“Last night, six coronavirus patients died, and that’s just in one ward. In previous waves, we’d see one case, maybe two per night; today, we’ve already reached eight or nine deaths,” said Dr. Joseph Mendelovich, the deputy director general for medicine at what is currently one of the country’s most crowded hospitals, Shaare Zedek in Jerusalem.
When medical staffers end the night with six fewer patients than they began, it leaves a psychological impact, Mendelovich added. “You don’t get used to it. The situation is much worse than in previous waves, and the staff is worn to the bone.”
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Doctors agree that this wave of the virus is more aggressive than its predecessors. More patients are seriously ill, their symptoms are worse, and their condition deteriorates to the point of needing ventilators more quickly. Moreover, many are in their forties, fifties and sixties, and not all of them have underlying health conditions.
Hospitals also say that many patients now require mechanical breathing assistance in ICU units for weeks after testing negative for the virus, due to lingering damage to the lungs. The number of medical staffers diagnosed with the virus or sent into quarantine has surged, apparently due to the British mutation, further exacerbating the manpower shortage.
In Haifa’s Rambam Medical Center, for example, patients who have tested negative often still require breathing assistance, and “currently occupy six of our 14 ICU beds, and they’re expected to be on ventilators for weeks,” the deputy director Dr. Michal Mekel said.
As a result of this, most coronavirus patients in Shaare Zedek are now being sent to hospitals in the center of the country, “and only patients who couldn’t survive the trip come to us,” Mendelovich added.
The increase in seriously ill patients has first and foremost resulted in a severe shortage of skilled staff, since coronavirus patients require double the staff that ordinary patients do. Hospital administrators are trying to find creative solutions, but with only partial success.
“There are certainly patients that, under different circumstances, we would keep in the ICU for two or three days longer, or patients that would ordinarily get an ICU bed but now, when this is a very, very scarce resource, have to be hospitalized in an ordinary coronavirus ward with ‘augmented treatment,’” Mendelovich said.
The overcrowding and the exhaustion sometimes cost lives. Around 10 days ago, a 47-year-old coronavirus patient died at Tel Aviv’s Ichilov Hospital after his breathing tube was accidentally disconnected and the staff failed to notice in time. Ichilov blamed the accident on the excessive workload. Other hospitals said that under the current circumstances, it was not inconceivable that something similar could happen in one of their wards.
“The staff is very, very burnt out, especially now, when a lot of patients are dying. Sometimes three or four relatively young people die alone in each shift,” said Dr. Gil Fire, Ichilov’s deputy director. “There’s an atmosphere of severe depression among the staff.”
“We aren’t collapsing and apparently won’t collapse, but we’re really fighting for the quality of treatment,” he added. “We’re insisting that all the patients be treated by ICU staff and anesthesiologists and not doctors from other units.”
Yet even with nine such staffers on every day, Fire said, “the workload is very high and very intense. Yesterday, for example, there were three resuscitations while three other patients were connected to ECMO machines and in need of constant care. The monitors never stopped beeping, and everything had to be dealt with at once.”
Spreading beyond coronavirus
All this undermines the quality of treatment for both coronavirus patients and other patients. Given that intensive care units are overburdened and don’t have room for most of them, many patients on ventilators remain in ordinary wards, requiring extra staff. Meanwhile elective procedures are reduced, operating rooms closed, and non-coronavirus ICUs slashed.
“Unlike during the first wave, when you saw mildly ill patients in hospitals, you don’t see that today,” Mendelovich said. “Most of the patients are very, very seriously ill. This is happening even at a time when community medicine is working superbly and is able to provide solutions for cases that used to require hospitalization.”
Meanwhile, at Ichilov, the general ICU has been completely converted to serve coronavirus patients; all other patients are referred to the coronary ICU. Three of the nine internal medicine wards are also devoted to coronavirus patients.
“We’re at 116 percent occupancy,” Fire said. “The corridors are full.” And the situation in the emergency room is complicated because verified and suspected coronavirus patients must be kept separate from others.
“Are all the patients ultimately getting optimum care?” he said. “The answer is no. I have no doubt there are patients who are paying the price.”
While the hospital is only postponing elective operations, these operations have been on hold for a year now, which is also a problem, he added.
Rambam Medical Center in Haifa has 91 coronavirus patients, including 67 in serious condition. Eleven patients are in their forties and 13 in their fifties.
“One of the most significant things we’ve seen in this wave is patients with more severe illness,” said Dr. Mekel said. “More patients in need of breathing intervention, and at an earlier stage.” The number of staffers who have fallen ill or been quarantined has also soared, she said.
Rambam, too, is postponing elective operations and has closed its general ICU so that the staff can be moved to the coronavirus ICU. The hospital has also been forced to make other compromises: “We’ve reached the point where I can’t give every patient optimal care,” Mekel said. “We’ve had to lower standards in some places – for instance, a nurse for every three patients instead of two.”
“From our standpoint, this is the worst wave so far,” she added.