Delays, inefficiency mar Israel’s response to coronavirus – comptroller
The State Comptroller’s Report details problems in the government’s handling of the coronavirus outbreak on a number of fronts.
By HANNAH BROWNIchilov Medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, July 28, 2020.(photo credit: YOSSI ALONI/FLASH90)
The State Comptroller’s Report, which was released on Monday afternoon, concludes that the Health Ministry’s handling of the coronavirus crisis has been inefficient and disorganized, particularly in terms of how long it has taken to get test results and its epidemiological tracking, which often takes four days to get started.It also offers suggestions for how to cope with many issues and to get the virus under control.It also pointed to a lack of cooperation among various branches of the government, including the Education Ministry, in terms of informing people of the need to go into quarantine; the management of the elderly in institutions, where a disproportionate number of deaths occurred; issues concerned with community medicine and flu vaccines, which is a serious public health issue in any year, but which are especially critical during the pandemic, when, if people become ill with the flu in addition to the coronavirus, they are more likely to become seriously ill and possibly die; and bureaucratic red tape the hurts the unemployed.A recurrent problem throughout the pandemic has been delays in getting patients their test results and questioning them about their contacts, two actions that have been found in repeated studies all over the world to be a key factor in reducing the spread of the virus. The report found that there is a “gap between the Health Ministry’s planning and the capacity of the HMO laboratories” to carry out testing. It noted that 74% of subjects receive test results more than 36 hours after the test referral and 33% receive their results more than 72 hours after the referral.It also found that the Health Ministry purchased 2.4 million kits for serological tests at a total of NIS 112 million, but that the ministry plans to perform only 300,000 serological tests and has no plans to use the remaining 2.1 million tests. In practice, by the time the report was written, 250,000 kits for serological tests had been brought to Israel but only 60,000 had actually been performed.The report recommends that the Health Ministry work directly with labs rather than the HMOs to make sure tests are carried out. It also recommends that the Health Ministry take a serious look at the delays in receiving test results and make a thorough investigation to clear up these delays.In terms of the epidemiological research into those who test positive, the report noted that there is only one researcher in Israel per 9,000 residents, compared to one in 4,000 in Germany and one in 2,200 in England. The State Comptroller’s office looked at 76 epidemiological studies of positive patients and found that 64% of them began four days after the patient tested positive, even though the most effective time to perform these studies is found to be 24-48 hours after the patient is diagnosed. Out of these 76 cases, in 22 of them, only the family of the patient was investigated and in four, no contacts were recorded at all.From July-August 2020, in many of the districts where epidemiological research was done, the results were recorded manually, using forms. Even when the information was entered into a computer, it was often done by entering free text, rather than filling out a form where the results could be searched efficiently. It also found that efforts were often duplicated, and that the same family members were sometimes questioned by different investigators. The Health Ministry epidemiologists did not coordinate with the Education Ministry to warn pupils and staff of exposure to the coronavirus.The report found “no effective system for quality management of the epidemiological investigation system.” It found that the merger with Alon Headquarters was a positive development, but noted that the collaboration with Alon was expected to be fully operational only in the beginning of November. The report strongly recommended a review of all testing and investigations.THE DEFICIENCIES the report points to in the treatment of the elderly during the coronavirus crisis are particularly troubling. Although elderly people living in institutional settings make up less than 1% of the population, they accounted for 36% of all coronavirus deaths, the report says. It found serious flaws in the testing of workers in these institutions. Another issue is that senior citizens with the virus were often hospitalized in regular hospitals although they might have received better, more targeted care in geriatric hospitals.
In the realm of community medicine, the report finds that the Health Ministry did not “work to formulate the best course of action that would reduce the public’s reluctance to visit community clinics, outpatient clinics in hospitals and emergency rooms when necessary and alleviate the concerns of caregivers who service patients there.”While there was an increase in remote medicine during the pandemic, the report finds that there was “no training according to medical guidelines” to allow healthcare providers to assess which patients were most suitable for remote medical care. The medical establishment did little to ensure that populations with “low digital literacy,” such as the elderly, had access to remote treatment.The State Comptroller’s Office recommends that the Health Ministry and the health funds formulate an “orderly vaccination plan,” which will make sure medical personnel and populations at particular risk from the flu are able to get vaccinated. It found that an extremely low number of healthcare workers, only 36%-47%, were vaccinated during the winters of 2018/2019 and 2019/2020 and suggests that the Health Ministry examine “tools used elsewhere in the world” to bring the rate up to 85%-90%. It also said that as of the date of the writing of the report, the Health Ministry had not completed plans for the administration of the 3.4 million vaccinations it had ordered, particularly how to get the vaccines to the populations that most need protection from the flu.The report found many inefficient practices in processing unemployment claims and recommends that grants be given to those who have been laid off and are now taking lower-paying work. The payment of such grants encourages people to stay in the workforce, the report notes, but these grants are rarely paid because the red tape makes them difficult to apply for. It also addressed the fact that independent workers have faced delays and lack of support from the Tax Authority when trying to find out for which aid they are eligible.
