IDF contact tracing unit overwhelmed by recent outbreak — but improving

Though the rate of confirmed coronavirus cases per day continues to drop, the military is still painfully far from being able to perform contact tracing for all who get infected — and might be even if it were operating at full capacity.

In early August, the Israel Defense Forces was formally tasked with “cutting the chain of infections” for the country — finding and testing those suspected of having contracted the disease and putting them into quarantine. This included taking responsibility for the country’s testing efforts and conducting epidemiological surveys: the practice of speaking with confirmed carriers to retrace their steps in the days following their infection to identify and warn those they may have unwittingly passed the disease on to.

Public health experts have identified this type of contact tracing as crucial in curbing the spread of the virus, as it allows authorities to locate people who may have contracted the disease before they have a chance to pass it on.

After receiving the directive from the government, the IDF began bringing in conscripted soldiers and reservists to operate the contact tracing unit. At the time, the military’s goal was to be able to perform up to 2,000 surveys per day with just over 1,000 surveyors by November 1, when the IDF Home Front Command’s “Alon” coronavirus task force and its contact tracing unit were meant to be fully up and running.

But by September, the number of cases surpassed 2,000, exploding to over 9,000 earlier this month, well beyond even the wildest imaginings of the task force.

The infection rate has trended downward in recent days, following a national lockdown, bringing the number of daily cases to roughly 4,000 on Thursday. This is still beyond the current capabilities of the military, but it is closing in.

We are pushing back the fog

Since then, the Home Front Command has altered its goals, bringing in more people to act as surveyors. By November 1, the military plans to have over 2,000 soldiers performing contact tracing, at a rate of roughly two investigations per day, according to an officer from the unit, Lt. Col. Raviv Hadar.

Hadar said he received a call around the time the unit was being formed and was asked if he’d be interested in joining. He had no background in public health or epidemiology, having served most of his career in human resource-related units in the Israeli Navy, but nevertheless agreed to come in, seeing this as a form of “volunteering.”

Military officials often compare the fight against the coronavirus pandemic to a war. Asked who exactly was the enemy in the conflict, Hadar said it was “the unknown.”

“We are pushing back the fog,” he said, speaking to reporters at the Alon task force offices in the Home Front Command’s headquarters in Ramle.

Hadar said the unit was currently engaged in two simultaneous missions: conducting contact tracing with the personnel and systems currently at its disposal and building up its capabilities to their full potential by November 1.

The Israel Defense Forces’ coronavirus task force ‘Alon’ in its headquarters at the Home Front Command’s base in Ramle on September 9, 2020. (Israel Defense Forces)

In a fitting turn of events, the task force is currently operating out of what was once the Home Front Command’s simulator facility — a full building where the military would train local governments on how to respond to emergencies.

The Health Ministry and local governments are also assisting in this effort, with roughly 80 percent of the country’s municipalities employing at least some contact tracers, Hadar said.

According to Hadar, the “bottleneck” preventing an expansion of the epidemiological survey program is a shortage in the number of qualified nurses from the Health Ministry to train and supervise the military’s contact tracers.

As it is, he said, the military has already streamlined the training process down to one week and translated the originally English program into Hebrew to make it easier.

Though the military hopes to eventually be able to reach every confirmed carrier of the novel coronavirus, it is currently overwhelmed and forced to perform triage. According to Hadar, who has served in the unit almost since it was created in August, a few options were considered as a way to prioritize cases: focusing on the worst outbreaks; on areas where outbreaks were just beginning, to prevent them from getting worse; and on the most recent cases.

Israelis perform tests for the coronavirus at a Maccabi Test Center, in Ramle. October 5, 2020. (Yossi Aloni/FLASH90)

Ultimately, they settled on a “last in, first out” model, where the latest cases get contact tracing, and older cases are low priority.

“After four days or so the cases have already dispersed anyway,” Hadar said.

The contact tracers work in two eight-hour shifts, the first of which starts at about 9 a.m., with  the second ending at approximately 9 p.m. Though they operate seven days a week, they are mindful of whom they call on Shabbat, when most Jewish religiously observant people don’t answer the phone or use electricity.

Hadar said the unit hopes to make the effort more efficient going forward, with a more powerful data tracking system that is being designed by Military Intelligence’s famed Unit 8200. Going forward, for instance, those diagnosed with the disease will receive a text message with a questionnaire to start them thinking about where they have been and with whom they’ve been in contact before a surveyor calls them to complete the process. (According to Hadar, the questionnaire itself is insufficient. A trained person is required to ensure the accuracy of the answers.)

Even when the project is fully up and running next month, Hadar said it will be no replacement for “personal responsibility.”

“Don’t expect that the authorities will get to you because of a survey. If you hear that someone who you were close to tested positive, you have to go into quarantine in order to protect those around you. Get a referral and get tested,” he said.