In light of the outbreak of the Corona virus, the State Comptroller published a report on the state's preparation for an infectious disease outbreak, as revealed in a series of investigations in "Israel Today" • The report predicts huge economic damage from a global epidemic • Ministry of Health: "Some of the conclusions are implemented in the current crisis"

Against the backdrop of the global corona epidemic and following the "Israel Today" investigations and exposures on the spread of the measles epidemic, the state comptroller's annual report by Netanyahu Engelman on Monday reveals a series of very serious failures and failures in the preparation, preparedness, handling and functioning of the health epidemic The report was conducted between February and October 2019, even before the corona eruption, and relates to other contagious and dangerous diseases such as measles, influenza and Ebola, but officials from the State Comptroller's Office and the Ministry of Health can learn from the Corona treatment system's preparations.

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Auditor Engelman states in the report that "eradicating epidemics is a mission the entire world is engaged in with a common goal of preventing rising health, economic and developmental damage to humanity. In Israel, the Ministry of Health is primarily responsible for this, together with the health funds, the Ministry of Agriculture and the Environment, the local authorities and the Ministry of Defense, "but despite this" the Ministry of Health has not prepared a regular plan of action for each of the diseases it has determined that include measles. "

The critic further warned that "the health system is not fully prepared for the global flu epidemic, despite the government's decision in 2005 on the obligation to prepare for such an epidemic. The increased risk of an outbreak of the flu epidemic requires the health and security ministries to formulate a plan to reduce the gaps discovered in such an exercise" .

Israel Today's Investigations on Health System Failures:

Thus, the Ministry of Health failed to treat the measles outbreak

Immune system failure

Danger in school: Hundreds of students were not vaccinated against measles

Suspicion: Doctors are encouraged not to vaccinate against measles

Fear of measles recurrence

Israel Today has learned that the issue of conduct of various government offices in the Corona epidemic is expected to be reviewed by the State Comptroller's Office in retrospect. The State Assessment Report for Epidemics was scheduled to be published in April, but after the World Health Organization declared the Corona virus a global epidemic, it was decided to take precedence. The report does address diseases such as measles and pandemic influenza rather than Corona, but pandemic flu is a very similar scenario.

The report found that in every context of the pandemic influenza outbreak, the inpatient system in Israel, which is also constantly on the rise, is not prepared for the Ministry of Health scenarios. This is also due to the government's need for closures, in order not to bring the system to a collapse, as is the case in Italy these days. The health system in Israel, and in fact every system in the world, has no solutions for morbidity in the order of magnitude attributed to the Ministry of Health.

The Comptroller details the preparation and treatment of the measles epidemic that erupted in Israel in 2018, as in other countries in the world, and infected 4,300 Israelis (by August 2019) when 3 patients died, including a one-and-a-half-year-old baby, about 10% hospitalized, In 4% of them, severe and life-threatening complications were discovered and tens of thousands were exposed to measles, which is the world's most contagious disease.

Lack of coping with vaccine opponents

In a series of investigations and exposures published in Israel Today, health officials have warned that a series of failures in the Ministry of Health have accelerated the outbreak of measles virus that has not been in Israel for decades, and that, among other things, very serious claims have been made about the ongoing harm to quality and availability of public health services at dairy and home stations. The book, about the lack of budgeting to complete vaccines in adults and the serious failures in dealing with vaccine opponents and doctors who spread false and dangerous information about the dangers of vaccines and led sections of the public to avoid receiving life-saving vaccines.

Indeed, the state comptroller's report reveals that the Ministry of Health's preparations for measles outbreak were very partial and critical issues such as identifying and treating unvaccinated populations were also not determined in advance. The media reported on the outbreak, no public outreach was set up to prevent the spread of the disease, there was no responsibility for providing guidance to the education system and no ways were set for practicing the outbreak of the disease, nor was there a way to learn lessons from it and there was no regular plan to deal with an outbreak.

The State Comptroller also revealed that although in 2007 there was a previous outbreak of measles in Israel, the Ministry of Health did not formulate a regular plan for further outbreak that could have been a vital tool for important actions that could have reduced the number of people infected with the disease and a regular and systematic response to its outbreak.

