Navigating Through the Obstacle Course of Israel’s Coronavirus Testing

Millions of lab tests go through Israel’s healthcare system every year – but coronavirus is subject to a labyrinthine process that makes costly mistakes almost inevitable

Magen David Adom staff outside the Nofim assisted living facility in Jerusalem after conducting tests on all 170 of its residents, March 26, 2020.
Emil Salman

Israel on lockdown saw serious confusion in the release of coronavirus test results over the weekend, forcing the Health Ministry to scrutinize its testing procedure.

In one case, a 14-year-old girl was informed that she’d tested positive even though she hadn’t been tested at all. Some test results were delayed by several, critical days, while others were incorrect; when that was discovered, the Health Ministry stopped notifying those who’d been tested and launched an investigation. It turns out the problem was not with the tests themselves, which are pretty accurate, but with the notification process, which malfunctioned.

Haaretz Weekly Ep. 72

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When one breaks down the testing process, that there was a foul-up is no surprise. During routine times, tests like these are done by health maintenance organizations, which do them well; some 100 million lab tests are performed each year. It’s a well—oiled, fully computerized process which is often completed the same day. It’s rare to hear of lost results or results being sent to the wrong person.

Coronavirus testing is a different process altogether. The test chain is much longer, and data entry is often done manually and not digitally, making the potential for error greater.

As of now, the task of taking the samples for coronavirus testing has been assigned to the Magen David Adom rescue service, which doesn’t usually get involved with lab tests. Most samples to date - 40,109 as of March 28 - were taken in people’s homes; another 11,000 were performed at drive-through centers set up in several cities. Drive-throughs have proven to be the best and most economical way to reach those people who can get to them; it saves an enormous amount of time (it takes 5 minutes to test someone, compared to 45 minutes with a home test) and money, which is sorely needed for expensive protective equipment.

During home tests, the person’s information is taken manually by MDA personnel. Samples then go to one of 27 labs that perform the tests. The lab enters the results into an electronic form and sends them to the Health Ministry. This means the ministry gets thousands of reports a day from 27 different places, some of them in different formats, which it enters into its own system, and then forwards the results to the correct HMO according to the person’s ID number. It is the HMO’s job to inform their member by phone of the test results. “The pipeline conveying the information has so many stops that it’s really a wonder the number of mistakes isn’t much higher,” a senior Health Ministry official says.

The Health Ministry has to cope with another challenge: Hundreds of people tested don’t belong to an HMO, including those without residency status, foreign workers, Israelis who rushed home from abroad after lengthy stays and whose HMO membership had lapsed, and prisoners.

This huge technological challenge is rife with problems, and given this weekend’s serious failure and the investigation that followed, the next step could be transferring all the responsibility to the HMOs, which do lab tests all the time.

Eliyahu Hershkovitz

Drive-throughs are likely to quickly become the main way of testing as all agree that they are the best and most economical way to reach those people who can get to them; it saves an enormous amount of time (a test takes 5 minutes, compared to 45 minutes at home) and money, which is sorely needed for expensive protective equipment.

The HMOs seem eager to take this on. “This is what we do,” sources there say. But getting organized for this will likely take time, since the labs must be prepared to process huge numbers of coronavirus tests.