As Serious Cases Swell, Israel's COVID Contact-tracing Can't Keep Up

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Man gets tested for COVIF-19 in Haifa, yesterday.
Man gets tested for COVIF-19 in Haifa, yesterday.Credit: rami shllush

The latest surge in the number of coronavirus patients has caught the Home Front Command’s contact-tracing center on the verge of shutting down, and its reduced staff can’t keep on top of all the new cases.

Moreover, some health care experts say the effort may be pointless given the volume of cases and their geographic spread.

Experts explain: If most Israelis are vaccinated, why is COVID surging?

Israel saw a drop in new coronavirus cases Saturday, with Sunday’s Health Ministry data revealing 2,886 new cases. Serious cases rose to 348 on Saturday, 19 more than the previous day. 

Some 5.8 million Israelis have received at least one coronavirus vaccine. Of them, 422,326 have received three doses as part of the new campaign to give booster shots to the elderly and other vulnerable people.

In late May, when new daily cases were very low, Defense Minister Benny Gantz and military chief Aviv Kochavi decided to close the army’s contact-tracing center, known as Alon. Responsibility for the job would be transferred to the Health Ministry.

The planned closure date was August 1, and Alon began preparing accordingly. But a few weeks later, the preparations were halted due to the renewed rise in cases.

At its peak, Alon had around 3,000 contact tracers capable of carrying out 6,000 epidemiological investigations a day. Today, its staff is smaller by several hundred people.

Consequently, though a combined 10,000 new cases were diagnosed over the three days from Thursday through Saturday, only 4,000 epidemiological investigations were conducted. More than 6,000 patients haven’t been questioned at all. And Alon’s effectiveness only declines as the number of cases grows.

The center has therefore decided to focus on high-risk people and those returning from abroad.

Contact tracers have been told to finish questioning patients 60 and older within 24 hours, and in fact epidemiological investigations have been completed in almost 90 percent of such cases over the last three days: 1,285 out of 1,429.

But the success rate has been lower among people returning from abroad. Alon identified 475 such patients on Thursday through Saturday, but finished questioning only 302, or 64 percent.

After these two groups, the next priorities are residents and employees of nursing homes, assisted living facilities and geriatric hospitals. They are supposed to be questioned within 48 hours, and Alon met this goal in 77 percent of cases over the last three days – 75 out of 97.

Everyone else is classified as a lower priority, meaning they are supposed to be questioned within 72 hours. But Alon is far from meeting that goal. Out of 8,025 new cases over the last three days, only 2,523, or 31 percent, have been fully traced.

Every week, the number of cases is growing by a factor of 1.38, and that number is only expected to rise. To keep on top of this caseload, Alon would need at least twice as many contact tracers as it has today. But recruiting and training more staff would be a slow process even if didn’t first require approval from several government ministries.

“To meet the targets, we need people,” a senior health official said. “But things work very slowly, with a lot of bureaucracy. So we’re doing what we can.”

Unlike during previous waves of the virus, today vaccinated people aren’t required to quarantine after exposure to a carrier. Moreover, contact tracers often make do with notifying people that they were in contact with a patient, and sometimes even leave this job to the patients themselves.

Consequently, it’s impossible to know how many people exposed to carriers have actually quarantined, or were even informed of their exposure.

Contact tracing has long been defined as a vital element of containing the virus. But Alon has never been effective once the number of cases exceeds a certain threshold and spreads to different areas of the country, because at that point the system starts drowning in data.

Consequently, health care experts are divided over how much of a contribution the system can actually make in a situation like the current one.

“The Health Ministry never held a thorough discussion about the system’s goals in principle and the question of whether it’s an effective tool in such a widespread outbreak,” one senior public health expert said. There are differences of opinion about this, he added, and many experts say that at this stage, contact tracing has become pointless.

“It’s an effective tool at the beginning of an outbreak, when you’re trying to contain it and delay its spread, but that’s not the situation right now,” he said.

“We’re at a morbidity level where countless sick people are walking around outside. Many aren’t required to quarantine, and others are required to but don’t obey the regulations. In the current situation, the benefits of this entire process are extremely limited.”

He even questioned the point of contact tracing on people returning from abroad, saying this isn’t necessarily useful in discovering new variants. Discovering such variants requires a broader analysis and can take weeks, he said.

“In this situation, contact tracing should focus on places where it will be much more beneficial,” he added – mainly residents and employees of geriatric institutions. But for Alon, these are only secondary priorities.

The IDF Spokesperson’s Unit said Alon had adjusted its staffing levels “in accordance with the situation assessment and at the Health Ministry’s request.” When incidence of the virus began rising again, Alon requested additional staffing and funding so it could keep up with the number of cases.

Alon’s method for prioritizing cases was decided by the Health Ministry, the unit said, adding that in recent days it has conducted epidemiological investigations on 77 percent of those defined as high priority.

Alon “invests all the staffing and resources at its disposal in trying to make contact with all verified patients,” the statement concluded.

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