The Israeli health care system is not ready for an epidemic, the state comptroller said in a report released Monday, blaming the Health Ministry, the health maintenance organizations and the hospitals at a time when the number of coronavirus patients increases in Israel and around the world.
The report was sent to the health care system in November, though the section on preparedness for epidemics is shorter than normal and contains little data.
“I strongly hope that this chapter, which was submitted even before the outbreak of the coronavirus in Israel, has ... contributed to preparations by the Health Ministry and the Israeli government for preventing the spread of the coronavirus,” Englman writes.
He says he hopes that publication of the report will “increase public awareness of the need to obey the directives of the authorized bodies.”
For its part, the Health Ministry responded that “the Israeli health care system started to prepare already in mid-January with the acquisition of protective gear, ventilators and testing kits for the coronavirus, and the hospitals prepared to open designated wards, as did the HMOs.”
One worrisome finding in the comptroller’s report is the absence of a Health Ministry plan for increasing the number of hospital beds, medical staff and equipment at the start of an epidemic. According to the report, Israel does not have enough flu medication, with the current inventory sufficient for only 16 percent of the population, not 20 percent as required.
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The report also discusses shortfalls in staffing against epidemics, including nurses for vaccinating patients and experts for conducting epidemiology studies.
“An important means to prevent diseases is to immunize the population and then monitor,” Englman writes.
He says “the Health Ministry prepared a general combat doctrine but failed to prepare an organized plan for operations, a designated combat doctrine for each disease that it is decided must be prepared for.”
Regarding a possible flu epidemic, the comptroller writes: “The health care system is not fully prepared for such an outbreak, even though the government’s decision on the need for preparedness was handed down in 2005.”
The increased risk of an outbreak requires the health and defense ministries to draw up a plan to reduce the gaps, he added.
According to the report, information is not transmitted sufficiently for locating patients in risk groups and giving them priority in preventive care. The comptroller also recommends that preparations include a plan for training at HMOs.
A bad flu epidemic
Englman also discusses the hospitals. “The Health Ministry has no plan for closing the gaps in hospital beds, medical staff and equipment in the event of the outbreak of a pandemic flu,” he writes.
Under the scenario presented in the Health Ministry report, the flu would strike 2.25 million Israelis, about 25 percent of the population.
An increase in morbidity would last more than eight weeks, during which an additional 150,000 or so patients would need hospitalization. Also, about 25,000 patients would require hospitalization in intensive care, and another 12,500 would need respiratory assistance.
In various areas Israel would suffer shortfalls during a flu epidemic, Englman writes. Israel has around 745 beds in intensive care, 5,677 in internal medicine wards and 2,354 in children’s wings, the report said, citing Health Ministry figures for 2017.
These figures may not be as grim currently; since the outbreak of the coronavirus crisis, designated wards have been opened at about 20 hospitals, and hundreds of beds have been added for coronavirus patients.
For example, at Hasharon Hospital in Petah Tikva, which is part of Rabin Medical Center along with Beilinson Hospital, five designated coronavirus wards have been opened with 200 beds, and the intensive care and respiratory units have been expanded.
The overall figures are worrisome in ordinary times, but considering the present situation, they paint a very grave picture. The rough calculations predict a contagion rate of 32 percent of the population, including over 20,000 patients in critical condition and about 8,500 deaths. This is based on a relatively conservative scenario.
Regarding the shortage of public health nurses who would help ensure a high immunization rate, Englman writes that “in eight out of 15 districts we found a gap between the actual number of work slots and the needs, which are calculated based on one nurse per 100 infants.”
Neglecting human capital
In response, the Israeli Association of Public Health Physicians said that the comptroller’s report “exposes a gloomy picture of the routine neglect of public health that harms us in times of emergency as well.
“Unfortunately, the writing was on the wall, and despite all our warnings there has been no investment of the resources and staffing needed to protect public health, neither routinely nor in times of emergency. It is incomprehensible that even now, during a global coronavirus epidemic, they continue seek only technological solutions and are severely neglecting the human capital that is the key to protecting public health.”
The Health Ministry added: “We have studied the report and are implementing some of the conclusions during the current crisis. We hope that the report that is being published as we address the coronavirus challenge will be used for study and practical criticism, not to attack us.”
According to the ministry, “Israel was one of the first countries to understand the gravity of the epidemic and, led by the National Security Council and the Health Ministry, drastic steps were taken to close the country’s borders, steps that were taken later in almost all countries around the world. In dealing with the coronavirus, the Health Ministry aims to flatten the curve of patients to prevent high morbidity and a dramatic increase in the number of patients and hospitalizations.
“The medical staffs in the hospitals and in the community are at the forefront of treating the coronavirus, a front that will probably stay active for at least several more months. Israel seems to be one of the countries that most successfully handled the global measles outbreak. This result is attributed to the quality of the service provided by the public health services at the ministry and to the mobilization of the nurses at the Tipat Halav well-baby clinics.”