Number of serious cases has almost doubled in past two weeks

Israel’s recent rise in serious COVID-19 cases partly due to change in criteria

Doctors at Israel’s largest hospital amended their approach to categorizing virus patients, impacting national stats; goal is to standardize criteria, they say, not inflate figures

Nathan Jeffay is The Times of Israel's health and science correspondent

Sheba Medical Center staff at the coronavirus isolation ward in Ramat Gan, June 30, 2020 (Yossi Zeliger/Flash90)
Sheba Medical Center staff at the coronavirus isolation ward in Ramat Gan, June 30, 2020 (Yossi Zeliger/Flash90)

One-third of the rise in serious coronavirus patients since late last week is explained by a change in doctors’ definitions, a top physician said.

Two weeks ago Israel had 45 serious coronavirus patients. On Thursday the number stood at 65, and since then it has jumped to 86.

Galia Rahav of Sheba Medical Center said that part of the increase happened because some of her staff are using a lower bar than they were for classifying patients as serious.

There are currently 15 serious patients in Sheba, Israel’s largest hospital, and last week “around half of them would have been classed as moderate or mild,” Rahav, the hospital’s head of infectious diseases, told The Times of Israel.

A medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, May 4, 2020. (Yossi Aloni/Flash90)

Jacob Moran-Gilad, a member of Israel’s Epidemic Management Team and Ben Gurion University professor, said he is aware that definition changes sometimes impact the reported numbers of serious patients.

“Every time that case definitions are amended, it can have an artificial impact on reporting,” he said.

Rahav stated that her doctors’ assessments have changed because she complained that they were deciding the severity of patients by applying their own symptom-based judgement rather than applying World Health Organization standards, as required by hospital policy.

Prof. Galia Rahav, Head of Sheba Medical Center’s Infectious Disease Unit and Laboratory, looks at data on COVID-19 patients (courtesy of Sheba Medical Center)

Rahav said she wants to see other hospitals, which currently follow disparate criteria, follow suit, and asked the Health Ministry to suggest they do so. But she said the ministry hasn’t made any such request, and based on her conversations with peers, other hospitals haven’t made changes.

Moran-Gilad said there has been no national policy change on definitions, and Gabriel Izbicki, senior doctor at Jerusalem’s Shaare Zedek Medical Center, said there have been no new guidelines at his institution.

Rahav cautioned against citing doctors’ conduct to play down the severity of the current spike, calling this “churlish.” She said: “It’s wrong to say that the increase is due to doctors’ definitions.”

Moran-Gilad said that there are currently differences between hospitals regarding how patients are categorized, and that the possibility of standardized criteria based on WHO definitions is “definitely something being discussed on a national level.”

He said that the motivation isn’t to categorize more people as serious, but rather to have a national set of standards. If this is in line with international definitions it has various benefits, he said, including improving eligibility for experimental treatments and drug trials, which often require adherence to WHO patient classifications.

Moran-Gilad said: “Standardization will ensure consistency of national data, allow comparability and also streamline patient management.”

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