The Health Ministry has published an updated, faster procedure for testing for the coronavirus in people who are under quarantine after being exposed to a verified carrier of the virus. The test will be conducted within 48 hours, instead of the previous period of 4-7 days elapsing from the last contact with an infected person. This procedure was installed on the backdrop of criticism regarding the delays in setting up a system for breaking chains of infection.
In a letter to health maintenance organizations sent from the Health Ministry’s director of public health services, Prof. Siegal Sadetzki, she said that “from now on samples must be taken from people newly in quarantine who need to be tested, such as people in educational institutions or people living in the same location as a person confirmed to have the virus. Tests must be performed within 48 hours of a person entering quarantine, including weekends and holidays.”
In recent weeks there was a protracted dispute between Sadetzki and other professionals and advisory teams, over the importance of breaking the chain of infection to block a new wave and prevent another lockdown.
Two weeks ago, on June 8, Sadetzki disseminated a procedure for infections in schools. It stipulated that tests be done within 4-7 days after a person goes into isolation. Her rationale was that this would maximize the reliability of the results. She said that the time frame was set to allow minimal incubation time on one hand, while minimizing the risk of infecting others on the other.
This procedure evoked stiff opposition and criticism in many quarters, including people at the Gertner Institute, which advises the Health Ministry and the advisory team at the National Security Council on epidemiology and health policy. Critics, basing themselves on reports and models they employed, maintained that “closing the circle,” from locating an infected person and his or her contacts, to quarantine and testing, should be done within 48 hours at most.
According to sources in the health system, ever since that procedure was published, appeals were made to Sadetzki and the ministry’s former director-general Moshe Bar Siman Tov, presenting them with data showing the importance of rapid testing on people in quarantine in order to break the chain of infection. Experts urged the ministry’s senior officials to change the procedure and shorten the time to testing, but in vain. These sources claim that Sadetzki refused to adopt these positions and Bar Siman Tov refused to confront her on this issue.
Time is of the essence in breaking a chain of infection. When it’s still unclear whether a person in quarantine is carrying the virus, the circle of people he or she was in contact with, and who are not in isolation themselves, can further spread the virus. Advisory teams argue that testing after 4-7 days means a loss of valuable time in trying to close this circle, to the point of losing control over blocking the spread of the virus. They say that testing must be done as quickly as possible, even if this means compromised reliability.
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The NSC team believes that the only way to avoid another lockdown is to quickly investigate, isolate and test to break the chain, as well as strict adherence to the donning of masks and its enforcement, maintaining social distancing and adopting correct hygiene.
Sources in the health system said that in view of the spike in the number of infections and the growing list of hotspots, Gertner Institute experts and others appealed to incoming director-general Hezi Levy, presenting him with their arguments. Levy was apparently convinced and the new procedure was published shortly thereafter, signed by Sadetzki.
The shorter time to testing is important, but it’s only one link in the chain. The apparatus for breaking the chain of infection is still faltering, suffering from many flaws which require speedy resolution. This includes a shortage of manpower in the system carrying out epidemiological tracking at Health Ministry district offices, as well as overburdened laboratories (37 in total) which conduct 15,000 tests a day. The oversight agency within the ministry, meant to orchestrate the entire system, has not been blended in and given the relevant authority by the ministry.
Sadetzki and the public health service section of the Health Ministry have been subjected to criticism by many officials within and outside the ministry. Some claim that the service did not make an effort or that it deliberately sabotaged the establishment of an effective system for breaking the chain of infection. A story in Haaretz earlier this week contained testimony indicating that the ministry did not have an orderly mechanism for making decisions, and that Bar Siman Tov and Sadetzki made policy decisions on their own.
“No one was allowed to voice a different opinion or to dispute her,” said one non-ministry expert who is involved in combating the epidemic. “There was no discussion. It was very badly managed”, he said.
With the changing of the guard in the Health Ministry, there is more involvement and decision making on the part of incoming minister Yuli Edelstein and director-general Levy. This includes going against Sadetzki’s concept, which was the dominant one during this crisis up to now. The new procedure is apparently an indication of the way things will now be done.