Policy responses for Israel - HSRM


Policy responses for Israel

1.5 Testing

Eligibility - Testing for COVID-19 is made available for symptomatic individuals who: (1) had close contact or (2) were in touch with, or in the same place as, a diagnosed patient, or (3) had arrived from abroad in the past 14 days, or (4) were in a severe health condition. Moreover, some hospitals have started testing their staff on a periodical base.

The eligibility criteria evolved with the spread of COVID-19: In early February, it was granted to symptomatic individuals returning from China, and then expanded to other risk areas such as Italy, as these were identified. When the spread of the virus began being domestic and not only from imported cases, the eligibility was further extended to include symptomatic individuals who were in touch with diagnosed cases.

Collection – the sample collection strategy also evolved according to the stage of the pandemic. In the initial phase of containment, eligible individuals were instructed to self-isolate at home until a paramedic from MDA or a trained medical student was sent to perform the test. But from the mitigation phase, and since March 17, 4 “drive-through” test stations were launched in each of the 4 metropolitan areas and these serve self-isolated individuals who reported symptoms of COVID-19. Symptomatic passengers returning from abroad are tested at the airport by MDA. As of March 24, around 5,000 tests for COVID-19 are being done per day, with plans to increase that rate significantly. In a similar timing, health plans (HPs) started to collect and perform the tests in the community.

Diagnosis testing and labs - At the beginning of the outbreak only four labs had the proper equipment (PCR devices) to perform COVID-19 tests. Since mid-March, the MoH has worked to increase the capacity of tests/day - e.g. it purchased new devices, trained and habilitated other existing laboratories, and recruited and trained lab workers to perform the tests. As of March 17, there were 17 labs authorized by the MoH to preform SRA-COVID-19 diagnosis. In addition, the HPs and some hospitals adapted their own labs to perform the tests and increase the screening capacity.

Tests are performed also for migrants and uninsured populations.
• The number of tests performed per day has increased from 466 on March 13 to 782 on April 4th. As of the 5th of April, a total of 12,000 tests per million people were performed.
• Nevertheless, there has been shortage of resources for testing (mainly lack of reagents) and testing facilities are not working on full capacity.
Testing in homes for the elderly became high priority, due to several outbreaks and public outcry.

Migrant populations:

Documented/Insured labor migrants can seek testing through their private health insurance. Yet, a variety of barriers exists such as fear of losing their job, stigma and distance, time and language.
For the three other groups (undocumented migrants, refugees, tourists with expired visa), there are little options for testing. Since 9.3.2020, free of charge testing is offered in one facility in South Tel Aviv. Uptake among undocumented migrants has been low (90 persons during the first three days). Reasons are, inter alia, fears of (assumed) costs and of personal information getting shared with the Ministry of Interior for the purpose of immigration law enforcement.

16.4.2020 Following a slump in COVID-19 test results, the number of COVID-19 test results has risen to 11,285 (as of 16.04.2020). This is up from an average of 8,087 COVID-19 tests results in the prior 7 days (MJB Institute analysis based on MoH data, link to data: https://data.gov.il/dataset/covid-19)

MJB Institute analysis based on MoH data, link to data: https://data.gov.il/dataset/covid-19
MoH Report No. 177760220

Changes in testing policy due to a second outbreak of COVID-19 in schools

About two weeks after the reopening of the entire educational system on May 18th, there have been several outbreaks of COVID-19 infection in schools all over the country. Infected individuals are majorly secondary school pupils and teachers. As per June 3rd, there are about 240 active cases, and 10,000 individuals quarantined.

The government has attempted to avoid these outbreaks to become a second wave of epidemic, through fast tracking of potential cases and immediate quarantine.
In order to speed up and improve this tracing, the new elected Minister of Health ordered on May 1st, to change the testing eligibility policy, as to include also asymptomatic individuals that were in close contact with a confirmed case. Until that day only symptomatic individuals were eligible for testing. Now, if a confirmed case is found in a school, all pupils, teachers and their families are tested and sent to quarantine.

Since May 1st anyone who meets one of these conditions is tested:

1. Household members of a confirmed case, including asymptomatic ones. They should be tested on the same day as the symptomatic case is confirmed and again after 5 days, for verification.

2. Individuals without symptoms who have been in close contact with a confirmed case in schools (in the same class, in the same vehicle and in some cases the entire school.

3. People without symptoms who have been in close contact with a confirmed case in institutional housing settings such as long-term care institutions, sheltered housing, nursing wards, welfare institutions.

4. Anyone with a referral from a physician, at the discretion of the attending physician.

5. All special populations in accordance with the instructions of the Ministry of Health in special cases.

6. Any person with symptoms who was in close contact with a verified patient.
Symptoms are: fever, cough, loss of taste.
‘Close contact’ means: Less than 2 meters apart, for at least 15 minutes.

7. Anyone with symptoms who visit a hospital.

Testing policy for illegal immigrants:

Foreign workers without a visa are not eligible to the National Health Insurance and therefore cannot be examined at MDA's regular health test stations. In April some hospitals established mobile testing posts for this population. Tests as performed free of charge for individuals without a formal visa or residence permit.