“Virtually overnight, we upped MDA’s 101 hotline from shifts of 30 people to 300,” says MDA’s medical director, Dr. Refael Strugo. “In the nine months of the pandemic, our teams have swabbed some 2.5 million people for the virus. The record day was September 29, when we collected samples from 34,027 individuals; we’ve increased our salaried employees from 2,100 to 4,000; converted our ambulances to ferry 200 to 300 coronavirus patients a day; contributed to the Ministry of Health’s Covid-19 initiatives; and continued our everyday work of responding to emergencies and collecting blood.”
If no one anywhere was prepared for a lethal global pandemic, MDA was among those who mobilized faster and more effectively than most. “It’s customary for MDA to be called to the flag in times of national need, even for emergencies that aren’t purely medical,” says Dr. Strugo. “Critical in enabling us to step up fast to Covid-19 were two dedicated groups of people: our 25,000 trained volunteers, who were with us within hours; and American Friends of Magen David Adom (AFMDA), who immediately launched a Coronavirus Emergency Campaign.”
Swift Covid response
“From the start of the pandemic, we have taken on three major tasks to prevent Covid-19 patients swamping Israel’s clinics and hospitals,” says Strugo. “One is the hotline. While other health bodies were quickly overwhelmed by the volume of calls, MDA answered its phones. The second is transporting virus-positive patients, usually from home to hospital and hospital to home, in converted ambulances where special partitions protect the drivers. The third is testing for the virus.
“It was clear to us all that it’s safer to test at home, so we send MDA paramedics in full protective gear to take throat and nasal swabs at home from those who are symptomatic,” Dr. Strugo explains. “The Ministry of Health originally projected we would sample only around 20 people a day. With the numbers quickly climbing to a daily 30,000-plus, we had to react on the hoof. As well as going to homes, we have set up Drive & Test and Walk-Through centers, as well as a facility at Ben-Gurion Airport for travelers.”
MDA is also developing a new model of EMS care, whose urgency is underlined by the pandemic: telemedicine. “Even before coronavirus changed the world, we were moving away from our ‘scoop and run’ approach — which brings patients rapidly to the hospital with minimal pre-hospital intervention — to treating them at home whenever possible,” says Dr. Strugo. “During the past five years, AFMDA has been helping us acquire the monitors and communications equipment that enable field teams to consult with specialists remotely, and to train our medics and paramedics in telemedicine.”
Continuing to collect blood
The emergency medicine services are inevitably dominated by the virus, but the range of other acute health needs have far from disappeared. “At the outbreak of the pandemic, I was panicked that our blood bank could run low,” says Prof. Eilat Shinar, MDA’s director of Blood Services since 1997. “Covid-19 isn’t a hematological disease, but births, accidents and surgeries don’t stop while it rages. Without a safe, secure and sufficient blood supply, Israel’s very existence is threatened.”
In normal times, MDA collects, tests and distributes 97 percent of Israel’s blood supply, and 100 percent of that used by the IDF (Israel has no designated military blood bank). With the virus closing down, locking down or quarantining many workplaces, high schools, yeshivas, IDF bases and more places where MDA bloodmobiles regularly collected blood, new solutions were needed. “We approached neighborhoods, kibbutzim and moshavim, and took our bloodmobiles there instead, along with the Ministry of Health’s permission for donors to come out to us,” says Shinar. “People were at home in lockdown, and they wanted to help. We have also collected over 10,000 units of antibody-rich plasma from convalescent Covid-19 patients, which hospitals are using to confer passive immunity in acute coronavirus patients.”
Israel’s National Blood Services center, an MDA division created in 1987, stores, tests and processes some 280,000 liters of blood — along with plasma and, since August, human breast milk. Located in the Tel HaShomer complex near Tel Aviv, the center’s construction was funded by AFMDA and was hailed at the time as a marvel of modernity. Some 35 years on, times are much changed. Israel’s population has grown from 4.4 to more than 9 million (and, pre-Covid-19, welcomed more than 3 million tourists a year). This, together with medical advances, means that 72 percent more blood units than in 1987 must be stored for daily needs, mass casualty events, national crises and wars. The building is bursting its seams, with no space to expand technologies, for research labs or for the blood archive, nor any flexibility to respond to unexpected blood-service needs. It is also vulnerable to threats that scarcely existed 35 years ago: it fails to meet Israel’s earthquake-resistance building code; it is exposed to cyber, chemical and biological attack; and, with Hamas and Hezbollah rocket fire now able to reach any part of Israel, it is also within range of conventional missiles.
“During the 2014 conflict with Gaza, all 200 lab technicians and phlebotomists worked from a tiny underground shelter for 42 days, having dragged the large, heavy machines down with them!” says Shinar. “Conditions were desperate. That must not happen again. An appropriate blood services center is vital for the State of Israel.”
New National Blood Services Center
Once again, AFMDA has stepped up, pledging to meet virtually the entire cost of the new $130 million Marcus National Blood Services Center, named for Home Depot co-founder Bernie Marcus and his wife, Billi. (There is currently a $20 million shortfall.) Its cornerstone was laid in 2016 on a weed-strewn 5.5-acre lot in Ramle in central Israel, donated by Israel’s government. Construction began the following year.
Shielded from both conventional and nonconventional attack, three of the new Blood Services Center’s six stories will be underground — the lowest reaching a depth of 50 feet. It will have four dedicated electric generators, and 90 anti-blast doors. Its upper floors are for offices, a cafeteria and an auditorium, as well as MDA’s national medical logistic facilities and national blood group reference labs. On those below ground, blood will be processed and stored, and new technologies developed to improve blood quality and safety. These floors will also house Israel’s only non-commercial cord-blood bank and its human milk bank. The current building at Tel HaShomer will be a reserve.
“The new building will allow us to work uninterrupted at all times, including during natural and man-made disaster,” says Shinar. “It will enable us to meet the demands of a population expected to top 10 million by 2039, to serve Israel’s 32 hospitals, and hold a daily emergency capacity of 3,300 blood units, and a total 500,000 units — almost double today’s 280,000.”
Shinar, who confesses herself an optimist, is hopeful that MDA will move into the building this coming summer. My dearest wish,” she says, “is that, by then, we’ll be able to inaugurate our new center with those who have made it possible — MDA’s American Friends.”
Most experienced in the world
As with so much else, Israel has put its own distinctive stamp on its equivalent to a national Red Cross society. Magen David Adom (MDA) was created in 1930 by a nurse named Karen Tenenbaum in response to the bloody riots of 1929. Designated 20 years later as the newborn country’s national emergency response and disaster relief service, it has grown from a one-room shack in Tel Aviv into the world’s most experienced mass-casualty response organization.
MDA has 30,000 professional medical emergency responders and volunteers, a national blood bank and a fleet of 1,200 ambulances and mobile intensive care units, which log nearly 10 million miles a year with some 832,000 patients aboard. It also sends teams worldwide to help out in times of disaster (such as earthquakes and floods), and in war it becomes an IDF auxiliary.
Despite its official mandate, however, MDA is not a government agency and exists in part on private contributions. Its American Friends are at the forefront here, funding not only year-round training, supplies, infrastructure and emergency vehicles, but also the lion’s share of two monumental projects currently underway. One is the coronavirus emergency, for which AFMDA has enabled protected transportation and the vastly extended call center, but also urgent development of MDA’s telemedicine capability. The other is construction of a state-of-the-art Marcus National Blood Services Center to replace Israel’s vulnerable, overwhelmed and outdated facility.
For more information about American Friends of Magen David Adom, go to http://www.afmda.org