In the midst of global uncertainty, with the CEO of Modern, Stefan Bensel, questioning the protection provided by his vaccine against the Omicron strain, and with Sharon Elrai Price expressing in the Knesset her concerns about the mutations and the ability to spread the virus - Prof. Eli Schafercher from Ichilov, the expert To unify the number of patients is difficult, sticking to the cane line that the hospital has been leading since the beginning of the epidemic.
He monitors the low number of verified people currently discovered in Israel, but sees no reason to panic.
Like many medical professionals, he advises the government to take advantage of the next two weeks when Ben Gurion Airport will be closed to incoming tourists, to launch an extensive campaign that encourages the public to continue getting vaccinated, including children.
Do you estimate that Omicron will have an impact here in Israel?
"I can not say no," he says cautiously.
"It is impossible to say that there is no chance that it will affect the morbidity, but at the moment there are no data that allow me to say otherwise. It was clear that variants would enter here, and it would not be the last."
The following varieties are likely to be more difficult?
"There is such a chance. This assumption cannot be ruled out and it is impossible to know."
Has the government acted wisely or hysterically in its decision to prevent inbound tourism at the moment?
"The decision made for a period of two weeks is reasonable. I doubt if it matters because there is no way to prevent variants from entering Israel, especially of a strain that is highly contagious, and the decision may be delayed a bit. There is no difference between a tourist from a country I have to go home. "
What would you do differently?
"The people who come from abroad and isolations are very closely monitored, and the electronic bracelets can be returned to the table.
At this time I was investing in the vaccination campaign because they provide the best protection against the omicron.
I do not remember when we had a vaccine so effective and so safe.
Do not understand how there are people who do not adopt such a gift, which came from science.
If the rate of vaccinators in Israel was higher, we would unequivocally be in a better position today with the new strain.
"There are two serious studies that state that the more vaccinated the country is, the fewer variants will develop in it. It will also have fewer infections and fewer patients. The vaccine is not only effective against infection and disease, but prevents economic collapse, social crisis and child harm."
So we are not at the threshold of a fifth wave?
"We are not on the verge of a fifth wave, nor will we be in two weeks. What will happen next, I can not say."
Have you already created a model that predicts serious patients in light of the emergence of the new strain?
"Only if he enters significantly, and at the moment it is impossible to know. My team and I derive the predictions from the number of people infected. The information we have at the moment is from the South African environment, where there are 20-30 percent vaccinated."
Is your model still active?
"He continues to predict difficult patients, but it is not so relevant and has no meaning at the moment, because we are in a different period since vaccinations began."
• • •
Prof. Eli Schafercher (58) is a renowned scientist and expert, who manages the dermatology department at Ichilov Medical Center and also serves as Vice President of Research, Development and Innovation at the hospital. .
At the beginning of last year he was still perfumed by the conclusion of a seven-year study he led, which revealed a genetic defect in black women who suffered from the problem of baldness, but then the corona broke into our lives.
Schaeffer, who prefers to hang out in hospital labs and meet with patients, found himself at the forefront of the media following a model he developed with a team of experts designed to help with the fog created by the unexpected virus.
The model, presented using colored graphs and tables, examines the relationship between morbidity and new patients and severe patients.
Thanks to medical data on the patients, the model was able to predict two weeks ahead and allowed Ichilov to prepare for receiving the patients in a critical condition and breathing.
The numbers initially provided defeated the apocalyptic predictions of the Ministry of Health.
In mid-June 2020, when the hospitals were treating about 30 respirators, Schaeffer claimed that within two weeks ten more would be added - and rightly so.
In July, when the number of patients was severe and the number of respirators was 130, the model predicted that by the end of the month Israel would face a much higher number - 300 seriously ill - but was still far from the Ministry of Health's thousands of respirators.
This time, too, he was the one who was right.
The model made Schaeffer one of the most influential researchers in the country on the subject of the corona.
How does a dermatologist, who also specializes in genetics and virology, become the one who creates a model for identifying a serious illness?
"We, like everyone else, took some time to understand what we were dealing with. Prof. Roni Gamzo, Ichilov's director, set up an internal Corona headquarters, which was divided into working groups, and we understood that we had to dynamically prepare for an ever-changing scenario. For the Corona department, what is happening today is much faster, and we wondered how we would manage to prepare without just closing departments in favor of the Corona. On the other hand, we did not want to be caught unprepared.
