Top hospital head to 'Post': Coronavirus strategy failed

'Health Ministry needs to rethink policy of isolation'

The Israeli Magen David Adom national emergency service at a coronavirus testing complex in Bnei Brak on April 1, 2020. (photo credit: YOSSI ZAMIR/FLASH90)
The Israeli Magen David Adom national emergency service at a coronavirus testing complex in Bnei Brak on April 1, 2020.
(photo credit: YOSSI ZAMIR/FLASH90)
The Health Ministry’s strategy for tackling the coronavirus crisis is a failure, the head of one of Israel’s leading hospitals told The Jerusalem Post on Sunday as the ministry announced it had fallen far below its original test target, leaving the country without an end in sight for its isolation strategy.
“We are in the third week of isolation and the numbers continue to rise – and in big numbers,” the senior official said. “We need to think about another strategy. Isolation has not brought us any good.”
The official, one of the most experienced members of Israel’s health system, told the Post that the Health Ministry had “wasted thousands of coronavirus tests doing irrelevant checks” on people who have symptoms of COVID-19 (coughing, fever or respiratory distress) but are already in isolation.
His words echoed what Prof. Zeev Rotstein, head of Hadassah-University Medical Center said at a meeting of the Knesset’s Coronavirus Committee on Sunday, according to which anyone in isolation, who came from abroad or was in contact with a known patient, should be defined as a patient even without a test. During the meeting, Rotstein clashed with Health Ministry deputy director-general Itamar Grotto about the failure to increase the number of tests.
If a member of a household is sick with coronavirus, then the entire family should be considered sick and enter isolation, Rotstein said. That way, he added, you can be sure that they do not spread the disease.
“You don’t need to prove anything,” Rotstein said.
Until now, the health official told the Post, the ministry has focused on testing people most likely to be infected. If the goal is to get the maximum number of positive results, he said, this is a good policy. But, “if the target is to stop the spread of the epidemic and open the economy,” then Israel needs to test more widely and develop a picture of how many cases there are across the country and where they are concentrated.
“You create two maps,” he said. “One is a green map, where there is no disease. The second one is a red map – or one that has the potential of becoming red. You take measures in these red spots to isolate the sick people.”
In this model, the country enforces closures on cities or neighborhoods where the disease is more widely spread, while maintaining safe but open procedures in other localities, that include wearing masks and maintaining safe social-distancing standards.
“But you need to base these decisions on information – and that information comes from a lot of testing, which the country has not done,” he said. “This is the number one failure of the Health Ministry’s system.”
The ministry said Friday that there is a nationwide shortage of reagents, the chemical compound needed for tests. According to new guidelines a test will only be administered if a person has a temperature above 38°C, a cough, difficulty breathing or any other respiratory symptom that corresponds to the virus – and has also spent time abroad or in the Palestinian territories in the 14 days prior to the onset of symptoms.
In addition, for asymptomatic cases, people are only eligible to be tested if they have stayed in the vicinity of a confirmed coronavirus patient for over 15 minutes or have returned from a country with a high rate of infections.
While the government had set 30,000 tests a day as its target, last Thursday, only 7,294 tests were performed, even less than the day prior when 7,833 people were screened.
"To date, 103,000 tests have been performed in Israel," Grotto said. "The rate of tests in Israel, contrary to popular belief, is among the highest in the world.”
Grotto said the country still hoped to get to reach 10,000 people screened per day by next week and then continue to grow, but admitted that, “there is an arms race around the world trying to secure the materials for these test kits."
He said that the Health Ministry had ordered reagents, but "the orders fell through because the source state or supplier decided that they would not supply us,” he said. “There is nothing to do but rely on ourselves. We are currently in the final stages of the experiment to make sure it works. We will know in the next few hours."
He also referred to a delay in receiving additional test kits from a Chinese company, explaining that the ministry was ready to sign but had heard about some challenges with Chinese testing sets and wanted to confirm their quality.
Still, Grotto insisted that even if testing was increased, “we have no intention or ability to open the economy the day after Passover. I did not recommend it… Even if we can do a million tests a day, it will not help free the economy. We should not be betting on testing taking us out of this crisis.”
Rotstein told the MKs that he disagreed. He explained about two testing experiments he conducted, one in which he tested 1,200 people who work in a government company, which like all others has been scaled back to 15% of its workers. The test showed that only one person tested positive for the virus and the rest were healthy. That one person was sent into isolation.
“This company should not be working at 15% but at 150%,” he said. “Why stop them? We need to produce national products. Without them, we will not be able to support the medical system. If we continue another month, there will be no money to reactivate the country’s economy.”
In a second experiment, Rotstein tested nearly 2,000 medical staff that work at Hadassah Hospital. He found that 30 people tested positive but were asymptomatic or had limited symptoms. These are people who are on the frontlines. He immediately put those who tested positive into isolation.
By testing his staff, Rotstein said he can ensure that he keeps sick people home and healthy people at work.
Gabi Barbash, a former director general of the Health Ministry, told the Post that “every time a different issue is popping up” for why the Health Ministry cannot conduct more tests. First it was the swabs, then it was test tubes and now it is the reagents.
“There was not enough planning,” he said, noting that two months ago all the needed test kit components were available whereas now they are indeed in scarce and competitive supply. “This has damaged our capability to understand the situation and have a clear picture of what we are fighting, where we are fighting it and to what extent the enemy is there.”