fact, data sharing is extremely limited. For example, the minutes of the meeting of the pandemic response team were never published, nor were those of other ministry forums. But it’s not just the public that’s excluded; people on the response team say they aren’t getting the information they need.
In a letter written last month by a member of the response team to Health Ministry officials, he claimed that members were not getting information about the true rate of infection in the population, they don’t know the quantity of protective equipment and ventilators in the hospitals, and that there is no unified protocol for treating coronavirus victims.
Only recently, after a long delay, was it decided to set up a national registry for coronavirus cases, similar to the registries that exist for other diseases and which are managed by the Israel Center for Disease Control. But even here difficulties have arisen, because the Health Ministry management objected to giving the ICDC access to the raw data. The opposition to this however, has since been rescinded. The infrastructure for setting up the registry is in place and only now the issue of access to the data is being discussed.
“It’s very difficult and frustrating and improper,” says Prof. Tamar Shohat, a former ICDC head and a member of the epidemiological department at the Tel Aviv University medical school. “There are groups of researchers who are organizing and are interested in examining alternatives, building models, and understanding what’s happening, even if they weren’t called on to help by the government. It’s information that is meant to be transparent to people.”
She is now working with another researcher at the Technion – Israel Institute of Technology on various models. “Data like how long it takes from when symptoms appear until ventilation, or information on underlying illnesses among patients aged 50 or younger, and lots of other information that’s meant to exist is not accessible to us. We are forced to rely on information from other countries and not relate to the characteristics here, and that’s a shame. In the end, it’s in this material that we’ll find the answers to those questions critical to exiting from the crisis.”
But it’s not just the issue of access that’s raising questions. No one has any real idea what information has been gathered by the ministry, how much, and what its quality is. One of the most talked about areas on which Israel lacks crucial “intelligence” is the general rate of infection in the population, which must include data on people who are infected but asymptomatic.
Four weeks ago, the Health Ministry launched an initiative to take random samplings in medical provider or HMO clinics. To date, only a few hundred samplings have been done, because the number of clinic visits has dropped and because of the Passover holiday. But at the same time, the HMOs have set up testing booths on the streets of various cities – with each HMO conducting this as it sees fit. Cooperation between the HMOs and the ICDC could expand the sample significantly and advance the collection of this crucial information. “It didn’t happen because the right hand doesn’t know what the left hand is doing,” said a Health Ministry source.
“I think that something bad is happening,” said a senior health official. “The Health Ministry has become enamored with dealing with the coronavirus and with its role in the crisis. It’s as if there are two parallel ministries – the Health Ministry, and the coronavirus ministry.”
In a Knesset Foreign Affairs and Defense Committee hearing this week, the ministry’s head of public health services, Prof. Siegal Sadetzki, supported the use of technology to identify coronavirus patients and those who have been exposed. Among the reasons she gave was to preserve “the fantastic accomplishment” that’s been achieved to date.
“To talk about a ‘fantastic accomplishment,’ that has cost the economy a hundred billion shekels, with more than a million unemployed, families that are collapsing and patients who will yet die from other illnesses that aren’t being treated – testifies to the ministry’s perception,” said the health official. “A dynamic has been created in which people closed in the same room are listening to the same ‘music’; the same line of thinking, and that’s what they keep on repeating.”
The Health Ministry said in response: "Shortly after the coronavirus outbreak, the Ministry of Health began collecting relevant medical and epidemiological information. In recent months, with the increase in the number of patients, the information has reached a sufficiently large size to justify its publicity, subject to privacy precautions."
"Through a diagnostic robotics company and in co-operation with the HMOs, information about symptoms that predicts the behavior of the coronavirus outbreak is collected. This information is collected in the Ministry of Health database and accessible to every researcher in a secure environment."