Inside the Effort to Keep Israel’s Hospitals, Airports and Telecoms Running Amid Coronavirus

Although most of the world is in lockdown due to the coronavirus, vital services must continue operating at all times. ‘We’re rewriting the rules as we go along,’ says a medical center CEO

Anshel Pfeffer
Anshel Pfeffer
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Workers spraying disinfectant outside the emergency rooms entrance at Hadassah University Hospital, Ein Karem, March 2020.
Workers spraying disinfectant outside the emergency rooms entrance at Hadassah University Hospital, Ein Karem, March 2020. Credit: Emil Salman
Anshel Pfeffer
Anshel Pfeffer

As the coronavirus started spreading across Israel in early March, technicians at the control center of Cellcom – Israel’s second-largest telecommunications company and largest provider of cellphone services – detected a spike in usage around 8 P.M. every night. Israelis were tuning in to watch the nightly briefings by Prime Minister Benjamin Netanyahu.

In the last couple of weeks, however, those spikes have all but disappeared as Israelis got used to life in lockdown and realized there isn’t much useful information to be learned from the briefings.

The control center on the southern outskirts of Netanya (a 20-minute drive from Tel Aviv) is usually bustling, but now only has four people in it.

The team of technicians working on the services Cellcom provides – cellphones and landlines, internet and television – has been split in two, with half the on-site team now working from an alternative control center in Or Yehuda (near Ben Gurion Airport) and many others working from home.

“For engineers, who are used to being hands-on, distance working is a significant change,” Chief Technical Officer Yaniv Koriat says. “We have the capabilities to monitor our networks from afar, and when necessary technicians go out into the field.”

The Or Yehuda facility is usually locked, except for annual disaster-recovery exercises carried out jointly by the Communications Ministry and the Israeli army’s Home Front Command. The previous time it was used was in November, during the last major escalation in Gaza when Palestinian Islamic Jihad launched some 450 rockets against Israeli targets.

The Cellcom control center in Netanya, near Tel Aviv, April 2020.
The Cellcom control center in Netanya, near Tel Aviv, April 2020. Operations are now being handled at two separate centers to reduce the risk of everyone becoming infected.Credit: Anshel Pfeffer

The two main scenarios in which Cellcom would need to shift its operations to this alternative facility are missile attacks or an earthquake. A pandemic is a very different scenario, but having the two facilities allows the company to split teams and reduce the risk of critical personnel infecting each other.

A crucial infrastructure company like Cellcom is the kind of place where the small number of employees turning up daily constantly use the Hebrew term “retzifut tifkudit” – operational continuity. The term originated in the Israel Defense Forces, but has become the working philosophy of many civilian companies and organizations at this time.

In late January, when the coronavirus still seemed like a local Chinese epidemic, Cellcom CEO (and former Labor Party leader) Avi Gabbay directed his department heads to buy up everything they usually import from China and fill their inventories. Now, ironically, China is back manufacturing at full capacity while Israel is in lockdown.

Some of the smaller communications companies in Israel have experienced minor breakdowns and slowing of services. Perhaps not surprising, given that Israel’s telecoms infrastructure is still a jumble of old “copper” phone lines (some which were laid as far back as the 1950s), a 25-year-old cable network, and a fiber optic network that only reaches a quarter of the country and a much smaller proportion of homes.

Since Cellcom uses all three networks, its management believes it can deal with the increased domestic use, which has grown by about 20 percent over the last six weeks. Koriat – who only became CTO in mid-March – is more concerned about cellular communications at this point. “What mainly limits us is bandwidth, and we’re asking the government for more,” he says. But it puts a greater strain on the control room teams, which constantly monitor service on all the networks.

Now they’re gearing up for the seder baseger” (seder night at home) curfew on Wednesday evening, with extended families across Israel split between different homes. “We’re seeing demand that we don’t normally see in routine times,” says Avi Bakal, the control room manager. “On seder night, when families use video conferencing like Zoom and will be joining in from different locations on different networks, it will be an interesting challenge,” he says. “But I don’t think it will actually create higher demand because everyone will be at the table, not using their personal devices.”

