Emergency rooms and internal medicine wards in Israeli hospitals were exceptionally overcrowded over the past few days as hospitals struggled to cope with treating winter illnesses, with one Tel Aviv ER forced to operate at 350 percent of capacity.
February is traditionally considered the peak season for overcrowding in hospitals because of seasonal illnesses, but this year the crowding is even heavier. Over the past few days, many hospitals have reported exceptionally crowded conditions. As a result, many patients are being forced to wait a long time for treatment and hospitalization, some waiting for more than 10 hours in emergency rooms.
The high levels of hospitalization are mostly the result of seasonal winter illnesses among older people – for example, flu or pneumonia. The overcrowding has been getting worse year by year, however, because life expectancy is increasing and there are more elderly patients, while the number of beds available for hospitalization and the number of staff has not changed, said sources in the health system.
The emergency room at Sheba Medical Center, Tel Hashomer, was filled to 350 percent of capacity over the past 24 hours (based on the number of staff, infrastructure and existing hospital beds). Hadassah University Hospital in Jerusalem was running at 200 percent of capacity in the emergency rooms and 140 percent in the internal medicine wards. In Haifa, Rambam Medical Center was operating at 140 percent in the emergency room, with 106 patients spending Sunday night there. Eighty of these patients had been in the emergency room for more than 10 hours because no empty beds were available for them in the wards. Rebecca Sieff Hospital, Safed; Wolfson Medical Center, Holon; and Poriya Hospital, Tiberias, were also at over 100 percent of capacity.
“We are constantly monitoring illnesses and feel an increase in seasonal flu, but it is not the only reason for the overcrowding,” said Prof. Shimon Reisner, deputy head of Rambam. “On Sunday, we accepted a huge group of people with various illnesses in the emergency room – from oncology patients, neurosurgery patients and cases of injuries, alongside other patients with complications, some of whom were transferred to us from other hospitals.”
Normally the hospital works at its limit, but when you add 20 percent to 30 percent more patients, this is exceptional, said Reisner. There are now 960 patients in Rambam, including over 90 on respirators – which is also extraordinarily high.
The number of hospital beds per 1,000 people in Israel is only 1.88, far lower than any European or American standard, and the only solution is to add beds, added Reisner.
Winter is the worst season because of flu and flu-like diseases, which hit older patients particularly hard and they fill up the hospitals’ emergency rooms and internal medicine departments. “I believe that at least part of the overcrowding stems from the seasonal flu that has arrived. The rest of the load is a result of a combination of coincidental events,” said Reisner.
Two weeks ago, Haaretz reported that the Health Ministry was preparing for a particularly severe flu season this winter.
The main reason this year’s flu season is expected to be especially severe is that the flu vaccine has proven ineffective against one of the year’s most common strains of flu. According to a statement released last month by the United States’ Centers for Disease Control and Prevention, this particular strain of the H3N2 virus underwent a mutation that makes it resistant to the vaccine. As a result, CDC experts said, the vaccine reduced the risk of getting a severe-enough case of flu to require a doctor’s visit by only 23 percent this year, compared to an effectiveness rate of 60 to 90 percent in normal years.
The local flu season is only expected to reach its peak this month, and to spill over well into March.
In preparation for the unusually severe flu season, the Health Ministry has taken the exceptional step of giving health maintenance organizations the antiviral drug Tamiflu at no cost, so they in turn can prescribe it for free to patients who need it. Normally, Tamiflu is available for free only at hospitals. But because more flu cases than usual are expected this year, the ministry decided to allow the HMOs to administer the drug as well and avoid excess hospital visits.
Flu can produce severe complications and even be fatal, especially for people in the main risk groups – babies, the elderly and people with weak immune systems. Consequently, in light of the vaccine’s reduced effectiveness, the ministry decided to dispense Tamiflu to the HMOs as well so it could be given to people who weren’t vaccinated or for whom the vaccine didn’t work. The drug is most effective when administered in the early stages of the disease, preferably in the first 48 hours after symptoms appear.