Even amidst the ongoing crisis, it is critical to adjust government decision-making structures and operational management procedures to “emergency” mode, in order to ensure optimal outcome.
The coronavirus epidemic was a global surprise, and its economic damage is significant. However, better government decision-making and decisive action can mitigate the worst effects of the epidemic. Unfortunately, most governments have been slow to realize that the main challenge they face isn’t medical, but administrative.
Effective national crisis management requires moving from “routine” to “emergency” mode of operations, as if one is waging a total war. While substantial damage to national and global health and economies already has been inflicted, it is not too late to shift gears and manage the crisis much better. Certainly, there are lessons to be learned for the handling of future such crises.
This paper seeks to draw on Israel’s handling of the crises in order to set-out recommendations for better decision-making structures and operational management procedures, in the immediate and long terms, for Israel and other countries. The key takeaway is this: More important than specific actions taken to manage the crisis is the methodology of crisis management.
Main Lessons to be Learned
- A transition plan needs to be in place for moving from “routine” to “emergency” mode of decision-making and government operations. This includes establishment of an ad-hoc cabinet to manage the crisis to be aided by a dedicated operations headquarters. Emergency laws must be legislated by parliament.
- Less rigidity in government operations is required, with responsibilities assigned only according to the actual capabilities of various agencies. In the coronavirus case, the Ministry of Health ought to concentrate on improving health services, leaving other tasks to better skilled ministries and government agencies.
- The establishment of ad-hoc intelligence capabilities, outside the Ministry of Health, is needed. Just as in military conflict, it is vital to gather and analyze all information available to deal with the crisis, in conditions of great uncertainty. (This is the situation always faced by intelligence officers).
- The apparatus for the effective testing of exposure to the coronavirus must grow rapidly, with special concentration on areas or populations at highest risk. The testing apparatus must give precedence to blood tests that indicate current status, allowing healthy individuals to return to routine activities. Emulating procedures that have proven successful in other countries such as South Korea, is highly recommended.
- The crisis ought to be managed 24/7 from a central operations room or command headquarters, headed by a prominent official such as the head of the National Security Council. This will best coordinate the activities of all relevant agencies. An advisory board should operate alongside this headquarters, tasked with thinking ahead and preventing the tendency to deal mainly with urgent matters rather than with the most important issues.
- It is imperative to design an overall strategy (and to put it in writing) regarding the battle against the specific threat at hand; a strategy that should guide each subsequent measure adopted by government authorities.
Chronology of the Coronavirus Outbreak and Government Responses in Israel
- The first outbreak of Coronavirus (COVID-19) occurred in Wuhan district, China in December 2019. On December 31 China notified the World Health Organization, and since mid-January first cases of coronavirus were diagnosed outside of China.
- On February 27, 2020 the first coronavirus case was diagnosed in Israel; an Israeli who returned from Italy. It took two additional days to trace the people he met and the places he visited.
- March 9-11 the Israeli government announced that every person arriving from abroad needs to be quarantined for two weeks. Yet there was no mechanism to enforce the restriction.
- On March 14 the government decided to close schools and all entertainment and leisure places, to forbid gatherings of more than 10 people, and it recommended social distancing (to keep a two meters distance from one other). Moreover, the government approved use of secret surveillance technology to locate infected people and those they have encountered.
- On March 20 the first Israeli died of coronavirus. On March 25 new restrictions were announced which barred Israelis from leaving their home beyond a 100 meter distance.
- As of April 4, Israel had 7,600 diagnosed coronavirus cases, with 115 patients in serious condition, and 43 deaths.
Despite being in better position than many countries in the world, this chronology indicates that Israel has made serious mistakes in dealing with the crisis. Similar mistakes have been made by other countries. Several crisis management lessons can be derived from recent events, which are applicable to every country and every crisis.
Lesson 1 – Transitioning from Routine to Emergency Situation
A state should have a clear plan of transition from routine to an emergency situation. The emergency could be a result of a war, a major terror attack, a nature disaster, cyber-attacks, or a pandemic. The concrete response will differ among the scenarios but the methodology dealing with the crisis must be similar. Here are several building blocks:
- Establish a small ad hoc cabinet of 5-7 ministers to be granted all powers in dealing with the crisis. (The specific ministers would be selected with reference to the type of crisis at hand).
- Establish a special operations room (a headquarters) to collect and synthesize all relevant information. Relevant ministries and agencies (such as the army and police) would post a high-level official to this command headquarters.
- The headquarters would operate 24\7.
- The government and parliament should give the ad hoc special cabinet the power to introduce emergency laws. These laws would require re-approval by parliament every two weeks (by regular or special majority vote).
Lesson 2 – Reassigning Boundaries of Responsibility
In the case of major fires or floods, it is firemen or a rescue organization that is tasked with responding. When faced with a terror attack, the police usually assumes responsibility for handling the event. In an epidemic, government health services manage the crisis.
