More Israelis died from COVID-19 due to hospital overload – study

“The mortality of hospitalized patients with COVID-19 in Israel was associated with health-care burden, reflected by the simultaneous number of hospitalized patients in severe condition."

Shaare Tzedek coronavirus unit (photo credit: MARC ISRAEL SELLEM)
Shaare Tzedek coronavirus unit
(photo credit: MARC ISRAEL SELLEM)
More people died of COVID-19 in Israel because hospitals struggled to manage the heavy workload, according to a new Israeli study published over the weekend in Nature.
“The mortality of hospitalized patients with COVID-19 in Israel was associated with health-care burden, reflected by the simultaneous number of hospitalized patients in severe condition,” according to the report that was written by a joint group of researchers from the Weizmann Institute of Science, the Technion Israel Institute of Technology, Rambam Health Care Campus and Tel Aviv University.
Among the team was Weizmann’s Prof. Eran Segal, a computational biologist, who has been at the forefront of creating models for predicting the spread of coronavirus. The report was officially released on Friday.
So far, around 6,180 Israelis have died of COVID-19. January 2021 saw the highest number of COVID-19 patients die in a single month.
The researchers used a model that had been trained and validated both during the earliest stages of the pandemic on more than 2,700 patients and again on nearly 6,000 individuals between July 15 and September 8, 2020. The latter period was defined as Period I.
It then looked at three other periods, including two periods of moderately high levels of COVID-19 hospitalization.
Periods II, III and IV were between September 9 and January 20. From September 9-October 28 (Period II) and December 15-January 20 (Period IV), the daily number of severe or critical patients topped 500.
The periods of time align with government regulations.
THE FIRST COVID-19 patient was diagnosed on February 21, 2020 and Health Ministry regulations were immediately rolled out. Restrictions were relaxed in May and the number of new daily cases began to spike.
By September 10, Israel had become the country with the highest rate of COVID-19 infection per capita worldwide – “the second wave” – and tough restrictions were once again put in place, leading to a decline in hospitalizations.
But 30 days later, as restrictions loosened, cases once again increased until early January where cases spiked so high – “the third wave” – that a third lockdown was imposed.
The Health Ministry had said that the hospital system could manage up to 800 serious cases before breaking down under the burden, but the report found that “the increase in hospital workload was associated with quality of care and patient mortality.”
Fourteen-day mortality rates were 22% higher mid-September to mid-October and 27% higher mid-December to mid-January than the model predicted. In the interim period, between waves two and three, the number of COVID-19 deaths reverted to match the predictions as the patient load subsided.
In other words, “Even under moderately heavy patient load, in-hospital mortality rate of patients with COVID-19 in Israel significantly increased compared to periods of lower patient load,” the report said.
“The increase in observed mortality was evident despite the fact that throughout the pandemic, clinical experience in treatment of COVID-19 patients increased, along with a better understanding of pharmacological and non-pharmacological treatment modalities that may be beneficial for the patients.” it said.
“We postulate that the excess mortality is likely due to the rapid escalation in the number of hospitalized patients with COVID-19 during these time periods in Israel, which may have resulted in an insufficiency of health-care resources, thereby negatively impacting patient outcomes.”
Segal told The Jerusalem Post that the team chose to evaluate the situation on a national level and not by hospital because “this gave us more statistical power for doing the analyses.”
He also said that the team is unsure why hospital overload resulted in increased mortality and that it could not be pegged to any one challenge, such as overburdened staff of spacing.
“There could be many reasons,” he said, “but certainly from our analyses during these high load times, there was a higher probability of dying even [when] conditioned on the same age, hospitalization status and gender of the individual.”
The median age of the patients during the study was 63, of which 49% were female and 51% male.
IN MID-JANUARY, at the peak of the fourth wave, a 47-year-old father of five from Tel Aviv, Moshe Harazy, died when his ventilator’s breathing tube detached and staff in the coronavirus intensive care unit at Tel Aviv Sourasky Medical Center did not catch it in time.
“I will not lie – the heavy caseload is taking its toll,” Prof. Ronni Gamzu, the head of the hospital, said at the time.
On the day Harazy died, there were nearly 2,000 people being treated in Israel’s hospitals, including more than 1,200 in serious condition, among them 272 who were intubated.
Recall, Israel entered the coronavirus crisis with the highest hospital occupancy rate of any country in the Organization for Economic Cooperation and Development (OECD). Israel also had by far the highest number of people dying from infectious disease per capita in the developed world – some 73% more than the No. 2 country, Greece.
“I think [the study’s findings] are completely in line with the high mortality rate we have seen from infectious disease in past years,” Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research and a Tel Aviv University economist, told the Post Sunday night after reviewing the study.
The researchers did say there could be other explanations that could account for the increased mortality. For example, during peak periods, there could have been a more virulent strain of the virus circulating in Israel. However, they said, there is no evidence for such a strain.
“Our study highlights the importance of quantifying excess mortality in order to assess quality of care and define an appropriate carrying capacity of severe patients in order to guide timely healthcare policies and allocate appropriate resources,” the report concluded.