Israel to Revise COVID Testing Rules Amid Rapid Spread of Omicron Variant, Soaring Demand

Health Ministry to rely more on rapid antigen tests, in place of PCR swab tests, and consider amending testing requirements based on vaccines and symptoms as testing centers in Israel fall under heavy loads

Ido Efrati
Ido Efrati
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People line up to get COVID tests at a testing center in Tel Aviv
People line up to get COVID tests at a testing center in Tel AvivCredit: Hadas Parush
Ido Efrati
Ido Efrati

The Israeli health care system is struggling to administer enough COVID tests in the face of the rapidly spreading omicron variant, leaving the Health Ministry no choice but to revise its testing policies.

Sources said the ministry is expected to begin allowing unvaccinated people exposed to an infected person to undergo a quick antigen test at official stations, instead of a PCR test, in order to be released from quarantine. The ministry also plans to set up more testing stations and make them more accessible, with an emphasis on rapid testing, the sources said. The ministry has purchased 20 million additional rapid-test kits.

“Everyone understands that we’re facing a rate of infection and illness that we haven’t seen before. Not for nothing we decided last week that vaccinated people (exposed to someone infected) would be given an antigen test and not a PCR,” a senior Health Ministry official told Haaretz. “We’ll probably decide this week that unvaccinated people should also take antigen tests.”

He said the ministry was discussing further changes to testing policy as the health care system adapts to the rapid spread rate of the virus, while diverting limited resources to where they are needed.

“We will have to reexamine whether everyone needs to be tested, which symptoms necessitate a test and which do not, whether the vaccinated and unvaccinated should be separated, and whether to differentiate between people with symptoms from asymptomatic carriers. These are some of the questions we’re discussing with the experts. I believe that the testing policy will be revised within two days,” the source said.

Rapid COVID testing center in Hadera, IsraelCredit: Ilan Assayag

Prime Minister Naftali Bennett and Health Minister Nitzan Horowitz said on Sunday that the number of those eligible to be tested should be limited. According to Bennett, precedence should be given to those at risk of severe illness and to essential workers.

PCR tests involve a longer process of sampling, transport, documentation, laboratory services and reporting mechanisms. By contrast, antigen tests are easy to administer and provide quick results. However, experts say rapid tests are far less reliable than PCRs, with accurate detection of asymptomatic carriers about 20 percent to 30 percent lower.

“The antigen test reveals the subject’s capacity for infecting others, but it’s known to be less sensitive than the PCR test in detecting infection,” said a senior figure at a COVID testing lab. “You need to conduct a PCR test to rule out an antigen test’s false positive result.” However, he added, that with the rapid spread of COVID there is no real alternative to administering antigen tests.

Dr. Yotam Shenhar, the head of medical laboratories at the Leumit health maintenance organization, said he agreed that the testing regime had to adapt to changing circumstances.

People line up to get COVID test at a testing center in Hadera, IsraelCredit: Ilan Assayag

“In my professional opinion, the attempt to control the outbreak with test and quarantines was doomed to fail. It was true for delta, and it’s definitely true for omicron,” said Shenhar. “In any event, we can’t administer all the PCR tests needed, so the antigen test, despite its reduced sensitivity, is a reasonable substitute. I think we have to stop trying to control infections and only test symptomatic people and high-risk groups.”

Meanwhile, tens of thousands of people crowded into COVID testing sites around the country over the weekend and on Sunday, creating lines that lasted hours. Saturday alone saw an 86 percent rise in the number of tests, compared with a week earlier, as the daily number of new confirmed cases crossed the 5,000 mark. While Israel has seen double that number in earlier coronavirus waves, it has never risen so quickly.

“On Saturday, we came to Petah Tikva Stadium to get tested for COVID after my daughter was exposed in her class. We waited for two-and-a-half hours to get tested,” one man told Haaretz.

Officials are predicting that by the end of this week the number of new cases will cross 10,000. “We’re talking about 30,000 and 40,000 new confirmed cases per day in a short time,” a senior Health Ministry official said.

A health care worker test a child for COVID in a rapid testing center in Tel AvivCredit: Hadas Parush

The result is that at any given moment tens of thousands of Israelis will be either getting testing or waiting for the results of a test, whether it’s due to COVID symptoms, exposure to a carrier or to shorten quarantine times.

Moreover, the official Health Ministry figures for new cases, which are based on the test results, are believed to be much lower than the actual number. As a result, testing is becoming less useful as an epidemiological tool. Meanwhile, it’s becoming impossible to locate all carriers, while genetic sequencing of COVID patients will soon be irrelevant as omicron becomes the sole variant in Israel.

It wasn’t only the PCR testing stations that were overloaded on Sunday. Long lines also snaked around antigen testing stations, which are operated as a separate network by Magen David Adom and Ichilov Hospital. The antigen testing network until recently served mostly to provide free testing of children to enable entrance to places restricted to Green Pass holders. Following a change to testing policy last week, now the network is dealing with large numbers of vaccinated people who have been exposed to a COVID patient and need to take the test to be exempt from quarantine.

Cars line up outside a drive-through COVID testing center in Modi'in, IsraelCredit: Tomer Appelbaum

“Just a few days ago, we were testing at a relatively low pace. But over the weekend we experienced a rise of several-hundred percent in people coming to antigen-test sites following the change in policy,” a source at Magen David Adom said. “We began trying to recruit more workers and volunteers on Thursday, adding testing sites and expanding operating hours. Yesterday [Saturday], we worked till midnight, as opposed to eight in the evening on previous days.”

The Health Ministry intends to expand the number of rapid-testing sites in the coming days, and is examining the possibility of administering tests in community HMO clinics, hospitals and elementary schools. “I hope that in the coming days we can already present a broader and more comprehensive deployment of the rapid tests,” a ministry source said.

In recent days, HMOs have had to recruit personnel to man more testing stations. However, sources at the HMOs call this effort wasteful and useless, saying it hinders their ability to provide ongoing health care that is not COVID-19 related. A health care official added that testing people who are not in risk adds an unnecessary burden to the whole system.

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