Nevertheless, one of the first decisions that should be taken in a crisis is to focus the main actor managing the crisis on aspects of the crisis in which its expertise is irreplaceable; to minimize its scope of overall responsibility. Other relevant tasks, beyond core specialties of the lead agency, should be immediately transferred to other government agencies or ministries.
Unfortunately, when Israeli authorities identified the coronavirus epidemic, the Ministry of Health was tasked with dealing with all aspects of the crisis including the purchase of necessary medical equipment. This was a mistake. The Ministry of Health doesn’t have any relative professional advantage in global procurement of equipment.
On the other hand, the Israel Ministry of Defense has a large procurement and transportation apparatus, with global reach. Moreover, there are dozens of Israeli defense companies with thousands of purchasing agents around the world, operating in all languages. The government should have transferred procurement responsibilities to the Ministry of Defense at the beginning of crisis (in early February). It could have processed hundreds of orders of equipment within 72 hours.
Another example of this failure relates to mass testing for coronavirus. The task of carrying out and collecting thousands coronavirus tests a day has nothing to do with medical knowledge. It is purely a logistic challenge, and here the well-organized IDF could and should have been tasked with this responsibility from day one.
Lesson 3 – Improving Intelligence Capabilities
In transition from routine to an emergency situation, it is not enough to assign tasks to various ministries as soon as possible, but it is important to simultaneously establish many ad hoc new operational agencies.
For the coronavirus epidemic, it was important to establish a special intelligence forum. This forum would include scientists, virologists, experts in artificial intelligence, military intelligence officers, and experts on socio-cultural matters. The task of this forum would be to research and understand how the virus behaves around the world, and specifically in Israel.
This special intelligence forum ought to have been established outside the Ministry of Health for two reasons:
First, to minimize the responsibilities of the health ministry, enabling it to focus on fighting the virus by providing support to hospitals, protection to medical teams and the like.
Second, intelligence officers are better suited to this task than health officials. Health ministries are not experienced in knowing how to act under conditions of uncertainty. They know to assess a situation based on scientific certainty. They know whether to approve use of a medicine after it has been properly tested.
By contrast, an intelligence officer deals with uncertainty all the time. He never has more than partial information and must complete the picture with his/her assessment of the situation based on proactive collection of new data.
Here are some examples of questions that the typical intelligence officer would seek to answer in relation to the coronavirus, through in-depth and swift research:
- Does a person who recovered from the disease acquire immunity?
- How long after contagion does it take to identify a person as sick?
- How reliable are the current blood tests (as opposed to PCR tests)?
- What can be learnt from the experience of other countries and what are their mistakes that should be avoided?
- Is the anti-malaria medication efficient in treating coronavirus?
- Is severity of the disease related to age and the strength of the immunity system, or related to genetic configuration in certain populations (populations that can be isolated)?
- What is spread rate of the virus in sick people by categories of age, gender, and location?
- Is quarantine at home efficient or harmful?
- What are the medical problems that create additional risk for younger patients?
Lesson 4 – Conducting Large-Scale Coronavirus Testing
It is important to understand what has hindered large-scale testing for the virus in Israel, and how to repair the damage now. Israel made five central errors in this regard:
- Even though in Israel there are 27 laboratories capable of processing coronavirus test samples, only one such lab operated during the first two months of the crisis. Since it takes two weeks to actively prepare a lab for coronavirus testing, critical time was lost.
- It takes six hours to process a test sample in these labs. However, it has taken the Ministry of Health somewhere between 36 and 48 hours to notify infected individuals!
- It is important to decide who should be tested as a priority? Although there has been a large increase in the number of tests conducted in Israel since the beginning of the crisis (to a high of approximately 6,000 tests per day by early April), it is still not clear who gets priority for such testing.
For example, supermarkets and pharmacies are still operating (while other stores have been closed). Every cashier, and there are thousands of them, meets 100 people in the supermarket every day; as do pharmacists. What is the point of closure on the broad marketplace if no one bothers to test the cashiers or pharmacists?
Three factors should be considered in determining who is to be tested. First, who has symptoms of the disease. Second, who are the people in a position during emergency times that encounter many people every day. Third who are the “precious” or critically needed professionals that must not get sick, such as medical staff.
Israel has not performed simple blood tests that can provide a result in 15 minutes, such as the test for antibodies (IG). If a person has the IGM anti-body, this means that he is still an active virus carrier and can spread the disease. An IGG anti-body result indicates that the person was sick but has recovered and has acquired immunity and is unlikely to infect others. The faster that such recovered people can be identified, the more quickly they can return to work.
South Korea was the first country to conduct such testing on a large scale, including the use of drive-in testing centers. Israel should have copied this approach in the early days of the crisis. Not doing so, means that precious time was wasted in fighting the spread of the virus.
Lesson 5 – Establishment of a Centralized Command and Control System
The transition from routine to an emergency situation requires dramatic administrative changes. In routine times, each ministry or government agency acts independently, and when coordination with other ministries is needed, meetings are scheduled. That kind of management doesn’t work in emergency mode. Crisis management must be conducted from a central operations room, as mentioned above, along these operational guidelines:
- In this operational headquarters (essentially, a war room) senior representatives must be present from all relevant ministries as well as representatives from operational agencies, such as the army, police and fire services. This HDQ should have its own spokesperson.
