Hospitals have begun scaling down surgery, canceling outpatient care and reducing the number of beds in internal medicine wards as pressure mounts to redirect resources to the growing number of coronavirus patients. A declining quality of care is already being felt in some departments due to the work load on intensive care and internal medicine.
On Monday, another 33 Israelis died of COVID-19, putting the death toll at 1,499, and 2,092 new cases were diagnosed, as the country paused for the Yom Kippur holiday. More than 1,500 people are hospitalized, and 763 are in serious condition.
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According to a report from the last few days by the so-called “barometer team” that keeps track of the situation in hospitals, about 10-15 percent of all emergency room beds and 40 percent of internal medicine beds in every hospital are being used to treat coronavirus patients. The burden is felt most on small and medium-size hospitals and in hospitals in areas at the center of pandemic outbreaks. For example, at Hadassah University Hospital, Ein Karem in Jerusalem, as of Monday morning, 112 coronavirus patients were hospitalized, 25 of them in serious condition. Out of 216 internal medicine beds, about 90 are occupied by coronavirus patients.
In Haemek Hospital in Afula, coronavirus patients now occupy 36 internal medicine beds. In the Western Galilee Hospital in Nahariya there are now 80 coronavirus patients in two expanded internal medicine wards, out of a total of six such wards. This number is expected to rise dramatically with the opening of an additional ward. In Shaare Zedek Medical Center in Jerusalem, 70 out of 200 internal medicine wards are now allocated to coronavirus patients.
There are currently 111 crowded internal medicine wards in all the general hospitals in Israel. The numbers of patients in these wards tends to spike and even double in winter. The coronavirus is quickly eroding activities in the internal medicine wards and today there is not one hospital that hasn’t allocated some portion, whether it be a quarter, a third or more, of its activities in the internal medicine wards to coronavirus patients. The burden on hospitals is compounded by the fact that COVID-19 patients requires longer hospital stays – between 12 and 15 days – compared to the average hospital stay of about four days for other patients.
All of this requires a quick emergency response by the health-care system, particularly hiring and training medical staff. The accumulated burnout of medical teams, increasing sickness and quarantines of medical personal is a cause of great concern to department heads, hospital directors and senior health-care officials. This is particularly worrisome since the number of infected people is still on the rise.
Last week the daily number of confirmed cases was more than 600 per million people. The number of hospitalized patients continues to rise, reaching 1,512 as of Monday morning. The number of seriously ill patients is inching steadily toward the 800 mark, and now stands at 763.
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The extent of the burden on a hospital depends on its size and its proximity to prominent focuses of outbreak. The “barometer team” report warns that “the lack of equality” in the distribution of coronavirus patients “does not manifest itself only in the burden of patients but also in the allocation of beds to coronavirus patients, which is determined by the Health Ministry,” the report said. “Some of the smaller hospitals must allocate disproportionate efforts to treatment of the coronavirus while the larger hospitals have to allocate less efforts relative to their size. This causes serious damage to the general capabilities of smaller and medium-size hospitals and improper utilization of the larger centers.”
According to the team’s report, in places where internal medicine wards are at 85 percent occupancy, COVID-19 patients should be sent to other hospitals in nearby areas, and only when wards in those hospitals reach 85 percent occupancy should a directive be issued to open more wards. But what happens in fact is that the Health Ministry is directing all hospitals to open more coronavirus wards any time a ward reaches 80 percent occupancy, regardless of the situation in other hospitals (in which there might be lower occupancy). Every time another ward is opened, personnel must be found to work there, shutting down other hospital services and restricting the availability of hospitals to non-coronavirus patients.
The “barometer” team says that the regulation of the flow of patients to various hospitals is not being managed well and suggests recruiting the Israel Defense Forces for this task. “Consideration should be given to receiving assistance from bodies with proven experience and ability to manage unified command posts in time of emergency, such as the IDF.”
As Haaretz reported last week, coronavirus patients have been stuck in ambulances for hours while the Magen David Adom ambulance service tries to find a hospital ready to accept them. This is because hospitals designated by the Health Ministry to take in patients from other areas have refused to do so. This puts ambulances out of service and unable to respond to other emergency cases for hours, as they search for hospitals with space.
Officials in the health-care system say that the refusal of hospitals stems from overcrowding, which is sometimes not reported for various reasons to the Health Ministry. Officials told Haaretz recently that some hospital administrators do not report the seriousness of their situation because they are afraid the public will avoid those hospitals or want to cancel treatments, which will hurt their income. They also want to try to convey a calmer and more optimistic situation to their staff. However, all agree that there is cumulative fatigue of hospital personnel, though what impact that will have on the quality of care is not yet clear.
“An increase can be seen in burnout of staff and their fear of the rising wave of sickness. In some hospitals there is a disconnect between staff and management and serious damage to the faith of staff in management in light of statements by hospital directors about the stability of the situation and the ability to contain it. In some hospitals the coronavirus staff has not been replaced in a long time, and the burden is increasing, especially for [care of] the serious and critically ill, which makes it more difficult to transfer responsibility due to the high level of skill required,” the report stated.