A COVID-19-free hospital

At the entrance to Hadassah University Hospital’s Mount Scopus branch in Jerusalem, the security guard interrogates visitors about where they have been spending time over the past two weeks.

A hospital worker taking a woman's temperature at Hadassah University Hospital, Eim Karem, March 2020.
A hospital worker taking a woman's temperature at Hadassah University Hospital, Eim Karem, March 2020. Credit: Ohad Zwigenberg

“Have you been to Rachel’s Tomb?” is the first question. The shrine at Jerusalem’s southernmost tip, on the border with Bethlehem, is not only a much-frequented spot for religious Jews, especially women, praying to the biblical matriarch for a speedy birth and healthy baby. It has also been detected as a coronavirus hot spot. Until a few days ago, the first question was “Have you been abroad in the past two weeks?” But there are now very few people in Jerusalem who have been traveling outside of the country recently.

And as the rate of infections has spiked in some of the city’s ultra-Orthodox neighborhoods and the Health Ministry has classified some areas “endemic,” medical staff have also been instructed, for the first time, to ask each new patient where they live.

Of Jerusalem’s three main hospitals, Hadassah’s Mount Scopus branch has been designated the “COVID-19 free” one, while the larger Hadassah branch at Ein Karem and Shaare Zedek Medical Center have opened designated coronavirus wards.

That doesn’t mean, of course, that the hospital at Mount Scopus doesn’t need to contend with the virus. It could have infected patients coming for other ailments, or infected visitors or medical staff. “We need to build a buffer zone around the hospital and for Jerusalem’s entire health system,” says the hospital’s director, Dr. Tamar Elram. (Full disclosure: Your correspondent is related to Elram.)

Dr. Tamar Elram at Hadassah University Hospital, Mount Scopus branch, Jerusalem. The lines guide ER staff and patients to departments.
Dr. Tamar Elram at Hadassah University Hospital, Mount Scopus branch, Jerusalem. The lines guide ER staff and patients to departments.Credit: Anshel Pfeffer

Israel’s medical establishment has been dealing with the pandemic in a typically chaotic mixture of incoordination and professionalism. The public health system in Jerusalem, which serves 1.2 million people in the urban area, has the advantage of two of its hospitals being run by the independent Hadassah Medical Organization, which under its mercurial director general Prof. Zeev Rotstein, can confront Health Ministry decisions.

It was Rotstein’s decision, for example, to reserve the Mount Scopus site for other illnesses, allowing the capital’s system to maintain operational continuity.

Once through the security gatehouse, there is an almost surreal sense of calm in the lobby and ground floor emergency department that filters arriving patients. The hospital is in the middle of an extensive renovation, which has been disrupted but not ended by the crisis. The corridor floors have colored lines to help emergency staff and patients make their way quickly to departments, minimizing the chances of infection – a red line leads to the sealed-off respiratory support emergency unit.

Unless they need immediate treatment, anyone who has suspected COVID-19 symptoms is immediately put in an ambulance and sent to the sister site at Ein Karem. Dr. Shaden Salameh-Joseph, head of the emergency department, has just ended a meeting of her senior staff, discussing intubation techniques of coronavirus patients. “We have to make up a lot of the procedures as we go along,” she says.

Mount Scopus’ policy has been to continue providing all types of treatment, despite the crisis. “I want people who need treatment to come,” Salameh-Joseph says passionately. “They should come to ER! Sick people are staying at home and dying of fear rather than the coronavirus.”

But keeping the hospital up and running during the pandemic has meant constantly learning and changing procedures on the fly. “I have to be in the ER much more than usual,” says the mother of three. “There are 70 medical staff here, and we need to constantly make decisions of how the place is run under the restrictions and what procedures to take. Sometimes it’s just logistical decisions like moving the space where we change our clothes,” she explains.

For Salameh-Joseph, the moment she realized she was in a situation unlike anything her medical training had prepared her was when she asked her mother to come from Tur’an in the Galilee, after it became clear she and her husband – who is also a doctor at Mount Scopus – wouldn’t be seeing their children for a while. “At every moment, questions are arising in the ER, and the solutions we’ve always had prepared for every situation are no longer so clear,” she says.