"At first there was a messy management in the country and there was uncertainty around it. To work in an orderly manner, we needed a forecast. I set up a team with diverse people: from the statistician Prof. Yoav Binyamini from Tel Aviv University, through Dr. Sarah Feldman from the National Center for Infection Prevention and Dr. Avishai Spitzer from the Weizmann Institute, to Dr. Ofer Sarig from the Dermatology Department, Noa Gissmer, Director of the Business Development Department at Ichilov, PhD student Tal Kozlowski, and I, who also serves as Vice President of Research, Development and Innovation at the hospital. Only difficult, because we knew it was what would burden the hospitals.We wanted to manage the situation and not be run by the virus.
"It was clear that the difficult patients stem from the verified, and we tried to understand the connection between them. Why one person becomes a serious patient and another does not. We collected personal data on the verified, such as age, background diseases, viral load, immune status, "
Were you surprised by the success of the model in the face of the Ministry of Health's forecasts?
"Most of the time the model predicted correctly, but we also had mistakes. For example, at the height of the second wave, when it became known that many patients, especially from the ultra-Orthodox sector, did not come to the hospital and were treated at home with oxygen generators. Only in retrospect did it become clear that if we had known about those who were treated at home, the model would have been accurate. "
Have you encountered contempt or lack of paragon on the part of the Ministry of Health?
"No. There was more noise around, in the media and on social networks, than in practice."
Looking back, were we too hysterical at first?
"I think some of the system's reactions were a bit exaggerated and not very well-founded, but I get it in a time of uncertainty. Judging in retrospect is the easiest. Whoever is in an event and holds the reins, is naturally dragged into an aggravating scenario. Sometimes a lot of data and evidence is required to pull it off. From there. "
Did it not bother you that only when Prof. Gamzo was appointed projector did he make the model nationwide?
"No. We were very confident in what we were doing and saying. So it is true that there were those who treated us a bit like Corona deniers, but in Ichilov there was paragon and support."
Did your immediate environment also treat you like a Corona denier?
"No, it was only in the media. There were arguments over numbers with officials in the Ministry of Health, but I saw them as constructive discussions. Even after Roni Gamzo finished his role as project manager, we continued to work with the Ministry of Health."
Why does the model present a forecast for two weeks ahead and no more?
"It is possible to examine a longer period, but then the model loses its accuracy. It also did not matter because we only needed the time to prepare for the opening of the Corona department.
"The main satisfaction with the model has to do with the fact that it has become one of the significant tools in Israel, which conveyed a message of a middle way. We were somewhere between 'Sabba' and 'Apocalypse'. It is an epidemic and it is a serious disease The rational. "
Although Gamzo was the projector and the model was by his side, you failed to prevent the third closure.
"At that time there was a disease of extremism. Illuminate everything in black or white. Catastrophe or rage as in Sweden. We diagnosed the situation and saw in the model that the country is heading towards almost a thousand hard patients. So of course the hospitals suffered, but the question is whether the ship was close to sinking. "She really did not. The third closure resulted in a certain benefit, reduced the number of patients severely, and after two months the vaccinations began."
Did you support this closure?
"I was not completely whole with him, but I understood the decision. Closure is an easy means, but its impact is destructive to the economy. I would increase enforcement, which is a complex issue, but relevant to this day."
Will the model have a different future use in the hospital?
"It is intended for a specific purpose, but access to the subject is important. Thanks to it, you are prepared in advance for a medical event that is expected to burden the hospitals."
"The decision to close Ben Gurion Airport to foreign tourists for a period of two weeks is reasonable."
• • •
The success of Prof. Schaeffer's model led him to adopt a new management method at the Ichilov Dermatology Clinic, for which he is responsible.
"I have 60,000 patients every year, and appointments are scheduled here a few months in advance, which is terrible in my eyes. There are patients who book an appointment and do not come, and there are adults whose appointment lasts a long time. This creates a traffic jam and disorder.
