Nearly 3,000 medical personnel have been quarantined, including emergency room physicians and nurses as well as laboratory workers, as the novel coronavirus pandemic and the strategies the government is employing to combat it pose new challenges to Israeli hospitals.
Regulations and guidelines are drawn up on the fly, amidst uncertainty. With the anticipated further spread of the disease, guaranteeing patients the treatment they need while protecting hospital staff members is expected to become increasingly challenging. On Thursday, 19 members of the medical staff in the emergency room at Sheba Medical Center outside of Tel Aviv were ordered into quarantine after a physician colleague was diagnosed with the virus. He had returned from France, where cases now number in the thousands, on March 2.
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Similar incidents are becoming increasingly common, forcing hospitals to change the way they operate, according to Dr. Zeev Feldman, director of pediatric neurosurgery at Sheba and the chairman of the Organization of State Employed Physicians. Around 100 Sheba staff members are currently in isolation, and 193 staff members at four of central Israel's major hospitals – Ichilov in Tel Aviv, Beilinson in Petah Tikva and the two Hadassah Medical Center hospitals in Jerusalem – are also in quarantine.
"Doctors at various hospitals turn to me with their concerns," Feldman told Haaretz. "Some report that there's a sense of a supply shortage. When you work and feel that you are exposed at the front and you're not being given all of the means, the anxiety meter rises and the measurement of commitment and a willingness to pitch in declines."
The closure of the country's schools and preschools also greatly affects the medical teams, Feldman added. "The entire structure of hospital operations is based on employees with families and children, many of them young children. So in wealthier areas, with some initiative something is set up for employees' children, but I am getting calls from around the country [from people who say] they don't have this option."
Staff stretched thin
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The sidelining of staff members in quarantine, combined with the opening of new wards and units for coronavirus patients, means that hospital staffing levels are being stretched increasingly thin. At Barzilai Medical Center in Ashkelon, physicians and nurses were brought in from various departments to work in the new inpatient ward for people with the virus.
At Hadera's Hillel Yaffe Medical Center, staff members for the new infectious disease ward designated for novel coronavirus patients were recruited from the internal medicine, intensive care, cardiology and emergency departments. The story is similar at Assuta Ashdod Medical Center.
Concern over contracting the virus is constantly hovering in the background. "In some of the departments, isolation of a doctor reduces the capacity of the department to function," Feldman said."I, for example, am one of two pediatric neurosurgeons at the hospital. If both of us get sick or enter isolation, there is no one to deal with children with head injuries and brain contusions who need to be operated on."
The way hospitals have decided to deal with the risk of infection that would shut down an entire unit is to have staff work together as a regular team on an ongoing basis as well as stepping up use of remote care, or telemedicine as it is sometimes known.
“In order to maintain continuity and the capacity to treat the patient, the entire issue of protecting the staff is particularly important because they are the ones who treat the corona patients and the other patients," Prof. Arnon Afek, the deputy director general at Sheba told Haaretz. "As a result, we have worked at changing work habits. We have canceled department meetings. We have made it possible to look at imaging results through virtual means, and we have shifted to working as ongoing teams and are careful to avoid close contact and to maintain distance."
At Hillel Yaffe in Hadera, staff have used technology to overcome the new limitations. "We have about 20 staff members in quarantine, and we are doing everything to maximize our capabilities. For example, we have been allowing radiologists to do diagnoses from home and thereby make up for the loss of personnel,” said Hillel Yaffe’s director, Mickey Dudkiewicz, whose hospital has maintained ongoing working teams throughout the facility, including administrative and maintenance staff. "Up to now, it has proven itself," he added.
Respirators for seriously ill patients
At this stage, things have been going relatively smoothly and efficiently. But the preparations that the health care system has been making will be put to the test when it is had to deal with larger numbers of seriously ill coronavirus patients who require intensive respiratory treatment.
Israel has about 3,300 respiratory care devices and they are currently being used at about 70 percent of capacity. The health care system is working to add about 1,000 more pieces of equipment, the deputy director general of the Health Ministry, Prof. Itamar Grotto, said.
Will that be sufficient? Grotto said he thinks so, noting that deferring elective surgeries will free up some of the equipment for use in serious coronavirus cases.
This week, Sheba Medical Center opened a new intensive care unit as part of its preparations to deal with the coronavirus. The unit has 40 beds, which will supplement the 43 hospital beds in the hospital’s current coronavirus unit.
"We are trying to prepare in advance for what might develop as the [spread of the] disease progresses, in the hope that we won’t need it. But when it comes to everything connected to ventilators, the response has to be on a national level," Afek remarked.
The changes are likely to continue to affect how hospitals function in a number of ways for a long time to come. Canceling elective surgery and medical consulting at clinics so that personnel can be shifted to deal with coronavirus patients will come at a large financial cost and is also liable to have an impact on the functioning of hospital wards.
“The horrible scenario is that the hospitals will become hospitals that mostly treat corona patients", said Sheba's Prof. Feldman. "The existing departments and units won’t be sufficient, and we are therefore trying to expand capacity as much as possible."