Analysis

Israel's Coronavirus Crisis Exposed a Starved Health System on the Verge of Collapse

Years of neglect by successive governments have made Israeli hospitals the weak link in the fight against the coronavirus pandemic

Amos Harel
Amos Harel
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An overcrowded ward at the Sheba Medical Center in Tel HaShomer, February 2019.
An overcrowded ward at the Sheba Medical Center in Tel HaShomer, February 2019.
Amos Harel
Amos Harel

The heart of the problem in Israel’s battle with the coronavirus – even before its flawed preparations, which are now being exposed – is the overall state of its health system.

The public health system has been starved for years, its staff and equipment systematically cut. Hospitals suffer from chronic insufficiency, and every unusually severe seasonal flu threatens them with collapse.

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Now they’re facing the coronavirus, for which they’re unprepared. Many staffers are already in quarantine for fear that they’ve been infected, and in the background are the past week’s terrifying events in Italy and Spain.

Based on conversations with many professionals, this is the main problem, before even mentioning the severe shortage of coronavirus test kits and protective equipment for medical staff. This is a frightening, years-long failure that stems from the health system being pushed to the bottom of the priority list.

A new ward for coronavirus patients at Sheba Medical Center, Tel Hashomer, March 17, 2020.
A new ward for coronavirus patients at Sheba Medical Center, Tel Hashomer, March 17, 2020.Credit: Tomer Appelbaum

When the coronavirus is over, a state commission of inquiry will be unavoidable. We can only hope Israelis still have the strength to fight for it.

As the internal medicine and intensive care units started off in bad shape, every effort has been made to protect them through “forward defensive lines” in the form of increasingly draconian instructions to the public. The Finance Ministry’s fears of enormous economic damage that could last for years have been pushed aside by the Health Ministry’s fears.

The latter no longer has anything to lose; hence this week’s warning about the possibility of thousands of Israelis dying of the virus. This analysis relies on similarities between Israel and Italy’s Lombardy region, which was severely hit by the virus. Lombardy has an excellent Western health system and a population about the size of Israel’s.

Nevertheless, there are also differences: Italy’s average age is much higher, and its preparations for the virus seem to have been exceptionally negligent.

Even as Israel’s Health Ministry urges the public to obey stringent orders and the state prepares for the possibility of a total lockdown next week, the health system increasingly seems to have accepted that the virus will spread widely. To a large extent, the horses are already out of the stable, thanks to infected Israelis and tourists who returned from abroad last month, used public transportation and visited crowded sites.

Empty Tel Aviv from bird's-eye-viewCredit: Tomer Appelbaum

The hope is that most people infected will have relatively mild symptoms or none at all. The main concern is over specific risk groups – the elderly and people with other illnesses. Some of them are likely to die, and estimates of how many vary widely.

The national effort is aimed less at the patients than at the hospitals, to protect them from collapse. The danger is real, but we should also remember a fundamental rule of organizational theory: Organizations tend to protect themselves. They are created to meet a certain need, but when that need changes or disappears, they invent new needs to justify their existence and reject criticism of their performance.

This crisis will quickly be followed by budgetary demands, just as the army demanded and got more money after the Second Lebanon War revealed its weaknesses in 2006.

The daily instructions restricting our actions are meant to keep the hospitals from being flooded to the point of collapse. The peak was the radical authorization given to the Shin Bet security service to track quarantine violators and people who may have been exposed to the virus.

Workers wearing protective gear spray disinfectant as a precaution against the coronavirus, at the main market in Gaza City, March 19, 2020.
Workers wearing protective gear spray disinfectant as a precaution against the coronavirus, at the main market in Gaza City, March 19, 2020.Credit: Adel Hana,AP

These prohibitions are also meant to reduce the number of people visiting emergency rooms. With no freedom of movement, it’s harder to flood the hospitals. This isn’t just a clinical need; it’s an issue of supervision and control.

This week, signs of a worsening health and economic crisis coincided with an unstable political situation. This invites trouble, as was evident in the police’s handling of protesters en route to Jerusalem on Thursday. These probably won’t be the last pictures of this sort, even if a unity government is formed between Likud and half of Kahol Lavan, as seemed likely Thursday night.

Every government in this situation fears that the masses will eventually take to the streets. That’s another reason to demand that we stay home, avoid congregating and be deterred by the invisible enemy.

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