- The war room must be operational 24\7, in three shifts.
- Each agency representative in the room must be fully connected to his agency’s data and operational systems.
- The manager of the war room should be a national, well-known figure, but not politician, or a ministry director-general. This person could be the head of the National Security Council, in countries where such an organization exists.
The main roles of this HDQ would be:
- Assign specific tasks to various ministries and agencies, not necessarily related to what they do in routine times, but to their relative advantage in the current situation. It is important that the tasks will be specific, with clear goals and precise time frames.
- Recruit all necessary national resources and agencies to the task. This includes research institutions and scientific institutions, including retired academics and specialists. For example, it is possible to instruct a scientific unit to evaluate every technology, old or new, for use in dealing with the crisis.
Unfortunately, in the current case, the transfer of responsibilities from the Ministry of Health to other government agencies was done slowly, without appropriate paperwork delineating clear areas of respective responsibility. The result was gaps in the execution of orders. For example, decision (taken very late) to quarantine all people arriving from abroad lacked any mechanism to make sure it happens.
The most important role of the HDQ chief is to take decisions when there are disagreements, or recognized gaps of responsibility and operational ambiguity.
- Parallel to this HDQ, an advisory board should be convened in adjacent room. The advisory board is very important. Its role is to draw attention to matters that need to be managed in the upcoming days or weeks, to prepare alternatives on every crucial issue, and be ready to present these to the political echelon. It is important that participants in this forum be drawn from many disciplines, including psychologists, philosophers, and so on.
The reason for this is that during crises there is a tendency to make two big mistakes. The first mistake is to deal with urgent things, some of minor importance, and to forget or overlook more important and major issues. The second mistake is to discuss the right matters in real time, but to adopt the first option proposed while ignoring better alternatives. An advisory board can help avoid such mistakes.
- The manager of this HDQ, with the assistance of the advisory board, should decide once a day or every few days what issues must be brought for discussion and approval by the government, and what matters can stay within the operational responsibility of the HDQ. The recommendations to government proffered by the HDQ manager are important, but they must always be presented to government in the most candid way, with policy alternatives and different options for action.
Lesson 6 – Setting-Out a Clear Overall Strategy
Tactical decisions, even when taken and carried out correctly, do not substitute for overall strategy. It is essential to set-out a comprehensive strategy in dealing with a crisis, at the earliest possible moment (and preferably before a crisis hits), that includes the following components:
- Assumptions: These sketch-out the current reality and estimated future developments.
- Threat of Reference: This defines the kind of the threat at hand, its magnitude, its characteristics and the expected timeline of the crisis. This is not an intelligence estimate, but a directive of the ad hoc cabinet conveying to all agencies what to prepare for. This creates a common understanding for acting in unison. For example, if according to such an estimate the threat will reach the country affected at a specific intensity within a week, then preparations must be done within a week, or government agencies will need to advise their leaders and seek permission for longer preparations.
- A Strategy Document: “Strategy” means choosing an operational goal, which guides each step taken afterwards.
For example, the strategy that should be adopted in Israel during the current coronavirus crisis would be based on two core components. (Note: No such formal strategy has been articulated by the government).
- Consider only two data sets. The first is the capacity of the health services. How many seriously sick patients (aided by respirators) can the health system accommodate simultaneously? The second is the “curve” representing the number of sick that will likely need respirators. If Israel can ensure that the capacity of the health services is greater than the number of patients who may need ICU respiration, the national economy can return to normal function sooner rather than later.
- In order to restore normal economic function, there is a need to make a clear distinction between people at high risk (65 years old and up, and people with other diseases), as opposed to the rest of the population. The population at high risk should stay in quarantine, while the rest of the population can return to its routine, including work and school. Over the long term, as the population at low risk acquires immunity from the virus (“herd immunity”), the more it will be possible to reduce all restrictions. Over time this will be true for the high-risk populations too.
(Note: The UK sought to adopt the “herd immunity” concept but went about it the wrong way. One can return to routine activities and reach “herd immunity” only after isolating the population at high risk.)
Defining an overall national strategy requires close examination of all alternatives; but in the end, one clear and consistent strategy must be chosen. Of course, a strategy can be changed if circumstances demand this. But only a defined overall strategy allows for all tactical moves to be directed into effective action.
The management of an epidemic like coronavirus obligates the government to realize as soon as possible that it is fighting a total war. Waging such a war necessitates a conscious attitudinal change that is reflected in two main steps: the harnessing of all national resources, and readiness to temporarily put aside other matters, such as concerns about privacy. More important than specific actions taken to manage the crisis is the methodology of crisis management, as detailed in this document.
Major General (res.) Giora Eiland served as commander of the IDF Operations Branch, and as National Security Advisor to Prime Minister of Israel.
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