With an influx of coronavirus patients looming, Israel’s hospitals are scrambling to prepare for the worst, while working to ensure that procedures in place and lessons learned from other countries keep the country’s health system from being overwhelmed.
Israel so far has had 109 cases of COVID-19, including two people in serious condition, and no deaths. But the number of those with the virus has been rising exponentially in the past several days and experts expect that tens of thousands of people or more will eventually be infected.
On Thursday, Prime Minister Benjamin Netanyahu warned that the potential number of deaths from coronavirus “is very high,” ordering schools shut and urging people to maintain distance from each other to keep the virus from spreading.
Wary of turning into the next Italy, where the health system has been disastrously overstretched by the fast-spreading contagion, hospital officials in Israel are exploring different options for coping with the expected surge, from isolation units to triage procedures to methods keeping staff safe from infection,
Khetam Hussein, head of the infection control unit at Rambam Health Care Campus in Haifa, said that means hospitals are preparing for the possibility of having to shift resources away from other medical needs toward dealing with COVID-19.
“If the number of patients goes up, elective procedures will be cancelled and almost all our resources will go to coronavirus,” she said.
This would mean that all efforts will be made to clear beds, and ever-increasing parts of the hospital would be adapted in to isolated wards where coronavirus patients can be treated away from others.
Keeping patients from even needing to reach the hospital may also be
The Magen David Adom rescue service said that call center operators will soon start diverting many patients to web doctors where appropriate, reducing the number of non-coronavirus patients going to emergency rooms by a third.
Already, new triage procedures are being followed which mean that every emergency patient is assessed for their level of coronavirus risk.
“In the last week we have completely changed the emergency process,” said Eyal Leshem, an infectious diseases specialist at Sheba Medical Center in Ramat Gan outside Tel Aviv.
Everyone who arrives at Sheba for emergency care is taken to a location based on how likely they are to have the disease, and kept separate from people in other categories. Many coronavirus tests are being administered and, according to Leshem, “the labs are overwhelmed right now.”
Leshem explained that the rationale for this segregation is to minimize the chance of people who don’t have coronavirus catching it in the hospital. He said: “For example, if you have a patient who is supposed to be quarantined but they broke their leg and need casting the risk is relatively low, and we don’t need to mix them with people who are high risk.”
The lowest-risk categories are people who are unlikely to have coronavirus; and people arriving from quarantine for complaints unrelated to corona-type symptoms. The higher-risk categories consist of people with respiratory symptoms or fever, until they are verified coronavirus-free; and people who have arrived at the hospital from quarantine with respiratory complaints or fever.
Anyone considered high-risk is received at a tent outside the emergency room, where they are met by a doctor in mask and gown who takes blood pressure, heart rate and temperature. If the doctor suspects coronavirus, a lab test is ordered.
A more radical idea being considered by the Health Ministry would see the designation of one or two hospitals into special coronavirus-only medical centers, according to Leshem.
“It’s something that was tried and tested in Singapore, and we should really learn from another nation’s experiences,” he said.
But not everybody is on board with the idea, which is still the subject of debate.
“If we get to a stage where there are thousands of patients, one hospital is not enough,” Hussein said. “Staff will be tired and demoralized; everyone has to share the pressure. It’s not fair that one hospital should have all the pressure.”
Morale is currently good among staff at Rambam, she said.
“We have a lot of doctors and nurses who volunteered to work in the corona department. It’s amazing, the staff are not afraid.”
At Tel Aviv’s Sourasky Medical Center, though, staff have written to management complaining that precautions to protect them are too lax, according to Channel 13 news,
They were alarmed after a patient was treated there on Sunday for flu-like symptoms, released the next day without being tested for the virus, and then readmitted on Tuesday and diagnosed with coronavirus.
“We are beginning to fear for our health,” the doctors wrote.
At Sheba, the first Israeli hospital to receive coronavirus patients, doctors aren’t complaining about hygiene standards, but they are reeling from a revelation on Thursday that one of their colleagues has been diagnosed with the illness.
The doctor returned from France on March 2 and worked a shift that day in the emergency room before going into quarantine. Israel only ordered those returning from France to quarantine on March 4.
Treating coronavirus patients like this doctor — who was admitted to Sheba’s isolated area — is part of the challenge facing hospitals.
Five coronavirus patients are currently at Rambam in an isolated ward with negative-pressure rooms for up to 30 people, where doctors only venture for short periods, and always protected by hazmat suits.
“We have our corona department, and we have already plans for which other departments to change in to corona departments,” said Hussein.
In Sheba’s 35-capacity isolated area, robots scoot around, taking over much of the bedside time that would normally fall to doctors.
Sheba doctors minimize their chance of infection by largely avoiding face-to-face contact, and instead spending long stints in a tent near the unit, talking to the patients via displays on the robots, or sometimes using phone apps or television screens.
“The only time doctors really have contact is if they swab them, otherwise most of the work is done remotely,” said hospital spokesman Steve Walz, explaining that they often rely on robots to carry out tasks or give patients instructions to carry conduct their own tests and watch via live feed.
“The doctors can see how the patients do the testing, if the throat is red, and if they have a fever. All of this is done remotely,” Walz said.
Maintaining the isolated areas is difficult, down to the need for cleaning teams in protected suits and maintaining a schedule for when patients can visit a garden, one at a time. But this is just the tip of the iceberg of the challenge facing Israel’s hospitals.
Patients in coronavirus units are currently there because of their coronavirus symptoms, but as time goes on, doctors expect to have patients who are on the road to recovery coronavirus-wise, but have an unrelated heath issue.
Rambam has already set up a birthing room in its isolation unit, expecting that eventually there will be an infected patient who is pregnant.
Walz suggested that careful planning had put Sheba on strong footing. “We had a full drill a month before the first coronavirus patient was diagnosed in Israel,” he said.
Despite the challenges, Hussein said she also thinks her hospital can cope.
“I’m an optimist,” she said. “There have been outbreaks in the past and there will be in the future. We still have the hardest phase ahead of us, we know this, but we are ready.”