"Together with a group of researchers from Bar-Ilan University, we decided to predict the time a doctor will spend with a patient according to characteristics such as age, occupation, type of disease, etc. The system, based on artificial intelligence, knows how long each patient will stay with the doctor. "86 percent of the queue. Thanks to the system, 16 more patients entered the clinic every day. This is called resource management, and I attribute some of the innovation to Corona. It taught us to be more efficient and digital."
Prof. Schafercher is sitting in his room in Ichilov's skin department.
From the computer screen on his desk are graphs in blue and green, depicting the disease state in South Africa and Israel, from the beginning of the Corona.
At first glance it seems as if the Republic is in a better position than us.
The graph is relatively stable and does not have the jumps of Israel, which describe a state of increasing morbidity and then a sharp decline every time the residents are vaccinated.
Prof. Schaeffer focuses on the current situation, in which Israel is almost at the bottom of the graph compared to a jump up in South Africa.
The virus entered Israel after a foreign worker from Malawi broke an isolation and traveled by bus to Eilat.
"What is missing here is how many tests are done there," he explains with his gaze fixed on the screen.
"Israel is one of the countries that does the most. Maybe if they had done the same percentage of tests there in relation to the population number, the graph would have been elsewhere. We do not have enough data from there, and I do not know how reliable it is at the moment. But the sharp rise.
"In South Africa there are ideal conditions for the emergence of new varieties, because of the diverse population and ethnic background, but it is also a country that knows how to do genetic flooring and therefore quickly came up with the new variety. If the variety also exists in Zimbabwe, for example, ".
What do we know?
"There is a South African doctor who appears all the time on Twitter, claiming that the cases are mild and only appear in young people. According to her, the rate of spread is very fast, there is a slight increase in hospitalizations, but there is no worsening number of patients.
What population characterizes the verified there?
"80 percent of those infected with Omicron are not vaccinated. The remaining 20 percent are vaccinated with two vaccines but not with a booster like ours."
Is it possible to prevent variants from entering the country?
"I do not think so. Globalization and the ease with which people move from country to country do not allow it. Even New Zealand, which was closed, has the Delta strain room."
Is it possible to prevent the spread of the omicron in Israel?
"Israel is in good condition, but vulnerable, because of a significant mass of people who have not yet been vaccinated. At the moment, the effort should be directed to vaccinations and enforcement of wearing masks and gatherings at events. The situation should be managed with inspectors, ".
This week, the World Health Organization asked its member states to announce any infection with Omicron. Is this excessive panic or foresight?
"The message is committed to reality, because data transparency is critical. Global governance is a necessity, especially in medicine, and it is not a panic. The possibility of mutual fertilization with insights, numbers and data is the right move."
Would you fly abroad now?
"I canceled a work flight to Switzerland even before they announced no entry for Israelis, just because of the isolation back to Israel. I can not afford not to come to work for another three days. In my opinion, the Omicron is not a reason not to fly abroad unless it is a red state.
On the other hand, I understand that it is less fun to go on vacation in a country where there are closures or restrictions. "
How can Israel prevent itself from entering another wave in light of the Omicron's infection data?
"One should not wait for a fifth wave, regardless of one strain or another, but prepare for it before the numbers of the verified begin to rise. It is worth looking for a biological marker, something that will measure the immune system through a blood test, and can predict the next antibody decline, if any. "Once it is discovered that a decline is beginning among the citizens, it will be time to give another booster. That is where the research effort should be directed to keep the curve flat."
Insufficient serological tests?
"Normal serology is not a good enough biological marker because it tests for general antibodies to the entire corona. We want to see antibodies that neutralize the corona and prevent the virus from entering the cells."
In view of the new variant, would you recommend that parents wait with the children's vaccine until an update is issued?
"There is no point in waiting. Even if the omicron catches a significant part of the morbidity in Israel, and even if it is much more contagious than the delta, we know that the current vaccine is effective. The range of antibodies is high. The immune system to act against the strains is expanding. "
What should we do with the children's shows in the few days we have left of Hanukkah?
"They must not be canceled and it is important to maintain a normal lifestyle. It is a pity we did not have enough time before the holiday to vaccinate the children. He did not stop to check whether the viewers were careful about masks. "
How can a 6-year-old be instructed to wear a mask?
