A new statistic is dominating coronavirus conversations in Israel. It’s not the number of fatalities or people infected, but how many machines there are to save the lives of the worst-stricken patients.
“We won’t get to a situation where [we] need to choose to whom we administer artificial respiration,” Boaz Lev, who heads the Health Ministry’s pandemic unit, told the Kan public broadcaster Thursday morning. He said that Israel has 4,000 ventilators and is working to acquire more.
But that contrasted starkly with a warning issued by the ministry’s director-general, Moshe Bar Siman-Tov, who said the same day that he was “not optimistic” the healthcare system would be able to properly deal for much longer with the scope of the coronavirus pandemic. Prime Minister Benjamin Netanyahu, similarly, was quoted Wednesday as having told ministers: “If the current pace of infection continues for another 15 days [that is, with the number of cases doubling every three days ], we’ll find ourselves in a situation where we’ll have to decide who to put on ventilators and who not.”
Former Health Ministry director general Gabi Barbash, now professor at the Weizmann Institute of Science, also thinks it’s entirely possible that hospitals could run out of ventilators. “If you would have asked me a month ago I would have said no; today I am worried,” he told The Times of Israel. He estimated that around 1 in 20 people with coronavirus will need a ventilator at some point.
With large numbers of coronavirus patients expected to need ventilators as a matter of life or death, interest in the supply level of these machines is so high that some elderly Israelis are trying to invest in their own units. Lior Hessel, a high-tech engineer in Kiryat Bilaik, has been inundated with calls from pensioners, who heard of his simple ventilator invention, made from pistons normally used for his agritech business.
“They are hysterical and wanting to buy ventilators,” he said.
While his machines would be of little use at home without a hospital support system, he said, the calls capture the mood of some Israelis.
“There are older people dying of fear at home, worrying they will not be accepted for a ventilator because they are too old, like what’s happening in Italy right now,” said Hessel.
Some physicians and philosophers are already starting to ask how resources should be allocated if they become scarce.
Members of the public who are looking for a straight answer on the ventilator count aren’t getting one. Even the Knesset Research and Information Center, which gathers statistics for lawmakers, is “confused,” spokesman Shmulik Grossman told The Times of Israel on Thursday.
In the morning, as Lev told an interviewer there are 4,000 ventilators, the Knesset’s coronavirus committee announced there are 2,173 ventilators, but just 1,437 are available. Grossman said this was based on a response sent to his research center by the Health Ministry at 10:30 p.m. Wednesday, which he understood to cover all ventilators, civilian and military.
Of a total 2,173 machines in medical centers, 708 are currently in use and another 28 are not working, according to the review prepared for the committee by the Knesset Research and Information Center.
When quizzed about a possible looming lack of equipment, Bar Siman-Tov told the Knesset’s new coronavirus committee chair MK Ofer Shelah that there are additional machines in storage, and others held by the armed forces and in the private sector.
Bar Siman-Tov said there are 1,500 machines in storage, and the Israel Defense Forces has another 800 to 900 that the ministry hopes will be made available.
Grossman said that the figure released by his center was supposed to include all ventilators in the country, and should still be considered definitive. A Health Ministry spokesman didn’t respond to a Times of Israel request for clarification.
Barbash thinks that whatever precise figure one settles on — and he estimates 4,500 units nationally with just under a third of them not being used, which he said is a similar to the level of provision in well-equipped European countries — leaves Israel vulnerable if the crisis hits hard. He said: “Israel has a reserve of 1,400 ventilators but if the number of patients grows to 100,000, and it can easily go there, this 1,400 reserve is a drop in the ocean.”
Yehezkel Caine, director general of Herzog Hospital in Jerusalem, thinks that the Health Ministry is doing an “excellent job under extraordinary circumstances,” but said that hospitals could be pushed to take extreme steps.
“Once you reach a crisis, when there are far more patients than there are ventilators, you will resort to anything available, because anything is better than nothing, and then whatever you can get that can do the job will be used, even if it was designed for experiments, or for animals,” he said.
The hospital, a geriatric center that is one of Israel’s most ventilator-dependent healthcare centers, has 300 beds and 200 breathing machines.
Caine explained what while he hadn’t heard of any plans to use veterinary machines, “hypothetically a machine that is capable of ventilating a sheep could be capable of ventilating a human.”
Despite public interest in ventilator stats, Caine believes they don’t give any clear picture of what the eye of the storm will look like.
He doubts there is any reliable scientific formula for calculating how many ventilators will be needed, and said anyone who tries is “always dealing with the unknown.”
“We are dealing with an extreme situation, unprecedented in modern history, and as we have seen in highly developed western countries — Italy, Spain — the events outrun the available facilities,” he said.
While he believes the Ministry of Health is doing an “excellent” job to obtain as many units as possible, he’s sees little hope with the world market melting down. “There is a crisis with all ventilators at the moment because anything that can do anything is being snapped up,” he said. “They are being snapped up like toilet paper.”
He added that not all ventilators are the same, and patients will fare best with top of the line models.
“They have almost as many functions as an aircraft cockpit and do almost everything apart from making the coffee. They cost tens of thousands of dollars, even up to $100,000,” he said.
With the ventilator market jammed, doctors are looking for creative solutions. Hessel, a bored engineer, has spoken with some large hospitals that are keen to hear about his invention, which he said could be used for 90% of patients needing a ventilator.
Hessel became deeply concerned about the potential ventilator shortage two weeks ago, when work at his company Growponics, which helps to automate agriculture, ground to a halt because of the coronavirus crisis.
The ventilators he is building use the very same pistons that he normally uses for the agricultural systems. “We were working on various projects and, boom, everything switched off. We had nothing to do. So I decided to do something instead of watching the news. I was a medic in the army. There, we used manual ventilators which are a similar shape and size as an American football, to squeeze air into the lungs.
“It’s a very standard piece of equipment and costs about $18, but your hand gets tired and there’s no way you can keep the same pace and pressure. I thought, as a high-tech engineer, that I should develop a pneumatic piston that does the job of a medic’s hand.”
Hessel said that his creation ticks three key boxes for a ventilator — being able to adjust the volume of air going in to the lungs, being able to set how many “mechanical breaths” take place per second, and being able to adjust how long it takes between air going in and coming out.
He has made a prototype, plans to start production soon, and is already receiving tentative orders.
“The beauty is that we built it using the most simple straightforward components — pneumatic pistons, which I can get by the thousand, and hand-held ventilators,” he said.
In terms of regulatory approval, Hessel believes that it will be given quickly “because people will want to live,” and said he feels a responsibility to help solve a seemingly-unsolvable problem. “It’s like there’s a tsunami on the way, it hasn’t come yet, and I want to prepare equipment for when it does.”