30,000 coronavirus tests per day: Too little, too much, too late?

Is taking so many tests ideal? Will it help curtail the spread of the virus or let Israelis out of isolation?

By MAAYAN JAFFE-HOFFMAN
TEST TUBE with coronavirus label is seen at the end of January. (photo credit: REUTERS)
TEST TUBE with coronavirus label is seen at the end of January.
(photo credit: REUTERS)
Within the next two weeks, Israel is expected to increase daily testing for the coronavirus to as many as 30,000 people per day. The move comes 10 days after Magen David Adom medical director Refael Strugo told The Jerusalem Post that Defense Minister Naftali Bennett’s aim to carry out 30,000 coronavirus tests per day was “extreme and likely unrealistic.”
Is taking so many tests ideal? Will it help curtail the spread of the virus or let Israelis out of isolation?
And why did it take us so long to get here?
“There is no magic number,” said Prof. Jacob Moran-Gilad of the Faculty of Health Sciences at Ben-Gurion University of the Negev. But he explained that whereas screening is important for data gathering, isolation is what will control the spread of the coronavirus.
“The way you stop the spread of the disease is isolation,” Strugo also told the Post. “The number of tests you do can give you an idea of how much the disease has spread throughout the community and can tell you if we are reaching the peak, reaching the plateau, starting to get to the point of crisis.”
For most of late February and March, Israel tested around 750 to 1,000 people per day. In recent weeks it increased to 2,000 then 3,000 and lately as many as 6,000 tests per day. For perspective, South Korea, a country that is considered a model for how to “flatten the curve,” tests around 15,000 people per day and has a population around five times larger than Israel’s.
Flattening the curve prevents a sharp peak of cases and spreads out those infected over a longer period of time.
Moran-Gilad said the country should not rely on testing in any phase nor would it benefit from testing “asymptomatic people just randomly. The testing strategy needs to be well thought out.” But he said the tests will provide data that has been missing up until now and “making decisions blindly without hard data is also not optimal.”
Bennett, however, believes he released this strategy on Sunday. In a detailed report he claimed that by establishing an extensive testing system to identify those with the virus and carrying out 30,000 to 50,000 tests per day on a regular basis Israel will be able to “reopen schools and businesses... Life will return to normal. People will return to work” because “we will not be blind.”
Those who test positive will immediately be sent to a quarantine hotel and their family members, colleagues and friends will be tested too.
It’s logical, Moran-Gilad said, that testing will become “more important” in the next phase of the coronavirus crisis, when Israel wants to lift some of its restrictions. It is unlikely that these tests will change anything for Israelis in the present.
“The strategy in the next phase could be to rely more heavily on tests to monitor the situation,” he said.
Jonathan Gershoni, a professor of immunology and virology at Tel Aviv University, seems to agree. He told the Post in a previous interview that testing could be a meaningful tool in controlling the spread of the virus in Israel.
“In general, when a person is infected with a virus, a test is conducted to be able to diagnose what the person is suffering from and to be able to better implement a good therapeutic treatment,” he said.
In contrast, in the case of the pandemic coronavirus, there are additional goals to testing.
First, about 80% of people infected by SARS-CoV2 (coronavirus) tend to develop mild disease and many don’t have any symptoms at all, so they are carrying the virus without knowing that they are infected. Nonetheless, they are contagious and can contribute to spreading the disease to other people.
Additionally, said Gershoni, “it seems to be a stubborn virus, that people who are infected and have symptoms and then recover and feel great, are still shedding the virus and thus can potentially continue to be contagious.”
This, he said, is why we see only 132 people recovered from the virus and the number of infected continuing to grow. And what that means is that a person could feel great, but from a public health perspective, this person still poses a danger.
“If you identify people who are asymptomatic and don’t realize they are ill, and you make them aware of their disease status, this is a very important factor,” he said, noting that it may also give the general public some degree of confidence and less anxiety about where the country stands in its battle against coronavirus.”
So, if more is better – regardless of how many more – why did it take so long to increase the number of tests?
“We all believe it took too long,” Moran-Gilad said of the work of the Health Ministry. “At certain points things were sluggish, but I see now that the message has been received and the process is rapidly improving.”
In other words, he said, in late February, when coronavirus first came to Israel, the vast majority of cases were imported and “I am confident the majority of those cases were captured.” However, as more members of the general population started contracting the virus, it would have been helpful to start screening more widely.
But Israel likely did not have capacity to increase testing so fast.
According to Prof. Cyrille Cohen, vice dean of the Faculty of Life Sciences at Bar-Ilan University and head of a laboratory of immunotherapy, there was a shortage of test kits, not enough machines to read test results, a deficit of staff trained to take the tests and work in the laboratories. And, of course, there were not enough laboratories.
“You need manpower,” he said. “You need test kits. It is very complicated.”
In recent weeks, the Health Ministry, Defense Ministry, Home Front Command, Mossad and Magen David Adom have all worked in various capacities to change this reality.
Said Moran-Gilad: “Even though there have been bumps along the way, I think the country is moving in the right direction.”