"A child who can not be cared for, may not need to get to a mass show. If I were the father of a child at that age, and I was not able to get him into a situation where he would go with a mask in a place like this, then I would not take it. It is a minimal responsibility."
"Most of the morbidity today is in children and unvaccinated."
A boy gets vaccinated against Corona, Photo: Gideon Markowitz
• • •
Pfizer and Moderna's conflicting messages have confused the global medical community and the vaccinated.
Pfizer was quick to announce that the decline in vaccine efficacy is slight and stands at 90 percent compared to 95 percent.
Data has not yet been released, but the CEO is pessimistic. In an interview with the Financial Times, he estimated that vaccinations would need to be updated and that it could take months. Substantial.
I still do not know how much, we have to wait for the data.
But all the scientists I spoke to said, "It does not look good."
What do you say about Moderna's reaction to the new breed?
"These are computerized predictions and maybe their results look like this. I have no idea what happened there."
At the end of 2020, with the start of vaccines, you said that maybe it's the end of the corona era and 2021 will look different. Do you still think so, or is the new breed devouring the cards?
"So far this year has been better than the last. Is it similar to the year I wished for myself, my family, hospitals and my country? The answer is no. I was hoping that immunization, at least in the Western world, would be faster and more effective. .
I have not seen it in the country.
If it exists, then in a very minor way. "
Why do you think the corona vaccine is causing so much resentment?
"This is how it is when health officials appear in the media and do damage by spreading fabrications about the epidemic or vaccines. This is how it is when public emergency council members speak without data and manage to influence some of the audience. Not people who can't read numbers, because some are doctors and researchers. "
Even though the vaccines have received FDA approval, do you understand people's concerns about the new technology of the vaccine and since it has not been followed for many years?
"I can always understand, but on the other hand every passing day provides more and more evidence that the fears are unfounded. Millions of people in the world have been vaccinated. In Israel alone we have vaccinated four million for the third time. And here, everything is fine. They would run to get him. "
The claim of vaccine refusers is that the effects will be seen in the future.
"I do not know what will happen in the future, and this is true for any new technology or drug. Every drug has the potential for long-term or short-term side effects. I know what awaits me in the short term. Now I am at risk of getting sick, hospitalized, breathing, dying. I can catch My children, my wife, my friends, and also contribute to economic and social collapse.
"Those who refuse must understand that it is a deadly disease. It is not an itchy feeling. It also has severe long-term symptoms. After all, people take drugs and receive new treatments for cancer, and even hang their hopes on them. "What to be proud of in Israel compared to other countries in the world. However, we must still not be satisfied."
How can you convince those who refuse a year after the vaccinations start?
"They can be encouraged in different ways. For example, not allowing unvaccinated people access to certain places, luxuries, such as places of entertainment, restaurants, cafes, flights abroad, concerts."
Is not this a disproportionate step towards the unvaccinated?
"No. There is a very wide range of restrictions. I do not think a doctor or teacher should be prevented from doing his job because he is not vaccinated. It is disproportionate, certainly not at this stage and in the current disease state.
"In my opinion, unvaccinated citizens are likened to people holding a steering wheel without a license. Any citizen can do it as he pleases? Such people if they drive, will not only crash into a tree, they may collide with other licensed drivers and injure them. This is how it is with an unvaccinated person. He is endangering not only himself, but his environment.
"I do not prevent vaccine refusers from living, working, shopping in the supermarket, spending time in the mall or receiving medical treatment. I limit them to the pleasures of life, but do not punish them. If they want to see a play in the theater, then watch it on TV. That is the right balance. "Look at the graph to see how the vaccine has reduced the number of people infected."
Will such restrictions also affect the hard core of the Public Emergency Council for the Corona Crisis?
"They are not, but they are a minority. If we reach 90 percent vaccinated, our situation will be very good."
What do you think of the Austrians' decision to enact a law that would require all citizens to be vaccinated, otherwise they would be fined?
"I'm really not in favor. It's too extreme a step."
Have you ever imagined that wild incitement would develop against doctors in the context of their work, as happens with Dr. Sharon Elrai Price?
"The fact that Dr. Elrai Price, a senior in the health care system, is forced to hang out with a security guard is horrible to me.
Since the Corona, we have witnessed an extreme in social discourse, and medicine is at the center of that discourse.