According to the report, as early as 2016, the Ministry of Health began to warn about a new outbreak of measles in the world and the Health Bureau in Jerusalem began to alert the July Ministry of Health, the HMOs and the Jerusalem Municipality about the mass outbreak of measles in the capital and demanded action to locate the unvaccinated babies. However, it was not until October 2018 when the outbreak was at its peak that the Public Health Services of the Lung Ministry held a first hearing on this issue and in early October there was an emergency hearing with the office's CEO following the death of the baby quarry in Jerusalem. The auditor determined that earlier preparations, in accordance with the warnings, would have reduced the extent of the measles outbreak in the country.

According to the report, there were many serious and ongoing failures of the Ministry of Health in obtaining information and treating areas, communities, neighborhoods, schools and dairy care stations where vaccination rates are very low and require many actions to increase vaccination rates to protect infants and children not vaccinated and the general public in the country. The comptroller criticized another firm that the firm's leadership had not worked for a decade before the measles outbreak to advance the explanatory and educational legal treatment of vaccine opponents whose numbers had soared over the years.

The State Comptroller further revealed that the epidemiological investigations of measles patients (the investigations are critical to reducing the continuation of the infection and are intended, like the daily coronary investigations, to map the sites where the patient was - RR) in the Ministry of Health's provincial bureau as required or delayed It is very difficult because of the lack of public health nurses who are missing both routine and emergency room and that this severe shortage of nurses has also led to very low availability of vaccines in some neighborhoods in Jerusalem where it was precisely the severe outbreak of measles. He also found that health funds were not prepared enough to assist the Ministry of Health in these important investigations. According to the report, the health bureaus collapsed from the burden of investigations required for measles patients and there were cases where a sick child's parents were asked to notify themselves to a kindergarten teacher or school, instead of doing so by professionals. According to the report, there was a shortage of 222 standards Nurses in the drops of milk. Especially in the south and in Jerusalem.

As revealed in "Israel Today", the auditor revealed that at the height of the outbreak there was a shortage of vaccine that was passable for susceptible populations such as infants, as there was no contingency plan to complete the required inventory and there was a delay in vaccination of the population and there was no co-operation between government ministries and other authorities. One that concentrates on addressing this issue.

Millions will stick, the global economy will collapse

According to the report, 25% of the population, which is about 2.25 million Israelis, may suffer from a worldwide outbreak of influenza and that the heavy economic price the world may pay in the event of a worldwide outbreak may reach $ 4.3 trillion, which is about 5% of the total. "The global c, which may also explain the reports and estimates of a global recession that the world will enter as a result of the Corona crisis.

The report also shows that Israel has been dealing with more than 10 diseases and epidemics (measles, mouse, flu, Leishmania and more) over the past decade. $ 16 in childhood vaccine is saved for $ 16 in case of illness. The report states that Israel is seventh in the world In terms of the morbidity rate, the figure refers to 2018-2019 and at this time 4,300 have had the disease.

The Association of Public Health Doctors in the Medical Association said: "The State Comptroller's Report on Outbreaks and Renewal Diseases reveals a bleak picture of neglecting public health in a routine that also harms us in an emergency. Unfortunately, the address was on the wall and despite all of our warnings not invested in routine or emergency resources and manpower required to protect public health. It is inconceivable that even today, within a global pandemic of the Corona virus, only technological solutions continue to be sought and severely neglecting human capital, which is the key to protecting public health.

Ministry of Health Response

"The State Comptroller's report on health care treatment for outbreaks is being studied by us and we are applying some of the conclusions in the current crisis. We hope that the report published while dealing with the Corona Challenge will be used for learning and criticism rather than for a rant. The outbreak of the new Corona virus is unusual, unique in its strength and creates a challenge for all health systems in the world. The Israeli health system was held on the subject from mid-January when From this date, procurement of protective equipment, respirators and test kits for Corona began, hospitals were opened to open dedicated departments and so were the health funds. Israel was one of the first countries to understand the severity of the epidemic and led by the NSC and the Ministry of Health took drastic measures to close the country's borders, steps taken Then as it were All countries of the world.

