At Least Fifth of Israeli Second-wave COVID Deaths Were Preventable, Study Finds

Researchers at three major institutions find that more coronavirus patients died than was projected while hospitals were overcrowded, providing a warning for the current wave

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A coronavirus ward at Rambam Health Care Campus in Haifa, December 15, 2020
A coronavirus ward at Rambam Health Care Campus in Haifa, December 15, 2020Credit: Oded Balilty / AP

As many as one in five Israeli COVID-19 deaths – or 20 percent – during the peak of the second coronavirus wave in the summer and fall may have been preventable had hospitals not been overcrowded, a new study released on Monday found.

The study, which examined whether the massive overcrowding in Israeli hospitals during that period affected excess mortality, was conducted by scientists and mathematicians at the Weizmann Institute of Science in Rehovot, Tel Aviv University and the Technion.

It focused on the 620 Israelis who died of the COVID-19 in hospitals from September 9, 2020 through October 28, and found that 130 people may have died unnecessarily. The study, which was first published here, found that excess deaths had been highest when hospitals were most crowded.    

According to the researchers, excess mortality began to occur when the number of patients in serious and critical condition in Israel reached 500, and when the numbers of those hospitalized in coronavirus wards passed the 1,000 mark. The death rate rose significantly as the number of hospitalizations rose. The researchers also found that during the current third wave of the outbreak, too, signs have appeared of unnecessary and excess deaths.

The coronavirus ward in Rambam Health Care Campus, Haifa, October 5, 2020Credit: Rami Shllush

The research was conducted jointly by Prof. Eran Segal, a computational biologist at the Weizmann Institute of Science in Rehovot, and his research students Hagai Rosman, Tomer Meir and Smadar Shilo; Prof. Malka Gorfine and Assaf Ben Arie of the mathematics department at Tel Aviv University; and Prof. Uri Shalit, Yonatan Zomer and Rom Gutman of the Technion: Israel Institute of Technology.

“We collected all the data on those hospitalized, and studied the chance of people surviving according to age, gender, ethnicity and their condition when they were admitted to the hospital,” said Segal. “From this, we learned the chances of survival and deterioration of the patients in ‘routine’ times, when there is no major overcrowding."

Segal added, "These are complex models that take into account the move from the states of diagnosis to seriously ill. The models also take into account various characteristics of the patients. For example, it is known that Haredim," or ultra-Othodox patients, "are hospitalized at home more often – so it could be that a Haredi patient who comes to the hospital is a priori in more serious condition.”

In the second stage, the researchers built a model for forecasting mortality for every week beyond September 9 – the day the steep daily rise in hospitalizations during the second wave began. They factored in age, gender and the state of illness when patients were admitted – in other words, how many were “supposed” to die during those weeks based on the model of previous weeks.

In the final stage, the researchers compared the number of those who died to the forecast based on the model. “Then we saw the differences growing: In one week, 70 were supposed to die – but 100 died within 14 days. In another week, we forecast 80 deaths – but 105 died, and so on,” said Segal.

Prof. Eran Siegel Credit: Weizmann Institute of Science

These differences represent the number of people who died, but it seems would have survived if not for the overcrowding and excess load on the hospitals. Which is to say, “people who didn’t need to die,” said Segal. The researchers' conclusions were bolstered when after the waning of the second wave, beginning on October 28, the number of people who died very precisely followed the model they used.

“After the drop in the second wave, we returned to the expected mortality (numbers) – but now, in the third wave, we are already seeing that we are again in a situation of excess mortality. In practice, it is doubly excessive: Once because it is possible to reduce infections using preventative measures, and secondly because it seems that people who could have survived are nonetheless dying because of the overload,” said Segal.

This is why “the public needs to understand that the minute the infection rate is allowed to rise, we pay a double price – total mortality rises, but also when [when hospitals reach capacity], there is more excess mortality than expected,” he said.

As for the question of whether the country is willing to accept the figures so as not to shut down essential systems, such as schools, Segal said: “When you make decisions, you need to know it. Anyone who says there is no problem with the overcrowding of hundreds of patients in hospitals is wrong.”

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