World Health Day was established in the same year as the founding of the State of Israel, 1948. However, this year, the year after a year of COVID-19, the day has taken on new meaning.
According to Prof. Sigal Sviri, director of the medical intensive-care department and the COVID-19 intensive-care unit at Hadassah-University Medical Center in Jerusalem’s Ein Kerem, 2020 was a year of learning new processes, studying new treatments and training new staff to serve in a time of crisis.
Hadassah is located in Jerusalem, the city that almost consistently had the highest number of active cases nationwide. The hospital admitted 4,500 patients last year, 10% who were admitted to the ICU.
In honor of World Health Day, Sviri offered seven lessons learned during the pandemic:
1. Be flexible
“The greatest challenge when dealing with an ongoing mass-casualty event that really was a year long is that the influx of patients was not steady,” Sviri said.
She said that some days Hadassah had 30 COVID-19 patients and other days 150. To manage it, the ICU management learned to increase and decrease beds almost overnight, pulling staff from other departments as needed.
2. Treat, test, treat differently
Another challenge was that doctors and scientists did not know anything about COVID-19 before it arrived, and treatments and other guidelines needed to adjust rapidly “to be very careful not to treat patients in any way that won’t work or, worse, could cause harm,” Sviri said.
Staff received regular updates from management, the microbiology department and the Health Ministry that included the latest publications and recommendations from all over the world, she said.
“Most of the drugs we started giving in the beginning, we stopped giving by the end,” Sviri said, adding that the hospital maintained ongoing research and analysis during the pandemic. “There was not a lot you could do for people who already came in with a critical illness and multi-organ failure… It was frustrating because you want to give or do something.”
3. Invest in the ICU
Before the pandemic, the value of intensive-care units was “underestimated by decision-makers at all levels,” including hospital managers, health ministries and governments all over the world, Sviri said.
“ICUs are expensive to maintain,” she told The Jerusalem Post. “This pandemic increased the realization that without the ICU we cannot save lives; we just cannot.”
4. Elective care is not optional
At the peak of the pandemic, Hadassah’s patient load increased by 66%, and while doctors and nurses were being transferred to support COVID-19 patients, the hospital strived to maintain regular activity everywhere else, Sviri said.
“Patients who have cancer or need surgery for other reasons were in danger of being neglected or developing complications because they were not receiving timely treatments or procedures,” she said. “If you do not retain elective activity, you get collateral damage. People die or become very sick because they were not treated in time.
5. Train the next generation
One of the reasons it was so challenging to maintain a standard of care for patients who did not have COVID-19 was lack of staff. In Israel, specifically, many doctors are getting older and are retiring, and there is a steep shortage of nurses, especially critical-care nurses, Sviri said.
“We need to train doctors and especially nurses to treat clinically ill patients,” she said.
Hadassah opened a second critical-care nursing course this year to prepare teams for the future. In addition, during the pandemic, the hospital started a mentoring program whereby a critical-care nurse would work an eight-hour shift with a non-critical-care nurse and train the nurse during the shift.
“We really took it upon ourselves to increase the reservoir of nurses who can treat complicated cases,” Sviri said. “Who knows how long we are really going to live with COVID?”
6. Families matter, too
In the beginning of the pandemic, hospitals were so focused on treating COVID patients, they forgot about their loved ones.
Family members were unable to visit their loved ones in the ICU due to the risk of infection. This left not only the patients but also their relatives feeling alone and disconnected. So many patients died with no one to come and say goodbye.
Eventually, Hadassah and other hospitals developed systems to better communicate with family members, including phone calls from nurses and doctors, as well as bringing iPhones or iPads around the ICU to allow for video calls between loved ones.
Moreover, some hospitals, including Hadassah, found ways to allow family members into the ICU. At Hadassah, each family was given a time slot to come and visit, Sviri said. Staff would help them dress in personal protective gear and enter the ward.
“This was a tremendous effort, and it took a lot of time,” she said. “We did it because it was important.”
7. Success is achieved by working together
Sviri said that everyone at the hospital worked together – management, teams from different medical and paramedical departments, infrastructure, medical engineering, purchasing and all other support systems.
“We worked in unison, supporting each other,” she said. “This was one of our greatest achievements.”