Unfortunately, in those two years we have become accustomed to extreme messages.
Israel is not a non-violent country, but I have never seen such a passionate outburst against doctors.
I think it's part of a comprehensive messiah and extremism that exists on social media. "
Regardless of the vaccine deniers or the new breed, can you understand the concerns of parents of young children?
"Absolutely. I do not underestimate or judge them. It is our responsibility as doctors and as a health system to explain and convince them. I think we have greatly improved in advocacy."
If you had a 5-year-old child, would you store him?
"Obviously. I was standing in line from day one."
If in Israel more than half of us were vaccinated against corona, why did the coefficient of infection increase even before the introduction of the omicron?
"אותנו מטריד מספר החולים קשה, שלא עלה. עיקר התחלואה היום הוא בילדים ובאנשים שאינם מחוסנים. אמנם פוטנציאל העלייה אינו מהווה איום ברמה המיידית, אולם כשמתווספת מסה של אנשים זה יכול להגיע לאוכלוסיות פגיעות, למרות שהן מחוסנות. אלה עלולים להיות הקורבנות של הלא מחוסנים.
"מצד שני, צריך לזכור שגם ילדים מתאשפזים, גם הם חולים קשה וגם הם יכולים להיות מונשמים. ילדים סובלים יותר ממבוגרים מתופעות הלוואי".
נהיה עם החיסונים האלה כל חיינו?
"קשה לומר. בעבר התברר שיש חיסונים שנדרש היה לחזור עליהם מספר פעמים, כמו פוליו או הפטיטיס. אולי זה יהיה כך גם עם הקורונה. אני מאמין שבשלב כלשהו נגיע לחסינות תאית חזקה. הנעלם הגדול הוא הווריאנטים. כמה וריאציות הנגיף הזה יצליח לייצר".
זה לא אינסופי?
"באופן תיאורטי זה לא אינסופי. בסופו של דבר, אחד מעדכוני החיסונים יקנה את ההגנה הכי רחבה, ואז אולי נתמודד עם נגיף אחר".
אז כמה זמן אנחנו צפויים להמשיך ככה עם הקורונה?
"אני מעריך שכמה שנים. בניחוש פרוע, פחות מעשור".
ד"ר אלרעי פרייס. "הקצנה", צילום: אורן בן חקון
• • •
פרופ' שפרכר נשוי לחגית (56), גם היא רופאת עור באיכילוב שעובדת במחלקה הראומטולוגית ומתמחה בפסוריאזיס, ויש לו ארבעה ילדים מנישואים קודמים. שני בניו (30 ו־28) המשיכו את דרכו, ואחד מהם לומד בתוכנית המשלבת רפואה ותואר שלישי במדעי החיים, השני לומד לתואר שלישי בביולוגיה. בתו הגדולה (36) היא שוקולטיירית בארה"ב, והקטנה (21) השתחררה לאחרונה משירות צבאי כקצינה בחיל האוויר.
הוא נולד בווטרלו שבבלגיה להורים ניצולי שואה. אמו עבדה כנוירולוגית במכון פסטר בבריסל והיתה מחלוצי חקר האיידס. אביו היה כימאי. כשהיה בן 18 עלה שפרכר לישראל, למד רפואה ובמקביל השלים תואר שלישי (PHD) בווירולוגיה. לאחר שסיים את לימודיו, ב־1990, שירת כרופא בחיל האוויר במשך ארבע שנים וחצי, ועד היום הוא עושה מילואים בבסיס רמת דוד.
לאחר שחרורו רצה שפרכר לעסוק ברפואה דחופה, אולם פגש את מי שהיתה אז מנהלת מחלקת העור ברמב"ם, ושם עשה את ההתמחות. "הדבר האחרון שחשבתי היה שאהיה רופא עור", הוא מחייך. "היתה לי רק נגיעה קטנה לנושא במסגרת המחקר בווירולוגיה כשעסקתי בהרפס ווירוסים בעור".
