Magen David Adom: On the front lines of the war against coronavirus

Home Front: Answering the call

Magen David Adom worker test kit as he arrives for a patient with symptoms of COVID-19 (coronavirus), in Jerusalem on March 17, 2020 (photo credit: YONATAN SINDEL/FLASH90)
Magen David Adom worker test kit as he arrives for a patient with symptoms of COVID-19 (coronavirus), in Jerusalem on March 17, 2020
(photo credit: YONATAN SINDEL/FLASH90)
Israel is fighting a war without missiles, guns or Color Red rocket-warning sirens, said Dr. Shafir Botner, head of Magen David Adom’s paramedic education center. “Instead of a bomb, we have a virus.”
The coronavirus, also known as SARS-Cov2, produces the highly contagious COVID-19 disease. The Israel Defense Forces is powerless against the spread of this novel coronavirus.
“Magen David Adom is now the front line,” said Botner. “We’ve done war – this is harder.”
Welcome to the Magen David Adom dispatch center in the central city of Kiryat Ono, where 270 employees and even more volunteers answer over 80,000 calls per day from citizens afraid that they are sick with the potentially lethal virus or could become ill.
In the past, MDA answered around 6,000 calls per day at its various centers, which are located across the country. Some people still call because their elderly dad fell, they were in a car accident or their child is suffering from fever seizures, said call center employee Ofira Israeli. But now, “I would say that for every 50 calls, one is medical. The rest are about the coronavirus.”
It all started in February, when the Health Ministry contacted MDA chief Eli Bin and asked if the organization could assist by creating a hotline to deal with the virus by answering people’s questions and concerns.
When the hotline began, MDA staff worked side by side with ministry officials. If a civilian called the hotline who had been in contact with a coronavirus patient, and was suspected of being infected with the virus, or who had fever, cough or other respiratory symptoms, an MDA medic or paramedic would answer the call and determine whether to join a doctor or nurse onto the call, who would then decide how to proceed with medical care, including dispatching a MDA medic to administer a coronavirus test.
“We said yes and we started these two lines and trained about 170 people,” MDA spokesman Zaki Heller told The Jerusalem Post, pointing to a narrow row of buzzing computers on a line of white tables. Each computer was manned with an MDA staff member or volunteer sitting on a rolling chair.
Quickly, MDA and the Health Ministry recognized the inefficiency of the system, and MDA became inspired to determine whether the person needed testing, based on the criteria of the ministry. And just as fast, the hotline grew... and grew. Today, there are 500 paid employees answering coronavirus calls and three times that many volunteers.
“We get some crazy calls,” Heller said with a smile. One woman called from isolation explaining she wanted to get her hair done and wanted to know whether she could “just go to the barber.”
Another person phoned concerned that her neighbor’s Thai worker might have infected her just by living next door.
“People call because they have a fever or their baby has a fever and they are convinced they have coronavirus,” Heller said. “We are in the transition between winter and spring, and people in general are going to get viruses – not just coronavirus.”
At the time of this writing, there were slightly more than 500 Israelis infected with the novel virus. So far, no Israeli has died – yet MDA is receiving 80,000 concerned callers, Heller said.
“Most of these calls are spent calming people down and putting it all into proportion,” he noted.
Ofira Israeli was one of the first staff members to man the coronavirus hotline. She speaks Russian, English, Hebrew, Arabic and Spanish. She echoed Heller’s sentiments: “We get a variety of questions from all kinds of civilians and even tourists. For some it is, ‘What should I do if I have symptoms?’”
She said occasionally a call warrants action, such as dispatching medical care or sending someone into the field to test the person. More often though, “we are here to calm the mind of the people. They are more panicked than sick.”
Israeli shared about a call she received on the first day from a young mom who had locked her three-year-old in his room because he woke up with a cough.
“I asked her, ‘Did you go abroad?’ She said no. I asked her if they had contact with anyone who they knew had coronavirus, and she said no. But she had locked her child in a room,” Israeli recalled.
She asked to talk to the child, who cried to her on the phone: “I was not bad, why am I in this room?” Israeli recalled, with tears swelling up at the corners of her eyes. She said she ultimately convinced the mother to open the door.
Another time, she received a call from a 22-year-old man who had been clubbing in Tel Aviv and hooked up with two women he described only as Asian.
