PCR or Antigen, and What About the Unvaxxed: Israel’s New COVID Testing Rules, Explained

With Israel's testing facilities overwhelmed due to omicron outbreak, the Health Ministry has decided to change the rules: Who can get a PCR test and how long will they have to go into quarantine?

Ido Efrati
Ido Efrati
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PCR or antigen, and what about the unvaxxed: Israel’s new COVID testing rules, explained
PCR or antigen, and what about the unvaxxed: Israel’s new COVID testing rules, explainedCredit: Sarah Reingewirtz /AP
Ido Efrati
Ido Efrati

The Health Ministry announced changes to its COVID testing requirements on Wednesday due to the large increase in the number of tests over the past few days and the realization that the health system cannot continue to conduct and analyze so many daily PCR tests. Under the new guidelines, which go into effect on Friday, certain types of tests are to be earmarked for specific groups of people.

Who will continue to undergo a PCR test?

PCR tests are the most accurate for diagnosing COVID. The Health Ministry will now give them only to people aged 60 and up and people who are at risk, whether they have been vaccinated or not. A person who tests positive in a PCR test will be classified as being infected with the virus and will be required to go into isolation for 10 days, and will be released from isolation only with the approval of a doctor – without any need for another test.

The country’s coronavirus czar, Prof. Salman Zarka, clarified on Wednesday that the Health Ministry is still in the process of formulating the criteria for defining at-risk groups.

What will those who have been vaccinated or have recovered from COVID do?

Those who have been vaccinated or have recovered from COVID and were exposed to confirmed COVID patients can now, for the first time, take a rapid home test. Last week, the Health Ministry allowed those who are vaccinated to take a rapid antigen test under supervision – in other words, a test conducted by an approved organization, such as the Magen David Adom ambulance service or the “Well” service from Ichilov Hospital in Tel Aviv. If the result is negative, they can then continue on with their normal lives. The ministry will decide on Wednesday whether to allow those who are vaccinated or have recovered to take a rapid test on their own at home, without any outside supervision.

Another change is that from now on, a COVID infection can be officially diagnosed with a home test. In such a case, those who have been vaccinated or recovered and receive a positive result on a home test will need to go into isolation for 10 days. This means the government will no longer know how many people have been infected or diagnosed on any given day, but at the same time, it will not recognize these people diagnosed by a home test as having COVID. A person who has been vaccinated or recovered and has been diagnosed as having COVID by a home test – and wants their illness to be officially recognized, will have to undergo a supervised test.

A coronavirus testing center in Netanya. Credit: Amir Levy

Health Minister Nitzan Horowitz said the changes will “save a lot of people from waiting in line and will provide a solution for the overloaded testing stations.” The head of public health services in the Health Ministry, Dr. Sharon Alroy-Preis, explained in a press conference that the decision to use the rapid antigen tests as a diagnostic tool was “a very significant change, and it will take a few days until it works.”

Who will pay for the home tests?

Zarka said the government will not pay for the home tests, and anyone who is vaccinated or has recovered from COVID who wants to be tested will have to do so at their own expense. Horowitz said the supervised tests are provided for free, but doing the tests at home will save people time and travel expenses to the testing sites.

What will unvaccinated people do?

Until now, unvaccinated people were required to take a PCR test if they were exposed to a confirmed COVID patient. Now they can take a supervised test to diagnose if they are infected. These tests were not free for people who are eligible to be vaccinated, and starting last week the government began subsidizing these tests for vaccinated people who were exposed to a confirmed COVID patient. Now the unvaccinated can also take the supervised tests at the government’s expense.

If the test comes out negative, the unvaccinated will have to spend seven days in isolation. If the result is positive for the virus, they will have to isolate for 10 days – after which they can end the isolation with a doctor’s approval, but without having to take an additional test.

The line at a COVID testing center in Tel Aviv this week. Credit: Tomer Appelbaum

What will people already in isolation have to do?

Those who are not vaccinated and recently entered isolation are supposed to take a second PCR test on the seventh day after they were exposed in order to leave isolation. But the new policies will take effect on Friday – so those who need to take a second test after Friday will take a supervised rapid antigen test.

Why were these changes made?

Since the outbreak and spread of the omicron variant of the virus, the number of daily COVID tests climbed to new heights. For example, on Tuesday, 200,000 PCR tests and 60,000 supervised rapid antigen tests were carried out. The day before, a total of almost 300,000 PCR and rapid tests were conducted.

The organizations doing the testing are finding it difficult to keep up with the demand, which has led to very long lines at testing centers. In addition, the PCR tests are based on a large and expensive system that includes transporting the samples to the labs – and a large number of staff, equipment and materials for testing. The labs are also finding it hard to keep up with the pace, and waiting times for receiving the test results are growing longer. This has created a bottleneck that could endanger patients in at-risk groups, who could receive life-saving drug treatments if they are diagnosed immediately.

How does a rapid antigen test work?

The rapid antigen tests identify the presence of the coronavirus’ spike protein by testing a sample taken with a swab from the person’s nose. After the sample is taken, the swab is then placed in a test tube containing a liquid – and then a few drops of this liquid are dripped onto the appropriate place on the test. It is important to follow the accompanying instructions carefully.

The sampling liquid will spread after it is dripped onto the test, and in case of COVID infection two stripes will appear. One line is marked with the letter “C,” which is for the word “Control.” This stripe is supposed to always appear on the test and signals that the test is working. If this line does not appear, then it is a sign of a problem with the test and indicates that it is unreliable.

The second stripe is marked with the letter “T,” for “Test.” If this line appears, it means the test is positive and signs of the virus are present in the patient’s respiratory tract.

How reliable are the rapid antigen tests?

The rapid antigen tests are less reliable than the PCR tests – and they are more effective among those infected and those showing symptoms of COVID – who have a higher viral load. Ilana Gans, a senior public health services official in the Ministry of Health, told the Knesset this week that the rapid antigen test is “less sensitive for an asymptomatic patient.”

The test’s sensitivity in the case of asymptomatic infections is 65 percent. But conducting a number of frequent rapid tests could compensate for the lower sensitivity. Gans said a person who receives a positive test result from a rapid antigen test will also receive a positive PCR test result – with a certainty of about 95 percent.

What about taking a test to receive a Green Passport?

No changes here. People who do not have a vaccination or who have one that has expired are still required to take a supervised rapid test and receive a negative result in order to participate in activities requiring a Green Passport.

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