In COVID-19 war, Israeli hospitals are like soldiers without bullets

The combination of flu and COVID-19 doubles the chance of serious illness and could mean a return to impossible workloads in the country’s hospitals.

The coronavirus ICU at Galilee Medical Center (photo credit: MARC ISRAEL SELLEM)
The coronavirus ICU at Galilee Medical Center
(photo credit: MARC ISRAEL SELLEM)

Israel did not properly prepare for the fifth wave of COVID-19, which is now threatening the country at the same time as seasonal flu.

The combination of both viruses, which in the past was dubbed “flurona,” doubles the chance of serious illness and mortality and could mean a return to impossible workloads in the country’s hospitals.

“Concurrent flu and COVID peaks could mean the breakdown of Israel’s hospitals,” said Dr. Erez Barenboim, director-general of Samson Assuta Ashdod Hospital.

In the last several weeks, the number of daily COVID-19 cases has been on a sharp incline.

Two weeks ago, on December 8, there were 715 new daily cases. A week later there were 788, and on Wednesday there were nearly 1,000. While the number of serious patients first declined and then remained steady, growing infection threatens to swing the pendulum in the other direction.

 A SIGN at Ben-Gurion Airport directs passengers to the COVID-19 testing area. (credit: TOMER NEUBERG/FLASH90) A SIGN at Ben-Gurion Airport directs passengers to the COVID-19 testing area. (credit: TOMER NEUBERG/FLASH90)

At the same time, according to data from the Israel Center for Disease Control, as of last week 1,088 people had been hospitalized with influenza, equivalent or slightly higher than in most years prior to coronavirus, but a stark contrast to the zero patients that Israel had last year.

Among the patients were 401 children and 70 pregnant women, the center said.

Part of the challenge is that as COVID declined after the fourth wave, many people – especially young people – became complacent, health officials have said. They either chose not to get their COVID booster, or their flu shot, and they are also not maintaining coronavirus safety measures like masking and social distancing.

“People do not understand that the flu can be a very serious disease, which already today leads to the deaths of tens of thousands of people a year worldwide,” said Dr. Ehud Drucker, deputy of the Emergency Medicine Department at Assuta.

Despite all of the discussion about bolstering the health system, the country’s hospitals are still unprepared to manage the potential catastrophe that concurrent flu and coronavirus waves could bring.

Even before COVID-19, hospital occupancy rates in Israel were the highest in the developed world.

In a normal pre-coronavirus winter, just with the flu, Israel did not have enough room for its patients, and many people were hospitalized in the hallways, something that has impacted the country’s mortality rates from infectious diseases – rates that doubled in the past two decades alone and that are not only higher than in every other developed country but are more than 70% higher than the second-ranked country.

“Hospitalizing people in the corridor is a disgrace to the State of Israel, and I am ashamed each time I walk through the hallways and see elderly people there with the minimal privacy we can provide them,” said Prof. Arnon Afek, associate director-general of Sheba Medical Center and chairman of the Israeli Association of Hospital Directors. “I think the State of Israel is strong enough to support and provide the right healthcare to all the people who deserve it.”

He said that the Israeli healthcare system is repeatedly reported to be one of the most efficient in international rankings, “but once you speak about efficiency, it means we have no reserves.”

Afek’s association was asked to prepare an assessment for the Health Ministry after the second coronavirus wave of how many more intensive care unit beds would be needed in the event of future waves. They came up with the number 321.

“We gave the government this paper, and until today we have not received these beds,” Afek said. “So, what do you expect us to do?”

Moreover, Israel is woefully understaffed when it comes to most medical professionals, the statistics show, but especially when it comes to nurses. Israel has nearly the lowest number of nurses per capita compared with other OECD.

Under his tenure, former Health Minister Yuli Edelstein committed to adding 2,000 nurses and 600 doctors to the system, a decision that was reaffirmed by the current administration. However, the new positions were only to be rolled out based on need, which was evaluated according to the number of people hospitalized with COVID in Israel.

The first third of the positions were allocated to the hospitals, but as Israel vaccinated and COVID severe cases declined, the other two-thirds were never funded.

The same doctors and nurses who treat flu patients manage COVID patients, and they are already burned out from the last two years of the virus.

“I am worried,” Afek said.

Barenboim is also concerned about his staff, he said, but for another reason: the Omicron variant is hyper-infectious – likely four to five times more infectious than Delta – and even three shots of the Pfizer coronavirus vaccines appear to be less effective against it.

“The boosters are not more than 75% effective against Omicron,” Barenboim said, citing first reports. “That means there is a one-in-four chance that one of my staff members who comes into contact with an Omicron patient will get infected. The staff member may not develop serious disease, because the doctors and nurses are vaccinated, but they could wipe out an entire department” by putting others into isolation.

At Assuta, the management has taken action to remind all staff members to wear masks and take extra precautions, even among patients who display no COVID symptoms.

“We have told them to treat any patient who comes into the hospital as if he has Omicron,” Barenboim said.

As of Wednesday night, Assuta was treating only one COVID patient – a pregnant woman who is about to give birth. Nonetheless, the hospital is preparing, he said, because “we know that Omicron is already here. Omicron is not just at the airport anymore.”

Barenboim predicted that Israel will quickly and continuously see a spike in cases over the next few weeks. On Tuesday, Prof. Eran Segal, a computational biologist from the Weizmann Institute of Science who advises the government, said he expects 10,000 cases by sometime in January.

However, the final verdict on what those cases will do to the country’s hospitals is still undecided, explained Clalit Chief Innovation Officer Prof. Ran Balicer.

Whether or not the hospitals become overwhelmed will depend on two factors: the final number of new daily cases at the peak of the fifth wave, and how many of those people who become infected develop serious disease.

Contradictory data are being seen in South Africa and the United Kingdom. In South Africa a much lower percentage of Omicron patients are becoming hospitalized than in previous waves, while in the UK the percentage appears quite similar. Balicer said that if 20% fewer cases become serious, for example, even if the number of new cases is strikingly higher than in previous waves, the hospitals should be OK. But if the variant leads only to a 2% decline, the medical system could collapse.

“Remember the end of the last wave when we had a shortage of ECMO [heart-lung] machines?” Balicer asked. “We could see that happening again and worse.”

This is especially true if more people do not decide to get vaccinated.

There are still nearly a million unvaccinated children, a million people who are eligible but have not gotten their booster shot, and around 700,000 individuals who have chosen not to vaccinate at all.

“I am planning for the worst and hoping for the best,” Barenboim said.

“The healthcare system will always take care of our patients and do our best,” Afek said, “but we are like soldiers being sent to war without the ammunition we need.”•