במהלך ההתמחות יצא להשתלמות בנושא גנטיקה בפילדלפיה, וכשחזר עבד על מחקרים בנושא גנטיקה ומחלות עור. ב־2008 הגיע לאיכילוב כמנהל מחלקה שגדלה עד שהפכה למערך העור הגדול בישראל, עם יותר מ־40 רופאים. ב־2016 שימש במקביל סמנכ"ל בטיחות המטופל, ושלוש שנים אחר כך הפך לסמנכ"ל מחקר, פיתוח וחדשנות.
התפקיד המנהלי גורם לו להתרגשות. הוא אחראי ל־53 מעבדות מחקר ול־70 מיזמים טכנולוגיים הממוקמים במרכז החדשנות החדש של איכילוב, IMED, שבהם משולבים רופאים מבית החולים ביחד עם אנשי הייטק. הוא מסתובב בגאווה במכון לתרפיה תאית מתקדמת, שם נמצאות ארבע מעבדות מחקר, המפתחות תרופות חדשניות. אחת מהן עוסקת בסרטן הדם מסוג מיאלומה נפוצה, שם נותנים עוד תקווה לחולים שעברו כבר את כל הטיפוליים האפשריים.
"הרופאות שמובילות את המחקר בשלוש השנים האחרונות לוקחות מהחולים תאי דם לבנים, ובעזרת טכנולוגיה מתקדמת מלמדות אותם לתקוף בעצמם את הסרטן, ואז מחזירות אותם לחולה. החולה הראשון יקבל את הטיפול החדשני בינואר", הוא אומר תוך שאנחנו צועדים למעבדה, שם הוא מראה לנו מעין קפסולה לבנה שנראית כמו אינקובטור קטן, הנקראת "קוקון". "זו טכנולוגיה של מדע בדיוני. אנחנו מטעינים את התאים לאחר שעברו ניקוי, וכאן בקפסולה מרבים אותם כדי שיהיו כמה שיותר תאים 'מחונכים' שיוכלו לתקוף את המחלה".
משם עובר פרופ' שפרכר למעבדה שלו. אחד החוקרים יושב מול צלחת קטנה ומטפטף נוזל על תאי עור זעירים שנלקחו מאנשים החולים ב־Ectodermal dysplasia, מחלת עור הגורמת לכל שיער הגוף לנשור. "הנוזל הזה הוא תרופה, שמטרתה לתקן את החלבון הגורם למחלה", הוא מסביר.
"הקורונה לימדה אותנו להיות יעילים ודיגיטליים יותר". שפרכר, צילום: מירי גטניו, דוברות איכילוב
אם מעבדות המחקר נראות כמו חלק אינטגרלי מבית החולים, מרכז החדשנות נראה כמו חברת הייטק טיפוסית. המרכז ממוקם במגדל ויצמן שבשטח בית החולים. בר גדול נמצא מימין לכניסה, ממול כורסאות מעוגלות. מסדרון המרוצף בפרקט בהיר מוביל לחדרי ישיבות ומשרדי חברות הסטארטאפ, שכל דלתותיהם שקופות. המקום הוקם לפני כשנה והוא משמש בית גידול ליזמים בתחום הרפואה.
"בעקבות הקורונה, אנו רואים את הכמיהה של אנשי טכנולוגיה וחברות סייבר לשיתופי פעולה עם עולם הבריאות, כדי להעניק פתרונות לאתגרים קליניים. למשל, יש כאן נוירולוג שביחד עם מומחה לפיתוח קול עובדים על תוכנה לטלפון, שתאפשר לזהות בקולו של המשתמש אם הוא בסיכון לאירוע מוחי.
"Another venture is a kind of 'ceremonial divorce' for paramedics, who will be invited to departments through an app. There are other startups here that are related to finding the best embryos in IVF procedures, for adults who are learning to walk again to avoid falls and battle injuries."
What research have you done recently on the subject of corona?
"Together with the research labs, we have proven that vaccines protect medical staff from asymptomatic infection. A doctor who carries the virus and does not know about it can lead to a disastrous outcome when he meets an oncology patient or organ transplant.
"We have now completed a large study on Corona, which has not yet been published in scientific journals, and includes 2,000 hospital staff. We took blood tests from them, and for half a year we monitored antibody levels to test the effect of the booster."
And what are the conclusions?
"We have to wait for the publication," he smiles.
"Only then will everyone know if there has been a decline in antibodies or not."
tala@israelhayom.co.il
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