7 tips to get through Israel’s first coronavirus winter

HEALTH AFFAIRS: Israel’s hospitals are expected to be even fuller, as COVID-19 patients need beds and internal medicine wards are short-staffed.

WINTER WEATHER hits Jerusalem this week as shoppers in the Mahaneh Yehuda market brave the rain. (photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
WINTER WEATHER hits Jerusalem this week as shoppers in the Mahaneh Yehuda market brave the rain.
(photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
“Flurona” – the combination of flu and coronavirus – threatens to break the health system, attack the health of the most vulnerable populations, and put the general public at risk of receiving less than optimal care.
Before the coronavirus outbreak, hospital occupancy rates in Israel were among the highest in the developed world. Patients were treated in hallways or packed in rooms with only curtains between them, as medical personnel struggled to treat the sick.
This year, Israel’s hospitals are expected to be even fuller, as COVID-19 patients require beds, and their treatment pulls staff away from internal medicine wards, staff that would otherwise be available to treat people with other ailments.
“Currently, the healthcare system has no practical solution for large-scale hospitalization,” explained Itamar Offer, CEO of Sabar Health Home Hospital.
He said that sick patients who are treated in congested hospitals risk acquiring additional and even life-threatening infections.
Israel’s mortality rates from infectious diseases, which doubled over the past two decades, are the highest in the world among OECD countries – 69% higher than the second-ranked country, according to the Shoresh Institution for Socioeconomic Research. 
Moreover, people are likely going into the winter sicker than before. The recent lockdowns have left vulnerable populations lonely and off-balance. Stress and anxiety can affect anybody, especially people with chronic diseases and the elderly, who are already at greater risk of winter respiratory infections.
“When we talk about patients with common chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, then we already know that coronavirus complications are very significant for them,” said Amir Bar-Shai, head of Barzilai Medical Center’s Division of Pulmonary Medicine. “Winter is a source of significant complications, both in terms of weather changes and increased risk of disease flare-ups that can lead to hospitalization.”
The Jerusalem Post asked three top medical professionals for their tips for Israel to get through the world’s first coronavirus winter.
1. Exercise
A consistent exercise regime is an elixir for better health, according to Dr. Daniel Tsalihin, a family medicine and diabetes specialist who works with the Clalit Health Services.
He said that only a small percentage of people have home workout facilities, but little equipment is required to get the recommended 30 minutes of exercise five times per week. He said walking around one’s home or down in the garden is healthy.
“Even if they walk from room to room,” Tsalihin said; “they should just not stay in their beds.”
He said that some patients are afraid to go outside because of coronavirus, but that if people wear masks and walk in the open air, the risks are low and the benefits great.
2. Hydrate
Although “winter in Israel is not like winter in Siberia,” said Tsalihin, he advised that people try to drink an abundance of water or hot teas.
He said that proper hydration provides energy and ensures that people can maintain their normal physical activity levels.
For patients with diabetes or other chronic illness, Tsalihin said proper fluid intake helps ward off hypoglycemia, seizures or other complications that could lead to hospitalization, and ensures that medications are properly absorbed into the body.
3. Medicate
Stock up on medications that need to be taken regularly, Tsalihin said, explaining that in the cold winter, with the threat of COVID-19, it might be more challenging to head to the pharmacy.
Offer said that some of the health funds now provide home delivery of medications, which is safer than standing in long lines to pick them up.
“Readiness is important,” said Barzilai’s Bar-Shai, “whether in the provision of sufficient quantities of medication” or patients meeting with their doctors in advance of the winter to ensure they understand how to take their medications correctly.
Finally, he said that “the most important thing is taking their medication regularly.... When people take their regular medications consistently, they are much more protected from coronavirus and the complications of coronavirus.
“We see it every day,” Bar-Shai continued. “People who take their medications have mild symptoms. Those who don’t are really more prone to severe disease.”

4. See your doctor
Bar-Shai said that he expects many patients will choose to stay home this winter instead of going to doctors’ offices, for fear of catching COVID-19. But for patients with chronic diseases, he advises against it.
“We ask them to do their regular follow-up” visits and “to do status checks during the winter,” he said. “In the winter, there are a lot of viruses and bacteria” that can result in flare-ups of preexisting conditions. “Regular treatments should continue.”
Tsalihin said that patients should also ensure they have a direct line of communication with their physicians by telephone, email or WhatsApp in case of emergency.
5. Hospitalize at home
Home hospitalization in Israel today is provided free of charge to members of all the health funds for almost any medical challenge, including those that require intravenous treatment.
“The patients receive regular medical staff, who come to their homes daily, provide them with treatments, tests and medications, and 24/7 monitoring,” Offer explained. “Everything happens in the patients’ comfortable and safe home environment.”
He said that “in many situations, people can avoid being hospitalized and the risks that come with it, risks that are made worse in coronavirus times.”
Offer said that when a primary care physician recommends going to the hospital, patients should ask if they can be treated at home instead.
6. Leverage modern technologies
Using modern technologies, like video calls and other means of telemedicine, can enable people to get the care they need without the risk of crowded waiting rooms.
“The waiting room and sometimes the environment during the actual visit are not safe, especially for the elderly or immunocompromised patients,” Offer said.
Since the beginning of the crisis, the health funds have been encouraging people to contact their doctors through video or phone calls. This can work not only for general medical needs but even for some specialist appointments.
Offer, who has been running health organizations for many years, said that doctors were the first to resist telemedicine. However, after nine months of coronavirus, “they are ready to do it, they are doing it, and they know when to decide that they can meet [patients] virtually instead of in person.
“There are good things that happened to healthcare because of coronavirus, and this is one of them,” he continued. “Telemedicine is the future – and the future is here.”
7. Vaccinate
“We recommend that everyone get a flu vaccine,” said Bar-Shai.
He said that although it is not foolproof, being vaccinated against the flu tends to leave patients less exposed to catching other viruses in general.
“If a patient does not develop influenza, maybe this will also lower their risk of getting COVID. We know that when you are vaccinated, your lungs are much less predisposed to other viruses as well,” Bar-Shai explained.
Moreover, he said that in the winter, doctors often see people with “super infections” – having one infection on top of another. The flu shot can help ward off such a situation.
“We want people to be vaccinated so that hospitals won’t be full of people with influenza and they’ll have room for COVID-19 patients,” Bar-Shai said.
In a normal year, around 2.5 million Israelis are vaccinated, but estimates are that at least four million Israelis will aim to be inoculated this year.
“People are really afraid of coronavirus and are saying that this time I am going to get it [vaccination], even if they did not get it in past winters,” he said.
Bar-Shai added that some experts believe that the additional vaccinations, coupled with following Health Ministry regulations such as wearing masks and social distancing, could help slow the spread of general respiratory infections this year.
“There are two opinions,” he said. “One opinion is that there will be a lot of patients with flu and coronavirus, and that the hospitals will be overcrowded with patients. The other opinion is that in the end it could be an easier winter.
“I want to be optimistic.”