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Top Israeli Health Ministry officials ignored other experts’ Coronavirus advice, medical sources say

Prior to March, few Israelis knew the name of Israel’s director of public health services or even that such a job existed. It was the coronavirus pandemic that made Prof. Siegal Sadetzki a public figure. She was front and center at news conferences in March and April, alongside Prime Minister Benjamin Netanyahu and Health Ministry director-general Moshe Bar Siman Tov.

Sadetzki famously stuck by her policy of “no” – meaning no relaxing lockdown restrictions and no to stepped up testing for the virus.

Initially, she presented the public with a nightmare scenario – that unless major restrictions were imposed, within a few months the country’s hospitals would collapse under the weight of coronavirus cases – with 15,000 people in intensive care, 5,000 of whom would be on ventilators.

The policy of the stick with no carrot and the projected horror scenario angered a panicked public, and drew criticism from medical personnel, ministry officials and others involved in decision-making. In recent weeks, dozens of them have spoken to Haaretz about how the ministry handled the biggest health crisis Israel has ever faced.

Many described Sadetzki, who is a physician, as the supreme professional authority who steered the entire ship of state on her own. Their accounts suggest that Sadetzki and Bar Siman Tov, who is an economist by profession and who has just stepped down as director-general, made decisions without consulting with other experts, without transparency and without much backup by way of data. For its part, the ministry categorically denies that, and said a range of opinion was heard.

Arguably, other senior ministry officials, such as deputy director-general Itamar Grotto, Dr. Vered Ezra, who is the ministry’s director of medical management, and Dr. Boaz Lev, a former director-general and head of the team that advises the ministry on epidemics, should have been a party to the decision-making. In practice, a ministry source said, the decisions were generally made by Sadetzki and Bar Siman Tov and only on rare occasions were Grotto and Ezra involved.

Grotto, a doctor and the ministry’s senior medical official, would have appeared to be a likely candidate to lead the handling of the crisis. He was head of public health for a decade. He dealt with outbreaks of disease and founded a program on epidemiology research and management.

In February, when the ministry began to prepare for the prospect that the “virus from China” would reach Israel, Grotto was sent to Japan to tend to the first five Israelis infected with the coronavirus – passengers aboard the Diamond Princess cruise ship.

He returned to Israel and went straight into 14 days of home quarantine. He was not only socially distanced, but remote from the center of decision-making on the pandemic, some sources said.

Bar Siman Tov needed a medical expert at his side and the airtime that Sadetzki received made it clear whom he had chosen for that role.

“An esteemed professional”

“She’s very didactic and analytical and knows how to present things well,” a ministry source said of Sadetzki. “The prime minister also fell in love with her presence. That meant that Grotto, the top expert in the field, was pushed away for the table where decisions were made.”

Sadetzki, an expert on the epidemiology of cancer and radiation, has been in her position for a year. She was previously a researcher at the Gertner Institute (the national epidemiology and health policy institute) and an academic lecturer, who was very highly regarded by her students and colleagues.

“She’s a very talented and strong woman, whose understanding of her field is much greater than average,” said Prof. Yehuda Adler, a senior cardiologist who has known Sadetzki for many years. “She adds to the professional level and the quality of the decision-making at the ministry. I greatly admire her and think she’s an excellent professional.”

Even if mistakes were made in handling the crisis, he added, “Our situation is not bad and that’s largely to her credit. She deserves the credit.”

Along with those who sing her praises, there are others who have worked with Sadetzki at ministry deliberations who have described her as having difficulty accepting opposing points of view.

“Nobody can express a different opinion or disagree with her,” said a professional from outside the ministry who was involved in the handling the coronavirus crisis. “There’s no discussion. That’s very poor management.”

Sources have said that the ministry didn’t have an orderly system for decision-making and that Bar Siman Tov and Sadetzki set policy on their own.

During the first wave of the pandemic in Israel, which by many accounts has now been followed by the beginning of a second wave, the ministry had an array of entities and experts at its disposal to consult with – including the epidemic team, the Gertner Institute, the Israel Center for Disease Control, professional public health associations, experts in infectious diseases and viruses, hospital department directors and researchers and academics.

By most of the accounts that Haaretz has obtained, these experts were not a party to the policy set by the ministry because nobody sought their opinions. The ministry states otherwise.

Health system sources said Sadetzki set the tone when it came to the policy on coronavirus testing. At first, she maintained that expanding the number of tests and expanding the criteria on which patients would qualify for testing was not necessary to contain the pandemic.

Tests, she said, were not the solution. Their utility was limited because they only reflect the situation at a given moment. She therefore opposed testing patients who didn’t meet both of two criteria: symptoms of the disease and exposure to a confirmed patient or to someone who had returned from abroad.

A mistaken testing policy?

Sources said Grotto felt the criteria for testing should be expanded once testing supplies permitted, but his position was not accepted. The policy changed only after public pressure on the ministry with the outbreak of the pandemic at nursing homes.

In recent weeks, after Yuli Edelstein took over as health minister, the criteria have been expanded further.

