Speaking on Channel 12 news on Sunday, the director general of Magen David Adom emergency medical services announced that there will be no more testing for the coronavirus in the Arab community if the criteria aren’t changed. This surprising statement only intensified our fears that the number of those infected in the Arab community is far higher than what has been reported until now, but there is no information because there are no tests.
There are 38 patients diagnosed in Arab communities (according to figures published on March 27). Arabs constitute 20 percent of Israel’s population, and in addition are an at-risk population, due to the high percentage of those suffering from chronic illnesses, and to the crowded living conditions and problematic socioeconomic situation.
Therefore, according to a very rough calculation, there should be at least 800 Arabs now suffering from the coronavirus. And if there are six carriers for every diagnosed patient, we are talking about approximately 4,800 patients and carriers in Arab communities who are likely to infect others without being aware of it. At present the 38 patients comprise less than 1 percent of all those infected. That is a very low percentage, which contradicts the claims of the Health Ministry director general (on March 27) about Arab violations of home quarantine directives.
An in-depth examination seems to indicate that the presumably low morbidity in the Arab communities does in fact stem from absence of testing there. According to various reports, Magen David Adom reaches the Arab communities infrequently, and lacks a good infrastructure there. Emergency services in Arab communities are usually provided by private companies, which operate about 600 ambulances. The employees of these companies have not been trained by MDA to administer coronavirus tests, and the ambulance drivers have not been trained to evacuate coronavirus patients from the communities to hospitals, which are usually distant.
If there is a serious outbreak of the virus in the Arab communities, there will be no way of transferring patients in a protected manner without the risk of infecting others.
At the time of writing not a single drive-through station for coronavirus tests has been set up in Arab communities. The original plan for the drive-through points included seven Jewish communities, and not a single Arab one. Therefore, information about the drive-through plan was published only in Hebrew. The Arabs didn’t hear about these points on time, and due to the distance and the information delay, only a small number of Arabs asked to be tested in the Jewish communities. The paucity of requests led to a decision not to establish drive-through points in Arab communities. Only after the intervention of Arab members of Knesset was a promise made to set them up, but this is being delayed.
Arabs serving on medical teams − doctors, nurses, caregivers, laboratory workers and others − are now at the forefront of the war against the coronavirus in Israel’s hospitals, but they cannot be at ease about the level of protection of their families from the virus.
The health maintenance organizations have decided to establish initial coronavirus clinics, which treat patients in the community, and other clinics are testing people who show symptoms of the illness. But in the Arab communities there are very few such clinics. Clalit Medical Services, to which more than half of the Arabs who are insured belong, prepared only one clinic, compared to 45 in Jewish communities. Moreover, very few clinics have been prepared to test patients who are suffering from symptoms of the illness.
That raises a big question mark regarding the Health Ministry’s handling of the coronavirus crisis in Arab society. After the first coronavirus patient was discovered, in February, an emergency team was set up to handle the crisis. This team is in charge of planning the national emergency program, which includes crucial steps for diagnosing and treating coronavirus patients whose condition worsens. They include preparing hospitals, quarantining patients and carriers, testing, and a gradual stoppage of economy activity, like closing cafes and restaurants, and discontinuing work in places that are not vital for the economy, a well as studies in universities and schools.
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But this team in charge of the emergency program does not include a single Arab expert who could explain the unique nature of Arab society when it comes to handling the coronavirus crisis. The emergency infrastructures in Israel’s Jewish communities are based for the most part on security emergencies, with little infrastructure for civilian emergencies. That puts the Arab communities in an inferior position in terms of their ability to deal with the virus.
Therefore, immediately with the outbreak of the crisis, it was vital to set up an emergency team for the fight against the coronavirus in Arab communities, but this did not happen. What’s more, the Health Ministry refrained from meeting with the Arab national health committee, which was established by professionals (doctors, nurses, researchers of public health and other health-related fields) in order to help in the war against the virus in these communities.
The committee’s staff worked from the start of the crisis to make the information about the coronavirus and the importance of quarantine available in Arabic. But the Health Ministry information in Arabic failed to arrive, or was delayed, and when it did come, it was worded in incorrect Arabic, which caused a lack of trust. That created a delay in the arrival of authorized information to the Arab communities, and in its internalization. The lack of trust only intensified the panic.
Today the illness is harshly stigmatized in Arab society, and people treat patients like lepers. This situation could have been avoided had the information come on time and in a rational manner, from experts in the Arab community, immediately at the start of the outbreak in Israel.
In terms of public health, due to the present situation the Arab communities are likely to become epicenters of the coronavirus outbreak, which will threaten the health of the entire population.
Even in the separate Arab communities (and there are quite a few cities with mixed Arab-Jewish populations) it won’t be easy to isolate many of the people, because they include some who are vital to the health care system and to other Israeli institutions. Policymakers and the emergency team must understand that there can be no end to the coronavirus crisis without serious intervention addressing the needs of about one fifth of the population.
There must be a significant increase in the number of tests in Arab communities, and the private companies’ emergency workers must be trained so that they can evacuate patients when necessary. Initial clinics should already be prepared for receiving and treating coronavirus patients, who will probably arrive en masse; the hospitals in Nazareth should be reinforced and provided with the necessary equipment to treat the patients, and of course there must be a suitable streaming of information.
That can be done in a special media campaign. All of these steps could help to reduce the spread of the illness in both Arab and Jewish communities, and to contribute to a better exit strategy from the coronavirus crisis.
Dr. Daoud is a senior public health lecturer at Ben Gurion University of the Negev.