Israeli medical-care officials say that the Institute for Biological Research in Nes Tziona, the only lab in Israel allowed to examine blood samples of anyone suspected of carrying Ebola, is taking too long to test people and generate diagnoses.
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The criticism arose recently after the institute apparently took two days to determine that the first suspected case of Ebola in Israel was a false alarm. Experts say that labs worldwide produce results much more quickly. For example, published reports say, the U.S. Centers for Disease Control in Atlanta is diagnosing the disease within eight hours. This is apparently the fastest turnaround time for reliable lab testing for the virus.
“I don’t know if we’re talking about logistical problems or other problems, but Israel needs a better and more transparent diagnostic procedure for the illness than it has today,” said an expert who is familiar with Ebola testing here and abroad. “There’s no reason why it should be any different than in the U.S.
“In the U.S. it takes much less time, and there are companies whose new techniques are pending approval that are able to conduct reliable tests for Ebola within minutes. The labs that the Chinese are setting up in the Ebola-stricken countries provide results within a day. Here in Israel these tests are being done in the highest-level microbiology labs in which people work with these kinds of materials regularly. There’s no reason in the world for it to take 48 hours.”
These medical experts say the Health Ministry has been apprised of the issue. The ministry would neither confirm nor deny that it had been approached about the matter, but in a statement it said that “Israel’s diagnostic capabilities are among the best in the world and are in line with [those of] international authorities.”
On September 5, a Nigerian tourist in her 20s was quarantined at Shaare Zedek Medical Center after she was suspected of being infected with Ebola. The woman, a health-care worker in Nigeria, had arrived here with a high fever.
Although Nigeria is not one of the Ebola-hit countries and the hospital saw only a small likelihood that she’d been infected, it took no chances. According to a hospital source, cultures from the tourist showed a blood infection. The biological institute’s results arrived the next day and negated the presence of Ebola in her blood, this person said. According to a different source, however, the Ebola-test results arrived Sunday, after the tourist had already been released.
Ebola testing is conducted using a method called polymerase chain reaction. “This is a complex process, but it’s done in Israeli labs to detect other viruses,” a person who works in laboratory diagnostics explained.
“You take the blood sample and put it through a lab procedure called nucleic acid extraction, which produces an extract that contains the patient’s genetic material, including the genetic material of the virus [RNA]. Afterward, a reaction is created that can uniquely identify the RNA of the Ebola virus. It’s a diagnostic procedure that is done all the time for other viruses.”
With Ebola the situation is different, primarily due to the risk involved in the sampling process itself. If a test result is positive, meaning the patient has Ebola, no further testing is necessary. But an initial negative result sometimes requires several repeat tests to fully rule out the presence of the virus, this person said.
Lack of transparency
The means and medical know-how to diagnose Ebola are available in Israel. The choice of the Institute for Biological Research for Ebola testing is unsurprising and in some respects is required since the virus is so deadly.
But the choice of the institute to do the testing comes at a price: an absence of transparency and a practical inability to oversee or intervene in what’s being done at the labs there.
The institute is subject to the direct authority of the Prime Minister’s Office, and critics have said that the absence of transparency on such a sensitive subject as Ebola is particularly conspicuous. Prime Minister Benjamin Netanyahu’s office didn’t return a call requesting comment.
“These arguments are not new or surprising,” said a person who is well acquainted with the relationship between the biological institute and the Health Ministry.
“The biological institute reports to the Prime Minister’s Office and has a monopoly on what are deemed ‘anomalous biological events,’” this person said. When substances are sent to the institute for testing, it becomes a “black box,” from which the staff does not feel an obligation to report to anyone else, the person said.
“Because they are connected to the defense establishment, it’s very hard for the civilian sector to obtain details from them,” he said. That’s particularly problematic, he said, when it comes to Ebola, which, rather than posing a security threat, involves a public-health problem on which various sectors have to coordinate their efforts.