Israel’s inability to handle coronavirus known before pandemic arrived

Israel's inability to handle a pandemic crisis was known prior to the global outbreak of the coronavirus, according to information published Monday by the State Comptroller.The report focused on the possibility of an influenza pandemic but showed that Israel was not ready to fight any pandemic, including the novel coronavirus, while highlighting the country’s lack of strategic planning. “Before the outbreak of the current pandemic, hospital occupancy rates in Israel were already the highest in the developed world, while its mortality rates from infectious diseases, which doubled in the past two decades alone, are not only higher than in every other developed country, they are 73% higher than the second-ranked country,” said Prof. Dan Ben-David, president and founder of the Shoresh Institution for Socioeconomic Research and a faculty member at Tel Aviv University’s Department of Public Policy. The healthcare system has been under-budgeted for many years, medical staff and all other resources were overloaded even before the pandemic,” added Dr. Yotam Rosner, head of Information, Research and Development for Physicians for Human Rights. “So, we are not fully prepared to handle the coronavirus.”In general, the state comptroller report highlighted the lack of intensive care beds, medical staff and equipment, which would enable effective treatment in the case of a pandemic, and bolster capabilities to manage other major outbreaks. It also showed that hospitals are overcrowded year-round.The prime minister was quick to respond that the report is irrelevant to the current coronavirus outbreak, “as there has been no such event in the last century and no country in the world could have predicted or prepared for the spread of the virus,” while claiming that under his tenure the health system in Israel has been “significantly improved.” But Rosner said that the report “sheds a bright light on Israel’s unreadiness for this epidemic.” He said that some people have referred to the novel coronavirus as a “black swan,” though the coronavirus is not one. Rosner said that these types of epidemics occur in cycles around three times each century and health professionals know that. “The report acknowledged that the system is overloaded, which we have said many, many times and means that there are no reserves whatsoever in hospital beds or ventilation machines and which means that effectively when we do have address this pandemic, everything else has to be stopped and delayed because now you need to direct all your medical staff toward this pandemic.”Israel quickly postponed all voluntary medical procedures and cancelled any non-essential surgeries or other health visits. Moreover, Rosner explained that public healthcare does not center only around hospitals and clinics but also preventative medicine, public awareness and health literacy, all of which the report indicated were challenges. For example, the report indicated that during the recent global measles outbreak in 2018-2019, Israel had the seventh highest morbidity rate worldwide. Some 60% of 4,300 infected individuals were children aged up to nine years old. Three Israeli citizens died during the outbreak.Moreover, following a growing trend of anti-vaccine sentiment, the Health Ministry estimates that a total of 1.1%-1.7% of the population is not vaccinated against measles today, compared to 0.6% in 2011. During the recent measles outbreak, among infected patients aged between two and 19 years old, at least 49% were children of vaccine refusers. Half of all those infected were residents of Jerusalem, of which 80% were from the ultra-Orthodox Jewish community.Rosner said that communication between all minorities and subcultures and the Health Ministry is lacking and therefore all the populations that are in the periphery of society were even less prepared and the government is struggling to obtain their adherence.  “The level of health literacy is low, which means they are not following the guidelines, even ones that are crucial for them to follow,” Rosner said. “Their level of accessibility to the Health Ministry and their ability to prepare for quarantine is very low.”For example, quarantine requires that people have a separate room for anyone infected or potentially infected, which does not exist for many communities and it is unclear what alternatives exist for them.Many in the Haredi (ultra-Orthodox) and Arab communities have ignored government directives to remain at home and police have been used multiple times to break up large gatherings by members of these communities. Rosner said that there is “no strategic planning in healthcare” and he compared it to the Defense Ministry, which recently released a five-year strategic plan that consists of its vision and goals.  “One of the reasons for that is that the budget is so small for the HMOs that they are already so overloaded and all of their financial resources are for the here and now and not for what is needed in five or 10 of 15 years, which could be a pandemic,” he said.According to Rosner, every year the HMOs have to appeal to the Finance Ministry for additional funding just to pay for their day-to-day operations.“Investing in a 10- or 15-year plan or innovation or infrastructure? It is almost difficult to imagine,” he said.  Health Ministry Direct-General Moshe Bar Siman Tov promised to “study” the comptroller report and learn from it. In the meantime, as Ben-David explained, “We shut the country down to deal with something that we neglected for decades.”