As a hospital director, Elram is usually used to looking at the bigger picture – but “these days you’re constantly dealing with the micro,” she says. “You have to decide on every little thing in this new environment, and there are set procedures. But guess what? The reality now is different. Every day we’re making new decisions – of course coordinated with Prof. Rotstein and Hadassah’s infection prevention unit. But the truth is, we’re rewriting the rules as we go along.”

Every medical practitioner now has to balance the regular treatment of patients alongside dealing with the crisis. As a gynecologist who also works one day a week at a community clinic, Elram arrived there two weeks ago to discover that the health maintenance organization that owns the clinic had decided to cancel elective ultrasounds for expectant mothers.

“Every standard ultrasound for a pregnant woman is elective – that doesn’t mean there isn’t a risk to postponing or canceling it,” Elram says. “Delaying any treatment, except for cosmetic surgery, can cause damage or significant suffering. Which is why we’re not happy that fewer people are coming to our ER now. Anyone who calls me to ask whether to come to the ER, I tell them to do exactly what they would do if there was no coronavirus. Just come with a mask and, if possible, on your own,” she says.

An airport without passengers

When there were still only a handful of COVID-19 cases in Israel, most businesses were still functioning as usual. The first industry to get seriously affected was air travel.

The Arrivals board at Ben Gurion Airport, April 1, 2020. Four days later, there were just three passenger flights set to land at the airport in 12 hours.
The Arrivals board at Ben Gurion Airport, April 1, 2020. Four days later, there were just three passenger flights set to land at the airport in 12 hours.Credit: Tomer Appelbaum

The news was suddenly full of footage of an empty terminal at Ben Gurion Airport, as flight after flight was canceled and airlines began grounding their fleets. Since then, that shutdown has become a reality on every Israeli street, and photographers no longer need to travel out to the airport to capture a glimpse of that.

On Sunday, there were just four flights listed on the Arrivals board in the deserted terminal – and one of those, an Aeroflot flight from Moscow, had already been canceled. The incoming flights over the next 12 hours were United Airlines from Newark – the only daily link to the outside world still functioning; a chartered Israir flight that had been dispatched to “rescue” Israelis stranded in London; and an arrival from Minsk, the capital of Belarus, whose President Alexander Lukashenko has told his subjects they can counteract the coronavirus with vodka and saunas.

There are two daily domestic flights to Eilat, often taking off without any passengers. Behind the rows of parked El Al aircraft, a large shiny British Airways Boeing 777 suddenly emerges on the taxiway, causing excitement among the tiny group of observers. But it’s not carrying any passengers and is headed for the cargo terminal – the one place in the airport where activity has actually increased in recent weeks.

On the days before Passover, Ben Gurion Airport usually works at full capacity – over 100,000 passengers daily, as Israelis rush to escape on vacation and tourists from around the world flock in. On Saturday, a grand total of 145 passengers passed through Israel’s main entrance and exit point.

A balloon that floated up to the ceiling in the Arrivals hall at Ben Gurion Airport. It bears the message "Get well soon."
A balloon that floated up to the ceiling in the Arrivals hall at Ben Gurion Airport. It bears the message "Get well soon." Credit: Tomer Appelbaum

The duty-free is closed and the only businesses still open in Terminal 3 are two coffee shops – one air-side and the other in the Arrivals hall – mainly serving employees. The check-in desks are all closed. One passenger for Minsk, so anxious she arrived at the terminal a full 10 hours before the scheduled departure, is sitting outside, chain-smoking.

But the airport needs to keep functioning. Or as they call it here, the “systems have to remain hot.” An operating international airport is a strategic necessity, as is having an “alternate” – in Israel’s case, Ramon Airport near Eilat.

“We’ve gone from over 500 movements a day out of Ben Gurion to just around 30,” says Udi Bar-Oz, deputy director general for operations at the Israel Airports Authority. “But we have to remain capable of delivering any solution for air travel and transportation 24 hours a day.”

