During the intermediate days of Passover, just after he was diagnosed with COVID-19, H., a 53-year-old man from the ultra-Orthodox West Bank settlement of Betar Illit, said his good-byes to his family. He had no underlying conditions, but the weakness, the fighting for every breath and the incessant coughing led him to believe the end was near.
“I couldn’t breathe, I was coughing and felt my lungs spilling out,” he recalls. “I thought it was over and took leave of my children. I was disconnected from my surroundings, as if I was in some cloud for three days.”
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During the following days, with the help of an oxygen generator that the family borrowed from the medical equipment lending organization Yad Sarah, H. began to recuperate. Now his condition is much better. “They wanted to take me to a hospital,” he says. “But a physician in Shaare Zedek told me, ‘Let’s see if you can get over it with oxygen at home.’ My [blood oxygen] saturation was 87 percent.”
He’s convinced that if he had been hospitalized, he would have died. “If I’d been cut off from my family, I wouldn’t be here today,” he insisted. “I’m sure of it.”
H. is far from the only coronavirus sufferer with serious symptoms who decided to try to tough out the virus at home. Yad Sarah reported this week that between February 1 and October 11, there was a 95 percent rise in the number of machines to assist with breathing that were lent out, along with a 90 percent rise in the number of pulse oximeters borrowed.
Yad Sarah also noted that while the sharpest rise occurred in ultra-Orthodox communities, like Betar Ilit, demand had also boomed in more mainstream places such as Eilat, Rishon Letzion and Tel Aviv. The health maintenance organizations, meanwhile, which are meant to be the primary source for such equipment, did not report a similar rise in requests.
Dvir, 40, of Jerusalem, contracted COVID-19 in early September. While his doctor recommended hospitalization, the coronavirus wards in Jerusalem were full. After speaking to some friends, Dvir decided to be treated at home. “Of course I have no complaints about the doctors, who are pressured and are going above and beyond, but there were stories about infections and people defecating in their beds. I decided to do everything to try to stay home.”
His oxygen saturation level got as low as 84 percent, but there were no oxygen generators available in Jerusalem, and he had to wait two days for one to free up in Betar Ilit. For his first two days with the machine, he used it all the time, and then began to gradually wean himself off it. “I was so weak that I could barely go to the bathroom,” he recalls. “Then I had no strength to go back to bed. I would just sit on the floor to rest a few minutes and only then go back.”
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Avi, 64, from Ra’anana, who got sick in mid-July, also borrowed an oxygen generator from Yad Sarah at the recommendation of several neighbors. He said he had tried to get one from his HMO, but that after leaving a message and getting a call from a doctor who told him to call back again the next day, he got concerned that the process wouldn’t move fast enough to resolve his respiratory distress.
Avi, whose oxygen saturation had dropped to 88 percent, was connected to the machine for four days straight before starting to feel any improvement. “I was dizzy, coughing, had headaches and fever. I’m a healthy person with no underlying illnesses, I work out and I still haven’t gotten back to myself,” he says. “I had muscle pains in my legs and in my chest four weeks after I was infected.” He added he still has to rest after every few minutes of exertion and that his short-term memory has been affected.
Dvir didn’t even try to borrow a machine from his HMO. “It’s a whole procedure. They prefer that you go to the hospital, but that wasn’t really an option. You first had to do a series of tests and X-rays, go in a special ambulance and then wait for results, while what I needed was to breathe. That’s why I went to Yad Sarah.”
Avi, H. and Dvir are all convinced they made the right decision by staying home. “If I’d have been in a bubble in the hospital, I wouldn’t have had the will to live,” Avi said. Dvir, however, said he knew someone “with underlying conditions who borrowed a home oxygen generator, but it caused him problems and he was rushed to the hospital with a heart ailment.”
Medical sources say that anyone successfully treated at home could not have been seriously ill. They noted that oxygen saturation levels are only one index for deciding if a coronavirus victim has a serious case; the primary indicator is pneumonia. If in addition to pneumonia, oxygen saturation levels are less than 93 percent and the patient is breathing at a rate of more than 30 breaths per minute, they are in serious condition. Such patients need drugs, numerous tests, and 24-hour monitoring in a hospital environment.
These sources also stressed that the increased borrowing of oxygen generators from Yad Sarah has nothing to do with the state of the health system. They noted that coronavirus patients who are released from hospital often still need home respiratory support. The sources said that the HMOs supply these devices but that it’s possible some patients find Yad Sarah more accessible and responsive. Among the borrowers might also be people with chronic respiratory conditions who are afraid to go to the hospital, and who prefer to be treated at home for as long as their condition allows.
Medical professionals are divided about the quality of home care for coronavirus patients, with some noting that “home hospitalization” carries some risks. Prof. Dror Mevorach, director of the coronavirus department at Hadassah-University Hospital, Ein Karem, said he doesn’t “think it’s a good idea for a patient in serious condition to be treated at home before he was in a hospital and evaluated by a doctor who is familiar with coronavirus treatment.” Patients treated at home, he noted, don’t have access to treatments that are available only in hospitals, including special drugs.
Mevorach notes that he understands why people don’t want to be hospitalized. “To be hospitalized in a coronavirus ward isn’t pleasant because of the distance from family; the staff members aren’t always present and they’re dressed strangely. The conditions aren’t optimal,” he admits. “But those patients who say it’s best to be at home don’t have the full picture. They see only one patient – themselves. I see hundreds of patients. Out of every 10 at home, one could die, and we can’t allow that to happen.”
Home care must be done under supervision, Mevorach says. To provide safe home care, he thinks the HMOs should set up a network for community treatment that would include trained physicians who can monitor those treated at home. “If they see a problem with a patient they can consult with senior doctors and then [the patient] can be brought to the hospital in time,” he says. “That way you give patients who don’t need hospitalization a chance to recover at home, but there is still medical supervision, so a patient doesn’t come to the hospital at the last minute if God forbid they’re not moving in the right direction.”
Yad Sarah CEO Moshe Cohen says the organization’s founder, Uri Lupolianski, a former mayor of Jerusalem, saw that there would be a need for oxygen generators when the coronavirus started to spread, and imported hundreds of the devices to Israel. The organization notes that beyond the thousands of coronavirus patients who need respiratory assistance and were treated at home, there are thousands more with other conditions who were able to avoid hospitalization with the help of the organization.
“A hospital is a place solely for people whose condition is bad, but many doctors, department directors who speak to me, turn to us when they want to release a wave of people from their ward,” says Cohen.
Yad Sarah is not the only organization in Israel that lends out medical equipment; there are others that work on a smaller scale, and of course the HMOs are lending these devices out as well. “Some of the other organizations will give an oxygen generator only with a doctor’s referral, but we don’t require that,” says Cohen. “We do advise speaking to a doctor who will know how to set the machine to the right level.”
“Hospitalization is more expensive for the system and also creates risks of infections that can sometimes be avoided through home care,” says Rabbi Yossi Erblich, medical adviser and chairman of the Lema’anchem organization. But Erblich stresses that home care must be done under close medical supervision.
“The problem starts when volunteers get involved who have big hearts but little knowledge. That can be dangerous,” he says. “There have been deaths among coronavirus patients who were treated at home who might have been saved in the hospital. The trend is correct, but implementation requires the professional oversight of the health system.”