“He did not know where they were from, but said they had Asian eyes,” Israeli said. “Now, he was coughing. I asked him if he had intercourse with the women and, if so, if he used a condom.”
The man confirmed they had been together and that he had not used protection.
“He was not afraid of sexually transmitted diseases, but of coronavirus,” she said, her mouth agape.
Israeli said that over the years she has witnessed people trapped in their cars and little children with third-degree burns, but the coronavirus calls are even harder for her to digest.
“It is illogical. It is psychological,” she told the Post. “People have lost their minds.”
The environment at the dispatch center is friendly. Everyone wears the signature MDA shirt – white with a red logo. But the pace is fast and furious.
Each table is equipped with advanced technology that allows dispatchers to move fast. Heller said people come from around the world to learn about MDA’s technology, which was developed proprietarily by its own team of 40 programmers.
The system is in sync with first responders from 24 other mostly haredi (ultra-Orthodox) organizations, such as United Hatzalah and ZAKA. When a call comes in, the system immediately geotargets and MDA dispatchers can see the seven team members closest by. It can contact ambulances, ambucycles and those in civilian cars to respond in real time.
MDA manages 2,200 ambulances, 700 motorcycles and two helicopters. Some 30,000 people are involved with the organization – 2,500 paid staff and the rest volunteers from across the religious, gender and age spectrum.
The organization is responsible for carrying out the majority of coronavirus tests for the Health Ministry and has therefore been actively training new people to assist, including IDF reservists who had served as medics as well as approximately 700 medical students from five faculties across the country. The students are in the clinical phase of their studies, but class has been halted for the time being due to the coronavirus crisis.
“The training of about 700 sample takers in two days, while adhering to the gathering ban, is a huge challenge,” explained Botner. “Therefore, theoretical learning is being done remotely, with the help of technological means. This includes a dedicated app that was created overnight, which contains all the necessary learning material. Practical practice, which cannot be done remotely, will be carried out in small groups across the country.”
Some 500 15- to 18-year-old volunteers were also trained to answer phones.
Heller said that when the coronavirus first came to Israel, MDA did around 400 tests per day. That number first doubled, and now they are doing around 2,000 per day. Prime Minister Benjamin Netanyahu said he hopes to achieve as many as 5,000 daily.
Until now, only people who were in isolation were being tested for coronavirus, using a test known as the polymerase chain reaction, or PCR screening, which was invented in the US in 1983.
To administer the test, an MDA paramedic travels to the home of a potential patient. The paramedic then swabs the person's two nostrils and mouth and refrigerates the sample, which is then delivered to one of Israel’s five coronavirus testing labs.
This whole process takes about an hour and a half.
Next week, MDA is planning to roll out drive-through testing for the coronavirus. Individuals will drive up to large medical tents placed strategically across the country and be swabbed without having to leave their car.
This, said MDA medical director Refael Strugo, should allow for quicker testing – about two or three minutes per test – to see if someone is infected with the novel coronavirus. It would also allow the country to better determine how many people are really carrying the virus, since as many as 80% of patients are asymptomatic.
Moreover, the Hebrew website Ynet reported Thursday that starting Sunday the Health Ministry will allow Israeli clinics to test patients who have not been known to be exposed to the coronavirus. According to the report, the tests will be conducted in special clinics that are designed so that those visiting with a fever and respiratory symptoms will not infect others.
The specimens collected at these clinics could also help locate others who need to be isolated.
Heller said that in the beginning MDA volunteers were being ostracized for testing those potentially infected with coronavirus.
He related how one of his MDA volunteers took part in the mission to bring the Israelis who had been aboard the Diamond Princess “coronavirus cruise ship” from Ben-Gurion Airport to Sheba Medical Center, Tel Hashomer and was then ostracized by her workplace.
“She was so proud of it,” he said. “But the next day, when she returned to work, they sent her home and said they did not want her in the office.”
Slowly, he said, this has started to change.
Chief Bin has been in his role for 15 years. He said that he has “seen a lot” as the manager of MDA, from the Second Lebanon War to the "knife intifada," “but I do not remember so much need to answer so many calls so quickly."
“It challenges us,” he said. “We are really working around the clock.”
But he explained that he believes the coronavirus is preparing his team for any future national or other disaster.
“The coronavirus is showing the country what we are made of.”