Israel’s COVID antibody testing for schoolchildren started on the wrong foot, but it’s worth it

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Coronavirus serological testing for children aged 3 to 12, which began this week, became a target of criticism by the end of the first day. Mayors doubted the necessity of the antibody testing and even Health Ministry Director General Prof. Nachman Ash mentioned the possibility of canceling the project.

“If 5 percent of the tests are positive, we will consider whether to continue the project, because that’s a very low number,” he told Radio 103 FM on Sunday. Numerous mishaps on the first day of testing also contributed to the general feeling of disapproval. The app for registering children didn’t work properly, the data entry and results delivery system crashed, meaning that thousands of Home Front Command soldiers manning the testing sites had to fill in each child’s information by hand, and some parents still haven’t received their children’s results.

Education Ministry Director General Yigal Slovik announced on Tuesday that the scope of the serological survey will be significantly reduced, but the Health Ministry said that the move was not coordinated with them, and that the announcement took them by surprise.

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The matter of serological testing has to be looked at in a larger context: The idea behind it was to expose asymptomatic infection and recovery on a large scale, which would exempt many of the unvaccinated children from mandatory quarantine. Some experts said that the number of such cases is at least equal to the number of confirmed infections in this age group. Others believe that children who are asymptomatic or have recovered from COVID-19 make up less than one-fifth the number of confirmed cases. In fact, no one really knows how to assess the number of children – many of whom show no symptoms even after being infected – who have had the virus unawares.

The test results so far are preliminary, partial due to the system crash and the need to record data manually. Health Ministry officials have said in internal discussions that 16-17 percent of some 60,000 children have tested positive for COVID-19 antibodies. This includes children who tested positive for antibodies during a pilot project within the ultra-Orthodox school system, where the positivity rate approached 20 percent.

A girl is comforted by her mother while getting an antibody test Tomer Appelbaum

About 1.5 million children aged 3-12 can be tested through the current initiative, which is run by 1,400 Home Front Command teams. The operation is taking place at 183 sites throughout the country, with a total of 391 stations for administering the test, and will continue until next Thursday. The Health Ministry hopes that the response of parents and children will be high. A poor response might indeed cause the project to fail.

Those critical of the testing say there is no point in uncovering asymptomatic cases of the coronavirus before the school year starts and leads to new, symptomatic cases. Others, looking at the results of the first few days of the project, believe that the results are not worth the effort. However, even if the rate of asymptomatic infection among this age group is less than expected, the project has a number of advantages.

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The way back to normalcy

The serological testing project costs 63 million shekels (about $19.6 million). If the rate of positive antibodies is indeed 16 percent, it will mean 244,000 children found to have antibodies will not have to go into quarantine, and will be eligible for a Green Pass, which will allow them to enter places that are only open to vaccinated or recovered individuals, or those who can show a recent negative coronavirus test. That is, a about a quarter of a million children will be able to resume their routine without too much fear of infection.

The exemption from quarantine is very significant; when each child has to go into quarantine for seven days, it represents 1.7 million potential cumulative days of quarantine. At least one parent will have to quarantine with them, meaning that parent will be unable to go to work. And it might not end with one week of quarantine. The child may have to repeat the isolation period every time he or she is exposed to the virus.

A girl gets an antibody test earlier this weekOhad Zwigenberg

Shortening the quarantine period to one week instead of two is conditioned on two coronavirus PCR (swab) tests for the presence of the virus. Every such test costs about 200 shekels. Even if only 20 percent of all children in this age group have to go into quarantine, that comes to 48,000 children who will have to undergo two PCR tests. The cost of testing these children alone comes to about 20 million shekels.

Serological testing can contribute to a new normal: attending school alongside high rates of infection. The numbers are still not clear from the first days of the current initiative, but exemption from quarantine for even a fifth of the children has value. The education and health care systems now have tools that they didn’t have before: rapid testing and home testing. Alongside the serological tests, these tests are meant to allow for activities to take place safely in a good many cases, when integrated with other ways of reducing infection, such as holding classes outdoors or upgrading ventilation systems.

Serological tests also help provide a clearer epidemiological picture. If the rate of asymptomatic infection as revealed from the tests is high, it will show that the virus is more widespread than was initially thought, but less dangerous. It will also show that Israel has a long way to go in identifying infected individuals. Low rates of asymptomatic infection may also provide information on the rate at which infection is transmitted, efficiency in breaking the chain of infection and infection rates in schools and at varying levels of crowd congestion.