Analysis |

Israel’s First Line of Defense Against the Coronavirus Pandemic Held. But Next Time?

Old age homes did a pretty good job of containing the virus during the first wave of the virus

Meirav Arlosoroff
Meirav Arlosoroff
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Mishan nursing home in Be'er Sheva, April 8, 2020
Mishan nursing home in Be'er Sheva, April 8, 2020Credit: Eliyahu Hershkovitz
Meirav Arlosoroff
Meirav Arlosoroff

At the height of the coronavirus pandemic, Spain dispatched soldiers to nursing facilities after the residents had been abandoned to care for themselves. They even found elderly people dead in their beds. When nursing facilities emerged as epicenters for the pandemic, the staff fled for fear that they too would be infected.

Incidents like this took place in almost every developed country, but surprisingly it never happened in Israel. Nursing facilities – old age homes, to use the common parlance – have been hit hard by the pandemic. In the United States, 40% of those who died from COVID-19 were nursing home residents. In Sweden, that rate reached 50%. According to the World Health Organization, the incidence of death from the coronavirus ranges globally from 24% to 82%.

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Israel hasn’t been able to avoid this issue either. Many nursing facilities suffered major outbreaks of the coronavirus, but the number of those who died was relatively low at 141, or 45% of all deaths. Staff didn’t abandon their charges in large numbers, although it isn’t clear whether this was a matter of luck or good administration.

The element of luck was due to the fact that only 10% of elderly Israelis reside in an institutional setting. The rest live at home, where they are protected from the contagion risk institutions face.

“Nursing facilities are on the front lines of the coronavirus pandemic,” says Prof. Nimrod Maimon, head of the internal medicine department at Saroka Medical Center in Be’er Sheva. He is responsible for preparing old age homes for the pandemic as part of an undertaking called the Father and Mother Protection Project.

“Nursing facilities aren’t marginal. They are a frontline defense for the hospitals. If old age homes collapse because of the pandemic, then the whole health care system will collapse. Protecting old age homes constitutes a defensive shield against a second wave of the virus,” he explains.

In that respect, Israel is in a relatively good situation, and it’s not just the low institutionalization rate but also the Father and Mother Protection Project. The initiative was formulated at the peak of the pandemic by Prof. Ronny Gamzu, a former Health Ministry director general and today the CEO of the Sourasky Medical Center in Tel Aviv’s Ichilov Hospital.

Some 59,000 elderly Israelis live in assisted living housing and other less institutionalized facilities where the contagion risk is lower. But the 30,000 who do live in nursing facilities are the biggest concern, because they live in relatively confined and crowded conditions where social distancing is difficult if not impossible.

“You can’t prevent contagion in nursing facilities,” says Maimon. “That is because a resident is confined to a bed and requires constant care – to shower him, feed him, change his diaper. There’s no way to preserve distancing, so infection is inevitable. The least that we can do is reduce its incidence.”

The impossibility of preventing infection explains the awful situation encountered by the Spanish soldiers. The professional caretakers working in these homes didn’t want to take the risk of remaining at their jobs. All over the world, the job of caring for the elderly has little status and inevitably is done by people with little education and less training than those working at medical facilities. Society’s first line of defense against a global pandemic was manned by some of its weakest members, so it should come as no surprise that the line collapsed.

But not in Israel, which is shocking. Israeli nursing facilities are at the bottom of the food chain in terms of health care spending, equipment and government priorities. Salaries are almost always minimum wage, which impacts the quality of the workforce they can hire.

That workforce numbers about 10,000, a third of them illegal foreign guest workers from Africa and Eastern Europe, a fact the government turns a blind eye to. The rest are Palestinians, most of them Israeli citizens. Israel’s first line of defense against the coronavirus pandemic is composed to a large degree by its Arab citizens, and the country offers no thanks for their sacrifice.

Dispute the low pay, difficult work conditions and the racism both migrants and Arabs suffer, Israel’s front line held during the first wave of the coronavirus. How did this happen?

“Because of the resourcefulness and responsibility of nursing facility managers,” says Ronen Gellshtein‎‏, who has been helping the facilities prepare for the pandemic through the V’Shemarta program, funded by the businessman Ronny Douek through his National Initiatives Fund.

“Institutional managers early on made a decision to close their facilities to visitors. They organized longer work shifts and built a kind of capsule for work teams, despite the fact that there was a shortage of workers,” said Gellshtein. “They adjusted work routines, for example having teams stay overnight at the institution … and learned a lot from each other. Also, they supported their people – they gave them special benefits and raised morale. They did it all by themselves and succeeded despite the Health Ministry, not thanks to it.”

Gellshtein doesn’t hide his view that the ministry’s management of nursing facilities during the first wave of the coronavirus was problematic. It continues to be so.

“How are facilities being readied for the second wave? They’re not,” he says. The V’Shemarta initiative will wind down at the end of June after three months of operations, but it’s not clear that the state’s Father and Mother Protection Project will be up to the task. The Health Ministry is unprepared.