Coronavirus: The truth about Israel's ventilators

Medical personnel are concerned that Israel could soon look like Italy or Spain.

Medical workers in protective suits treat patients suffering with coronavirus disease (COVID-19) in Rome, Italy (photo credit: GUGLIELMO MANGIAPANE / REUTERS)
Medical workers in protective suits treat patients suffering with coronavirus disease (COVID-19) in Rome, Italy
There are only 2,864 ventilators available in Israel, including those that belong to the Israel Defense Forces, for what are expected to be 5,000 critically ill coronavirus patients who require artificial respiration.
Medical personnel are concerned that Israel could soon look like Italy or Spain, where the number of patients requiring respiration has significantly exceeded the number of machines available, and doctors are faced with the difficult choice of who to ventilate.  
“At some point we could have to avoid intubating and ventilating patients with a very poor prognosis,” said Dr. Tal Brosh, head of the infectious disease unit at Samson Assuta Ashdod University Hospital and a member of the Health Ministry committee that evaluates the coronavirus threat in the country. 
He gave the example of a 90-year-old with severe COVID-19 being admitted to the hospital alongside a 50-year-old patient. In the case of a ventilator deficit, the doctor would most likely choose to connect the younger patient, “who can be saved with that ventilator,” as opposed to the older person, who will stay connected to the machine for two or three weeks but likely still pass away. 
“Now, we don’t have so many severe cases,” Brosh stressed, but he said this ethical dilemma could be closer than we might think.
As of Monday morning, there were 74 patients in serious condition – more than double the number of critically ill patients just one week ago. Of those, 59 people are intubated. In total, 4,247 people have tested positive for the virus, and 16 people have died. 
“Ventilators are the most important thing in the fight against coronavirus,” MK Ofer Shelah (Yesh Atid), chairman of the Knesset Coronavirus Committee, said in a meeting on Monday. He accused the Health Ministry of failing to take proper responsibility for the procurement of the machines in a fast enough and efficient way. 
The country has ordered some 11,000 ventilators, but “not all of them will arrive on time” to meet the needs of Israel’s sickest patients, the Health Ministry’s Dr. Orly Weinstein, who is responsible for the purchasing of such equipment, said Monday. 
Specifically, she said Israel has ordered 11,000 ventilators, 7,400 monitors and 21,000 pumping systems. But many of those orders, which were only made on March 13, are on backorder and not expected to arrive soon. 
It was revealed last week that the Health Ministry was aware as early as January 20 that the coronavirus was likely to penetrate Israel but took little action. 
“There is a belief that the systems will arrive at the same time as or after the people who need them,” Weinstein said. “We currently have 1,400 available machines in hospitals and another 400 that are being transferred to hospitals from external emergency medical centers and 70 from the private sector.”
This number is added to the 800 to 900 units that Health Ministry director-general Moshe Bar Siman Tov said could be obtained from the army to reach the nearly 3,000 ventilators now available. 
Furthermore, Weinstein said 2,000 to 3,000 ventilators are slated to be produced in Israel within the next two months. One company delivered 27 on Sunday.
AVI BUSKILA is president and CEO of Sarel, which has been hunting down the gear Israel needs to fight the coronavirus. Locally, one company has been producing about 60 units per month and in a few weeks is expected to produce as many as 600 a month, he said. His team has received referrals from private companies and is considering those purchases, but so far most of the suppliers cannot commit to exact delivery dates, he added. 
On Monday, it was revealed that the Mossad brought a few dozen ventilators to Israel as well.
“I was a member of the Secret Service Subcommittee for six years,” Shelah said. “I know the institution’s capabilities well, and we don’t have the Mossad to deliver 30 ventilators.”
The country has earmarked NIS 4.7 billion to fight the coronavirus; more than NIS 3b. of that is specifically to purchase ventilators and protective gear for medical staff. However, as Shelah said, it is unclear whether the country will be able to use the money to obtain needed equipment. Moreover, he said the Health Ministry’s “inept management” could mean that when the ventilators do arrive, they will not be used properly.
“We have found that the relevant parties in the Health Ministry… cannot even provide basic figures such as how many ventilators we are expected to have in one week, two weeks or a month,” Shelah said at the committee meeting. “Critical components, such as basic raw materials for domestic production, are lacking, and there is no real certainty as to when the machines will arrive. Even the 900 machines from the IDF… have not yet been allocated for the time when we will need them.”
THERE IS an especially acute problem with ventilators in certain areas of the periphery and Jerusalem, MK Jaber Asakla (Joint List) said Monday. 
“In Nazareth, the situation is dire,” he said. “There is one children’s hospital with only one ventilator and in other hospitals only a handful of others.” 
The Galilee Medical Center in Nahariya, which serves about 500,000 residents, has only 30 ventilators; Hadassah-University Medical Center in Jerusalem’s Ein Kerem reported only 55; and the capital’s Shaare Zedek Medical Center only 100, Ynet reported.
In the South, there are significant gaps between Ashkelon and Ashdod: Barzilai Medical Center, which serves some 140,000 residents of Ashkelon, Sderot and Gaza, has 114 ventilators; Assuta Ashdod Medical Center, which serves some 220,000 residents and several thousand people from the surrounding area, has only 56 ventilators. Soroka Medical Center in Beersheba, which serves more than 200,000 residents and thousands of Bedouin, has 191 ventilators. 
The hospital with the highest number of ventilators in Israel is Sheba Medical Center in Tel Hashomer with 250 machines, according to Ynet.
ASSUTAH’S BROSH told the Post he does not think the current trajectory puts Israel at risk for becoming Italy unless certain communities, such as the ultra-Orthodox sector, fail to practice social distancing. 
“Our trouble is coming from these communities,” he said. “It could spike very quickly.”
But he also cautioned that the public should not see ventilators as the miracle and sole solution to the coronavirus crisis. 
“You cannot just take a patient, connect him to a ventilator, and that’s it,” Brosh said. “If you take someone and just connect him to a ventilator, he will die.”
A person who is ventilated needs around-the-clock care and must be monitored by nursing and other professional staff to prevent ventilator-associated infections and lung damage, which the country currently lacks, he said. Coronavirus causes extensive damage to one’s respiratory system, and most people, even those who will have a full recovery, will require weeks of care, he added. 
As the country is working to procure more ventilators, Brosh said it is concurrently training more medical staff to treat ventilated patients.
Israel does not have enough beds in intensive-care units that can accommodate ventilated patients, and there is a concerted effort in all hospitals to increase capacity for coronavirus patients, he said.