The purpose of the Health Ministry's policy in dealing with the Corona virus is to try to smooth the curve of the hospital so that there is not much morbidity and a dramatic increase in the number of patients and hospitalized patients. The medical staff in hospitals and the community are at the forefront of Corona treatment, a front that is likely to continue for at least another few months. "

"Israel is probably one of the best countries to deal with the global outbreak of measles. Israel managed to reach a few numbers per month of infection, with 5 measles patients reported from the beginning of 2020: January 4 and February 1, March no Report new patients! This result is attributed to the quality of service provided by the public health services in the office and to the nurses' enlistment in the milk drop set.

"The first public health department alerted about measles was released in April 2018, ie less than a month after the first case appeared and 4 months before the announcement of the Jerusalem Health Bureau. Division-level discussions were held every day and 8 circulars were issued to deal with the outbreak, including guidelines Uniqueness such as: vaccination of air crews, guidelines on measles vaccination among children departing from the Ministry of Education delegation, and exercise of powers by the county physician under section 19 of the Public Health Ordinance, 1940 to prevent unauthorized children from entering educational institutions at the time of the measles outbreak.

"The Director General of the Ministry of Health has also been handling the measles outbreak on a regular and intensive basis and in direct discussion with the Public Health Services Administration. There were regular assessments of the situation and even a national army was established in the matter. Dedicated programs for dealing with vaccine pockets at a low rate were established and a dedicated budget was allocated.

"The said meeting with the Director General of the Ministry of Health in October was not the first in the matter and was determined by a significant increase in patients during September. Recall that vaccine coverage in Israel is among the highest in the world and stands at 97% for the first dose and 96% for the second dose. There is indeed a problem of non-vaccination pockets and the formation of pockets cannot be prevented except to reduce their scope and during measles outbreaks have been carried out and many other actions have been taken, including increasing access to milk drop stations and legal measures against vaccine refusers. "

Prime Minister's Office Response:

"The Israeli health system is ranked in the Bloomberg index 2019 as one of the ten best health systems in the world. In the past decade, the health system budget has almost doubled and the health basket budget has doubled. However, there is room for improvement and we will study the details of the report.

The report is irrelevant about the Corona virus, as there has been no such event in the last century and no country in the world could have predicted or prepared for the spread of the virus. Indeed, no health system in the world, even the best, has been prepared to deal with the epidemic. That can be dealt with through the health system but by taking determined steps to curb the spread of the epidemic.

Thanks to the prime minister's steps ahead of the world, Israel's situation is better than that of many developed countries. Even before the spread of the Corona virus in Israel, Prime Minister Netanyahu has held extensive discussions, including the directive to set up a vaccine plant to help deal with epidemics. The PM also directed to increase the array of medical staffs, equip thousands of respirators and increase hospital readiness. Alongside all the efforts, over the next two weeks, more than 1,000 beds will be converted into ICUs and increased treatment, placing Israel in a higher position relative to the world. In addition, 200 physician standards, 605 nursing standards, approximately 300 cleaning staff, approximately 6,000 aid students and hundreds of medical internship standards will be added to the health system.

All countries and all health systems in the world now face a huge challenge in the coronary disease. The only way is to stop the spread. If the spread is not stopped, any health system will not face the surge of elderly patients. Israel is taking vigorous steps and will continue to take them. Alongside this, we continue to prepare the system for responding to as many patients as possible through staffing, equipment, and ventilation.

As for the health system, Prime Minister Netanyahu has jumped a step in the Israeli health system, ranking it as one of the 10 best health systems in the world. Doubling the health budget over the last decade has significantly improved the health system in Israel. "

Comments

Association of Public Health Doctors:

"The State Comptroller's report on outbreaks and renewable diseases reveals a bleak picture of neglecting public health in a routine that also harms us in an emergency. Unfortunately, the address was on the wall and despite all of our warnings not invested in routine or emergency resources and manpower required to protect public health. It is inconceivable that even today, within a global pandemic of the Corona virus, only technological solutions continue to be sought and severely neglecting human capital, which is the key to protecting public health.

For example, according to the report, there is a shortage of dairy drop compared to the standard (which also does not meet needs) in 13 out of 15 districts and sub-districts. The actual staffing of nursing standards at dairy drop stations is 77%, and in some districts, such as the district Jerusalem, reaches a low of 44%! To the best of our knowledge, in the privatized and truncated student health services, the situation is even worse.