A professional well-versed on the subject said Sadetzki’s policy was a mistake: “Her concept with regard to anything having to do with testing was mistaken, perhaps because she has a background in cancer and not infectious disease and didn’t have a full understanding of the nuances. Viewing tests as designed only to identify cases after symptoms appear is a mistake. The tests should be used to identify contacts and to cut the chain of infection. This is a blank spot that can slip up most doctors, but I would expect the head of public health to understand it. It’s much more dramatic than how it is presented, and in this regard, she is very conservative.”

The rising rate of infection in recent weeks has put the need to cut the chain of infection back on the public agenda.

The National Security Council’s advisory team headed by Prof. Eli Waxman of the Weizmann Institute has pointed to the need for a research center to handle this. Such an outside entity exists, but it isn’t active.

Sources have said that the center has yet to receive the necessary authorization and that public health services have not been permitting it to function. One person said Sadetzki “ordered officials in the field not to cooperate with the new investigative body.”

Sadetzki also did not respond to proposed steps to monitor the spread of the pandemic, a number of sources have said. “She stuck spokes in the wheels of any such initiative,” a member of a ministry advisory board quipped. “Detection of the virus in sewage has been discussed for a long time and it’s not happenstance that it hadn’t happened.”

Sadetzki initially rejected a request from the Center for Disease Control to monitor the presence of the coronavirus in sewage and then allowed it several weeks later following additional requests.

Sources have also said that she ignored Center for Disease Control reports of pockets of COVID-19 outbreaks.

In April a joint initiative with the Weizmann Institute was to have been launched involving Prof. Amnon Shashua, the United Hatzalah emergency medical organization and KamaTech, which works in the ultra-Orthodox community, to do diagnostic sampling among the residents of the Tel Aviv suburb of Bnai Brak.

At the last minute, the ministry decided against the initiative.

“Sadetzki opposed it for months, claiming that widespread testing would not only fail to help but do damage, and she scuttled the [Weizmann] Institute’s initiative as well as others,” a source at the Weizmann Institute said. “Now all of a sudden, there’s a 180-degree turn without any explanation.”

Other ministry sources said the cancellation of the initiative was not only based on Sadetzki’s position but also had to do with power struggles between the Magen David Adom medical organization and United Hatzalah, both of which were to have carried out the testing.

Information is power

Another claim raised in the health system against Sadetzki and Bar Siman Tov has to do with their purportedly not having made ministry information sufficiently accessible to the general public.

“[Sadetzki] had a great deal of trouble sharing information, and sometimes you had to forcibly pry it from her,” one source said.

Many in the health system believe Sadetzki and Bar Siman Tov took proper steps when they pushed for a lockdown at the relatively early stages of the outbreak in Israel and that, had they not done so, the numbers of serious cases would have been much greater. But medical personnel have also said that when senior ministry officials stuck to a strict policy line and rejected alternative solutions, they didn’t consider the cost to the economy.

Some medical system officials also took exception with the apocalyptic forecast that Sadetzki and Bar Siman Tov presented to the public.

They suggest that their projections were based on mathematical models developed by the Gertner Institute. But those who created the models qualified the forecasts, stating that the calculations didn’t account for a number of variables. That was not made public, however.

“Sadetzki was not at all involved in the subject of the [statistical] models,” a professional knowledgeable about the process said. “Boaz Lev worked on it along with the Gertner Institute. In one of the scenarios, they spoke of 14,000 intensive care patients, but the ministry never confirmed that and nobody ever said they were going by this figure.”

At a Knesset committee hearing on the coronavirus, ministry personnel had trouble presenting any data in support of these worrisome forecasts.

In response for this article, the ministry said in part: “Prof. Sigal Sadetzki is a first-rate professional in Israel and internationally and her contribution to the coronavirus events has been invaluable. The first wave of the coronavirus [pandemic] ended successfully, and there is no controversy about that. On a personal level, some of the criticism in the newspapers that was not on the merits, and not for the first time, is gossip tinged with misogyny.

“Prof. Sadetzki is a woman professional who lives and breathes the field and all its realms. She began her professional path as a deputy district doctor and served at the World Health Organization in disaster preparedness including global pandemics across Europe. Her knowledge as a leading researcher and her experience as a professional is a huge resource in the fight against the virus.

“On a professional level, the Health Ministry held innumerable consultations, beginning with the team handling epidemics and the committee setting testing protocols, and dozens of forums, official and unofficial ….”

“Any scientist or investigator who wished to have their opinion heard saw to it to do so. Everyone has been given a chance to be heard and the ministry has involved everyone in the formal and informal decision-making mechanisms.”

The ministry went on to say: “The falsehood that is repeated over and over and which unfortunately has stuck, that Sadetzki or ministry personnel have opposed testing, is untrue. Sadetzki conveyed a somewhat complex argument that there was a need for a strategic combination to cut the chain of infection, dealing with areas with high infection rates and focused attention on sensitive populations, and of course social distancing and proper personal behavior. A combination of these steps along with testing is the proper strategy for success.”.

Original: HAARETZ