Over half of the IAA’s 6,000 employees have been either furloughed or are on extended vacation. The remaining employees are there to ensure that even if only a few dozen passengers arrive or leave Israel, Israel’s crucial link to the outside world continues functioning and the airspace remains open. Only one of the four concourses at Terminal 3 is currently operational, but many of the roles the IAA performs have to continue functioning as normal.

At times like this, the crucial work of the air traffic controllers is emphasized. Bar-Oz’s job is to ensure that the control towers and control centers – which are managed together with the military – remain functioning. But he is no longer visiting Ben Gurion’s main tower.

Shuttered stores at Ben Gurion Airport, March 2020.
Shuttered stores at Ben Gurion Airport, March 2020.Credit: Tomer Appelbaum

“I’m the boss of the tower but I won’t go into the tower,” he says. “The risk of infecting the controllers there is too big to take.” Due to the low volume of traffic, it has been possible to cut the regular team at the top of the tower by half, to only four controllers. A similarly pared-down team is further down the tower, operating the radar systems.

Both teams are being kept as isolated as possible, constantly monitored for symptoms. Likewise the controllers at Ramon Airport and the three small general aviation airfields managed by the IAA. Another concern is the IAA controller teams that work in the IDF’s two main air control units in the Galilee and Negev, who have responsibility for Israel’s civilian airspace. They usually work 12-hour shifts and go home in-between. Now, they all remain on-site for three days at a time, to minimize the risk of infection.

Avid plane-spotters now have a rare opportunity to glimpse and photograph nearly all of El Al’s 45-plane fleet parked in rows, by the east side of the terminal and around the company’s nearby maintenance facility. But after the novelty of seeing so many identical planes clustered together wears off, it is a dismal sight: El Al was just undergoing the most major modernization program in its history and never had such a large fleet – almost all of which is now grounded.

No scheduled El Al flights are currently operating, although a handful of Boeings are being used to fly in vital medical supplies from China and eggs from Portugal, to alleviate the egg shortage before Passover. Ironically, the company in these weeks has broken endurance records with long-haul rescue flights of Israelis stranded in Australia and Peru – destinations El Al has never flown to before.

Usually, around 90 percent of movements at Ben Gurion are scheduled passengers flights, with the other 10 percent made up of cargo, private jets, test and delivery flights of Israel Aerospace Industries (which is based at the airport), and military flights. These days, over 50 percent of the movements are cargo flights.

One of El Al's fleet of new Boeing Dreamliner planes, December 2019. Now it is one of 45 El Al aircraft sitting idle at the airport.
One of El Al's fleet of new Boeing Dreamliner planes, December 2019. Now it is one of 45 El Al aircraft sitting idle at the airport.Credit: Yochai Musi

The number of cargo airlines operating here has doubled over the last month and their flights have tripled – making up for the shortfall in air freight capacity, 55 percent of which is in the holds of regular passenger airliners. But this can hardly make up for the shortfall in revenue for one of Israel’s biggest companies.

The IAA’s revenue in 2019 was 4 billion shekels ($1.1 billion), two-thirds of which came from landing fees and other income from airlines who pay for slots. Most of the rest comes from the commercial activity within the terminals. That income has now been slashed by over 90 percent, and the airports authority is scrambling to use its normally lucrative landing real estate in other ways.

Not only El Al has an immobile fleet right now: Car rental agencies have hired acres of space from the IAA to park their fleets of thousands of vehicles, Meanwhile, Russian carrier Aeroflot may start leasing space at Ramon Airport soon, so it can store as many as 150 of its own aircraft there in the dry desert air.

Ben Gurion has to be prepared to allow cargo or rescue flights to take off or land at any moment. It also needs to be ready for the moment the government eases the lockdown, whenever that may be, and many thousands of passengers will urgently rush off to visit relatives abroad, tend to international business and, yes – as far away as it feels now – to go on vacation.

The IAA had a 6-billion-shekel development budget that was committed, among other things, to expanding the space available for check-in desks. That money is now being diverted to keeping the company afloat, and all building plans have been put on indefinite hold. If anything, everyone right now is missing those nightmarish check-in lines.