The severe shortage of public health personnel in our routine severely impairs our preparedness in an emergency. Public health doctors and doctors, along with public health nurses and public health lab workers, have been working tremendously on a routine basis and over the past two months in response to Corona. Even in this emergency, no "reserve" recruits are allocated no public health personnel budgets and refuse to pay dedicated employees for work on nights and weekends. In order to conduct the epidemiological investigations properly, adequate personnel and computer systems must be taken care of. Inaccurate and unprofessional "magic solutions" such as automatic digital spotting, will lead to serious mistakes and cannot be a suitable replacement.

Investing in the public health system and public medicine is not on the "margins." Lack of standardization for public health personnel and lack of agreed mechanism for updating the budget of the public health basket hamper our routine and harm us in an emergency. Despite neglecting the health care system routinely, and wasting precious little time in preparing the health care system, it is still possible to invest most efforts in strengthening the health care system, investing in health care workers and providing the best mantle to enable them to do their vital work and protect our health.

As the auditor's report shows, investing in public health is the best investment. It is important that we implement this lesson immediately, right now in the Corona crisis and even after we pass it and return to normal. If we were preparing properly for routine, seasonal influenza and measles, we would also be much better prepared for pandemics. It is worth noting that public health doctors in Israel and around the world have for years warned of the need to prepare for pandemics, such as the one we see now. It is essential that this decision-making is transparent and will rely on data and public health professionals. We hope the system's captains will be open to accepting the audit and remedying the deficiencies that can be urgently remedied. "

Dr. Ze'ev Feldman, Chairman of the Association of State Physicians, and Chairman of the Supreme Court:

"The state comptroller's report regrettably does nothing beyond the fact that we are coming with the starving health system that is also inclusive of seasonal flu treatment, to the horrific scenario that is currently being implemented by the Corona epidemic. The report talks about the hospitalization of some 150,000 civilians at the height of the seasonal influenza epidemic mentioned, with 25,000 of them in need of intensive care and half of them needing ventilation. I hope we do not reach this situation because its result will be disastrous. On the eve of the current crisis, the Ministry of Health had 758 intensive care beds and 124 increased treatment beds in the internal wards.

He said: "Huge resources can be allocated quickly to purchase respirators and protective equipment, but the long-standing lack of standards and training of staff trained to operate cannot be overcome. Beds and medical equipment can be bought and manufactured within weeks, training doctors to take many years.

The obvious conclusion is that now, in the immediate term, when the epidemic is already occurring, doctors and doctors and medical teams at the forefront should be given the best protection in order not to lose anyone during the Corona virus war. In the medium term, the health system needs to be allocated and allocated to an immediate emergency budget in order to be prepared and ready for the peak of the Corona epidemic that may reach peak levels this winter. And at the same time, a long-term multi-year budget needs to be passed to bring about the rehabilitation of the health care system and to prepare for the next challenges and population aging. "

Response of the Israel Brothers and Sisters Association to the State Comptroller's Report:

Chairman of the Israel Brothers and Sisters' Association, Ilana Cohen: "The State Comptroller's report requires the State of Israel currently at war with the Corona epidemic, to prepare immediately and to allocate hundreds of standards for nurses to enter the system, in order to cope with the end scenario that the Ministry of Health estimates This winter, with 25,000 civilians in need of intensive care. "

At the same time, the prime minister, who is the top manager of this crisis, must give unequivocal and immediate instructions to give every nurse and medical staff in community and public hospitals, full protection and rapid tests to diagnose Corona virus when suspected of contact with a patient. Medical staff examinations should be given top priority and checked again that day to prevent further infection by medical staff. Any such department that closes offends the national ability to fight Corona and harms the morale of the warriors and fighters on the front. "

She added that "The State of Israel must prepare for the population vaccine in about a year when the vaccine is completed for Corona, and must complete the allocation of 220 public health nursing standards, and allocate the necessary budgets to meet the prevailing tasks of preventive medicine, alongside the population vaccination against the corona.

We are on the "Judgment Day" of the Israeli public health system and the Israeli government to gather and allocate a multi-year budget for its rehabilitation. "