Analysis

Israel’s Healthcare System Isn’t Ready to Cope With Coronavirus

System already stretched to the limit by flu. Meanwhile, the world is failing to cooperate to tackle the epidemic, making things worse

Ronny Linder
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Tourists from Korea wearing protective masks at the Ben Gurion airport near Tel Aviv, Israel, February 24, 2020.
Tourists from Korea wearing protective masks at the Ben Gurion airport near Tel Aviv, Israel, February 24, 2020.Credit: Ariel Schalit,AP
Ronny Linder

Over the weekend the world realized that the hope of controlling the spread of the coronavirus and containing it by identifying the sick and by quarantines has failed.

There has been no shortage of disinformation, confusion and cover-ups, but the numbers of infected outside of China has started to rise quickly. Bodies like the U.S. Centers for Disease Control and the World Health Organization are now talking openly about the transition from containment to pandemic.

In Israel, the affair of the pilgrims from South Korea, many of them having since tested positive for COVID-19b after traveling the length and breadth of Israel and the West Bank, is very worrying news. If they were already ill with the coronavirus while they were in Israel, as the Health Ministry suspects, it will be difficult, if not impossible, to effectively identify all of those who came into contact with them and put them in quarantine.

Here are some notes on the unfolding crisis:

A sick healthcare system: The assumption that a coronavirus epidemic numbering tens or hundreds of thousands of Israelis would be a challenge to the healthcare system is an understatement. The system already is at the point of zero reserve capacity – in other words, during an ordinary winter flu season, internal medicine wards are filled to capacity – or even beyond, meaning patients are treated in corridors.

Even today intensive care medicine is often given in ordinary wards rather than in ICUs, because of limited budgets and too few beds. The public healthcare system suffers a persistent shortage of doctors and nurses.

You don’t have to be a healthcare expert to understand what will happen if on top of the usual pressures of flu season, the hospitals have to deal with tens of thousands more sick people. Even if many of them can be cared for in separate facilities outside the hospitals, there aren’t enough healthcare professionals to care for them.

The combination of a disease that’s not fully understood, the large numbers of sick and a healthcare system stretched to the limit means the system won’t function in a crisis. The “zero reserves” system it now operates under isn’t a testament to its efficiency but a danger to public health.

That said, it is important to remember that as of now, 80% of those with the coronavirus have relatively minor symptoms and it hasn’t caused deaths among children or the young.

Every country for itself: Global politics has proven to be an obstacle to controlling the virus. That includes countries that lost valuable time preventing it by not closing their borders with China out of fear of angering their giant neighbor, and others such as Iran, it seems, that concealed the presence of the virus from their people, preventing measures from being taken to control it.

A man wears a face mask as he visits the Western Wall, the holiest site where Jews can pray in Jerusalem's old city, on Sunday, February 16, 2020.
A man wears a face mask as he visits the Western Wall, the holiest site where Jews can pray in Jerusalem's old city, on Sunday, February 16, 2020.Credit: Ariel Schalit,AP

The fact that no international organization took responsibility for the growing problem, even by taking modest steps like using guidelines or recommendations, has only made the situation worse. A good example of that is the corona cruise ship Diamond Princess, which turned into a giant petri dish where a fifth of its passengers became infected.

The return of the Diamond Princess’ passengers to their 15 home countries after the quarantine period ended is a sensitive issue from the perspective of epidemiology. It was supposed to be like a military operation – systematically planned and organized.

In fact, every country involved did as it chose. Japan, for instance, released thousands of travelers even though it was clear that many of them were expected to show symptoms later (which in fact happened).

It may be a cliché, but epidemics don’t recognize borders and don’t distinguish between nations and governments. When there isn’t any coordination, the chances of controlling it fall dramatically.

The economic impact: The coronavirus has already inflicted severe damage to the world economy. In our interconnected age, a global epidemic doesn’t just affect the physical health but the supply chain of manufacturing and distribution and forces millions of people to shut themselves into their homes or hospitals. That impacts on the lives of many more people than the epidemic itself.

The world is today highly reliant on raw materials, components and finished goods from China in almost every sector. China is the world’s factory and its paralysis over the last few weeks – and the uncertainty about when it will return to normal business – is being felt all around the world.

The tourism industry is the most prominent victim, but so are sectors like apparel and automobiles. Rising unemployment and perhaps a recession will follow. That portends a second-wave public sector health crisis from lost income, an impact that will be felt first by the world’s most vulnerable people.

Whom to believe: The public’s faith in their governments and policies has come to the fore with the coronavirus. Conspiracy theories and the spread of falsehoods, whether by intention or accident, are now in full flower. Troll the internet and you can find people insisting that the coronavirus was caused by a leak from a Chinese biological warfare institute in Hubei Province, where the epidemic originated.

It’s this kind of distrust in official institutions that has animated the global anti-vaccination movement (which raises an interesting question about how anti-vaxxers will respond when a COVID-19b vaccination is developed). The distrust is also expressed in many people’s refusal to follow the instructions of the authorities and the sense many feel that they have been abandoned to their fate.

The upshot could be to make things worse, if there isn’t enough cooperation on the part of ordinary people for quarantine and other measures and the epidemic spreads needlessly as a result.

A tourist from South Korea at theBen Gurion airport, Israel,  Feb. 24, 2020
A tourist from South Korea at theBen Gurion airport, Israel, Feb. 24, 2020Credit: Ariel Schalit,AP

In connection with the efforts to contain the spread of the coronavirus, Israel is taking dramatic steps compared to most countries.

Health or diplomacy: Israel was the first to close its border to Chinese citizens and the only one to tell citizens returning home from Japan, Thailand, Singapore, Hong Kong and, lately, South Korea, to quarantine themselves. It has barred citizens from these countries from traveling to Israel.

These measure have caused officials on the Foreign Ministry and in embassies overseas to warn that Israel will pay a diplomatic price for many years to come. For its part, the Health Ministry insists that public health takes precedence over diplomatic considerations. The steps needed to block or at least reduce or delay the coronavirus from reaching Israel is worth the price of a little inconvenience.

Voting and the virus: At this stage, next week’s election in Israel and the spread of the coronavirus are two separate issues. But that may not last much longer.

The pace of developments with the virus have been quick and often unexpected. It’s difficult to predict how many Israelis will be quarantined by next Monday and if they will be able to vote,

The right of the quarantined to vote is a small problem next to a scenario where voters or even poll watchers are barred from polling places. The path from that to a wholesale disruption of the election process isn’t very long.

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