‘Scale up health system or face collapse come winter’

It is time to scale up the capacity of Israel’s public health system or face potential collapse in the winter when Israel is likely to be struck with both seasonal flu and another wave of the novel coronavirus, said health experts.

“Israel’s healthcare system has been working at capacity or above capacity for years – under-funded and understaffed,” said Eyal Leshem, director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center in Tel Hashomer. “When you add on to a system like that an event that mandates a lot of skilled personnel, laboratories, health investigation teams – it is difficult.”

He told The Jerusalem Post that changes need to be implemented before the winter.

“We know there will be influenza in the winter and we know we won’t be able to differentiate influenza from COVID-19,” Leshem said. “When we have thousands of influenza patients coming to the ER every week, even if they test negative for COVID, we won’t know they don’t have it… The hospital will be overwhelmed.”

Leshem said that to help meet the challenge, the country must improve its ability to perform contact tracing.

“This capacity is under the district health team, which has epidemiological nurses who are skilled in contact tracing,” he explained. “What we need here is a major scale up of contact tracing.”

There are two ways to do it. The first is to train and staff these public health offices with enough qualified nurses.

“Now we have 160 patients a day, but during the winter we may have 1,600,” he said. “We need to be able to identify all these people or we will have to shut down the whole country again.”

The other way to perform contact tracing is using technology that identifies the mobile phone of a person who is infected with coronavirus and all the phones that were next to the patient’s, and automatically tells [those carrying them that] they need to be quarantined and tested.

“We have the technological capacity; we need a legal framework to oversee it,” he said.

Last week, the Shin Bet (Israel Security Agency) halted all coronavirus-related surveillance of infected citizens – although at the same time, the Ministerial Committee on Legislation approved a bill that would grant the agency the authority to restart mass surveillance in the future, if needed.

Leshem said that the Health Ministry also needs to focus on improving public health communication, “which is obviously lacking because people don’t understand many of the recommendations. They need a spokesman who is a doctor trained in public health communication and who understands

the principles of speaking with the media during a time of crisis.”

Dr. Manfred Green, a public health expert at the University of Haifa, agreed. He said, for example, that the country’s ruling that people must wear masks all the time, even on the street (when not crowded) or at the beach, “makes people less motivated.” He explained that masks are unnecessary in those situations – and if the ministry would be more specific about when masks are helpful and when not, people would be more inclined to follow the rules.

“The Health Ministry should not give the population

tasks that they cannot comply with,” he said. “For example, don’t tell the elderly, ‘Don’t leave your house.’ They can walk on the street and breathe fresh air. Tell them not to go to crowded places.”

Leshem also recommended that as part of strengthening public health services, the ministry should consider placing a nurse in every school, who could help identify the kids who are sick and who they are in contact with.

“This could save thousands of quarantine days,” Leshem said.

On the medical side, he said that the country needs to rapidly invest in increasing internal medicine and intensive care capacity.

“What we used to call the ‘old lady in the corridor’ is going to be the ‘old man with COVID on a ventilator in the corridor,’ if we don’t have enough doctors to treat those ventilated patients,” he said.

But he added that this situation cannot really happen, because ventilators are useless if there are no doctors and nurses to care for the patients who are connected to them.

Israel is expected to have as many 15,000 ventilators available by winter. But Leshem said to treat only 20 ventilated patients, hospitals need 20 doctors and 100 nurses.

“So, if you plan to treat 2,000 patients – do the math,” he noted.

Treating 2,000 patients would require 2,000 doctors and 10,000 nurses, according to Leshem’s calculation.

He recommended getting started by increasing the number of full-time positions funded by the country in public hospitals, as well as immediately training young doctors and nurses. He said he believes there are people to fill the needed slots.

Green recommended building infectious disease hospitals or upgrading a handful of hospitals across the country to include separate buildings for COVID-19 patients, who can be kept away from patients in the general hospitals.

During this first wave, many sick people would forgo needed care for fear of contracting the virus. He said Israel cannot let that happen again as it leads to sicker patients and even deaths.

Leshem told the Post that “People are under the false assumption that corona is over or will be over,” but added that “the reality is that we will probably have to adjust our lives for several years – even if we have an effective vaccine.” •