Doctors treating COVID-19 in Israeli hospitals say that patients are less seriously ill during the second wave of the outbreak than the first, directly impacting the number of hospitalizations, as well as the number on patients on ventilators.
The doctors attribute the change in part to improved knowledge and treatment – as well as to current patients being younger in general. All the doctors interviewed by Haaretz said that at this stage they cannot confirm any significant change in the disease or the virus.
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The head of the coronavirus department at the Shamir Medical Center in Beer Yaqov, in central Israel, Dr. Jonathan Shapira, explains that the condition of patients hospitalized now deteriorates at a later stage compared to the previous wave of infection. “In the first wave, we saw respiratory deterioration within five to 10 days from the onset of the disease, but now we are running into patients who worsened only after two weeks or more,” he said. “The respiratory infection is more common but milder.”
Shapira says that those hospitalized still have pneumonia and a low level of oxygenation in the blood, but most of them do not deteriorate. In addition, the inflammation they suffer from “is less volatile. There may be a high fever and increased inflammation indicators in the blood, but not like in the past.”
Experience and expertise
At least some of the changes in the appearance of the disease can be explained by variables that do not depend on the coronavirus itself or the nature of the disease. The health system has accumulated experience and knowledge on how to treat COVID-19 patients, the expertise of the medical staff has increased, the ability to find early signs of the disease has improved and the treatment protocols have been updated. Adaptation of the drug treatments to different situations and stages of the disease has also improved, and now the types of respiratory support for patients are adapted more appropriately.
One of the differences between the first and second waves is in the number of patients needing hospitalization out of the total number of those infected. The number of those infected has risen greatly recently and passed the peak of the first wave by a large amount – though many of them are asymptomatic and were only diagnosed because of the changes in the criteria for administering the coronavirus test.
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In spite of this increase, the number of patients hospitalized is relatively low. As of press time, 434 patients out of a total of 16,025 are hospitalized. In comparison, the highest number of actively ill patients during the first wave was on April 17, with 10,133 out of whom 632 were hospitalized at the time.
Another difference is in the percentage of patients on ventilators out of the number of patients in serious condition. Today, 122 COVID patients are hospitalized in serious condition, including 39 on ventilators. This is different than the situation in the first wave, when most of those in serious condition were also on ventilators. On April 17, for example, 129 out of the 182 patients in serious condition were on ventilators.
Age, testing, treatment, and the weather
Shapira points out that those hospitalized now are younger and healthier than during the first wave, in the 50 to 70 age range. “It is possible that the elderly with chronic illnesses are being more careful not to be exposed to the virus,” he said. Because the hospitalized patients are younger and healthier, they have the ability to recover better, he said.
It is also possible to explain the change in the approach to treating the patients. “We are now treating serious ill patients earlier and in a more aggressive manner before the situation deteriorates. There is a respectable arsenal of treatments that improve and shorten, in my opinion, the harshness of the disease,” said Shapira. “We are trying very hard not to ventilate patients if we don’t have to. Mostly it works well. But this does not mean that we will not experience a catastrophe soon and now it is just the tip of the iceberg.”
The head of the intensive care unit in one of the hospitals in the center of the country also says that he sees a change, but makes it clear that “we still don’t have a clear explanation. Today there are less people ill whose condition worsens and requires ventilation. Even the severe immunological response [known as a cytokine storm] that characterizes the coronavirus patients seems more moderate. The clinical feature of thrombophilia [excessive blood clotting] has remained the same, but it is relatively easy to treat it,” he added.
The head of the coronavirus department at Hadassah University Hospital in Ein Karem in Jerusalem, Prof. Dror Mevorach, says the assessment of the disease has changed, but a number of reasons for this are possible: As well as age and early testing, he also thinks the weather may have an effect. “It is possible that the heat affects the infection” says Mevorach. “We don’t know. But it is a possibility. We need to treat things cautiously. There are still serious cases and just this morning two patients were transferred from our department to intensive care.”
Prof. Ronen Ben-Ami, the director of the infectious diseases unit at Ichilov Hospital in Tel Aviv, as well as doctors from Sheba Medical Center in Tel Hashomer, all told Haaretz that they agree that the younger age of the patients and the medical staff’s capabilities have led to an improvement in the situation compared to the first wave.
Or maybe it's the virus itself?
The head of the infectious diseases department at the San Martino Hospital in Genoa, Italy, Prof. Matteo Bassetti, provides a different perspective. He attributes the improvement in the condition of COVID patients either to changes in the coronavirus or the disease. He recently said that the virus was “like an aggressive tiger in March and April, but now it’s like a wildcat” that can be domesticated. In an interview last week with Israel's Channel 12 News, Bassetti said that the routine had been to see patients arriving at the hospital in extremely severe condition, needing oxygen or ventilation immediately. In May and June, there were hardly any such patients, he said. Now there are fewer and fewer patients, and cases resembles the flu rather than a much more dangerous disease as was the case in March and April.
“It is known that the virus is capable of changing, and changes in its genome in hundreds of places have already been discovered,” says a doctor who treats COVID-19 in one of the hospitals in the center of Israel. It is possible that the virus in the second wave is a less virulent strain, or it causes a more moderate immunological response. “We will know that in another few weeks.” But, says the doctor, “we must remember that even if it is true and there is a change, it could also be in the other direction and become a more virulent strain. We must not become complacent.”