Rise in adhesives, rise in isolation, beginning of war.
The headlines in recent weeks show apocalyptic predictions of tens of thousands of patients in the omicron strain, predictions reminiscent of the days of uncertainty of the onset of the plague.
But alongside the forecasts, directors of large hospitals across the country say, in a special interview with Shishvat, that we too can control this wave.
Managers go against the sense of panic and harsh predictions and emphasize that although the omicron variant seems to be out of control, and despite the daily changes in guidelines, the health system has gained enough experience and knowledge and is prepared to deal with this war, however long it may be.
Along with the optimism, they warn of a shortage of intensive care beds, which could be felt in the event of a sharp rise in those infected and hospitalized, attrition by medical staff and the irresponsibility of the public, who claim not to care about wearing masks and maintaining social distance.
The six principals we spoke to are: Dr. Eran Rotman, General Manager of Beilinson Hospital in Petah Tikva; Dr. Shlomi Kodesh, Director General of Soroka University Medical Center; Dr. Yaron Muscat, CEO of Meir Hospital in Kfar Saba (all three from the Clalit Group); Prof. Yoram Weiss, Acting Director General of Hadassah Medical Center in Jerusalem; Prof. Masad Barhoum, Director General of the Galilee Medical Center - Nahariya, who, in addition to managing the hospital, is also a member of the Advisory Committee to the Directorate of the Ministry of Health. Director General of Laniado Hospital in Netanya.
The current wave, which so far is not reflected in a significant increase in the number of critically ill patients hospitalized, is meeting the health system at the peak of winter illnesses.
Unlike last year's winter, where seasonal flu morbidity was relatively low thanks to maintaining social distance and wearing masks, this year there is a wave of flu and other winter illnesses, such as respiratory infections.
Many hospitals report an increase in the number of people hospitalized due to winter illnesses, and an occupancy rate of more than 100 percent in inpatient wards.
At the hospital in Nahariya, for example, the internal medicine departments occupy about 150 percent.
Only two of the patients, as of Tuesday this week, are Corona patients - one in moderate condition and one in severe condition, and they are hospitalized in a special ward closed in an internal ward.
Laniado Hospital in Netanya is 140 percent occupied in the inpatient wards, and 160 percent in the pediatric wards;
Only two of the patients are corona patients.
According to Dr. Yaron Muscat, director general of Meir Hospital in Kfar Saba, due to the rising incidence of non-Corona diseases, Corona patients are being discovered among people who come to the hospital.
"Maternity or trauma-injured people arrive, do a corona examination and are discovered to be blue, along with a few patients who arrive due to corona," he says.
"We currently have 11 patients, one of whom is connected to an Acme device (which replaces cardiopulmonary function), and another patient in a serious condition who needs oxygen. We have a ward, part of which is assigned to Corona patients, where 12 patients can be hospitalized. We have not reached that number yet, but no "I doubt we will get through it very quickly. That's why this week we reopened the Corona department, and we are opening the Corona classification in its entirety."
Beilinson Hospital also announced this week the reopening of the corona ward in the hospital's underground car park.
At Hadassah Ein Kerem, they opened a ward with 18 patients, including one mother and an advanced pregnant woman.
In Soroka, one corona ward continues to operate since the fourth wave, alongside a corona intensive care unit.
"As of mid-week, we have 11 hospitalized with Corona, eight of them in critical condition, including five respirators," says Soroka Hospital director Dr. Shlomi Kodesh.
"In the intensive care unit children are hospitalized two children with corona in critical condition. This is the situation with us not today, it is quite constant. Infected vaccines are usually protected against serious illness. "
Is there a feeling of panic?
"There is not even a crumb of panic. Some people treat this strain as if we are meeting the corona for the first time, but there is no reason for it. We know it, we have faced very heavy loads in the past, and we knew how to move resources from here to there. With Corona, and this deployment will serve us well in the fifth wave.
"The only thing that may require further reference in this wave, is the absence of staff members due to infections, which we have hardly seen in the third and fourth wave, thanks to immune efficacy. Now we see that vaccinated can also be infected, because immune efficacy decreases."
Are there a lot of sick staff or in isolation?
"Currently there are about ten verified and about ten isolates, and precisely the change in the policy regarding isolations is very important to us here, because it allows the system to work a bit. Sick".
Forecasts speak of tens of thousands verified a day within a few weeks. This is likely to hurt medical staff as well.
"I have already heard an estimate that there will be 50,000 verified a day. I do not think we will get to that, but even if we do - it is impossible to send the entire population to isolation, because the state will not be able to function. "Safe, and let people feel confident that they are not in contact with a corona patient."
Huge queues for corona tests in Haifa, this week.
"The quick tests are starting to run out," Photo: Herzli Shapira
Meir Hospital currently has about 70-50 employees in isolation, out of 3,500 employees.
"Most isolators are infected at home from children or other family members, rather than exposure in the workplace," says Dr. Muscat.
If and when there is an abnormal increase in verified Corona among the population, I have no doubt that there will also be an increase in staff, and that is a problem.
As much as you defend yourself, you can not completely prevent employees from being infected. "
Beilinson also reported this week about 30 workers who fell ill in Corona, and another 15 in isolation.
"These are relatively low numbers, but they could mark the beginning of a trend," says CEO Dr. Eran Rotman.
"When we were under the vaccine in the third and fourth wave, morbidity among staff members was low and allowed us to function. But once we see an increase in staff morbidity, including vaccinated people who are not seriously ill but need isolation, it is disturbing.
"And when we start the winter in advance with a relative minus of staff in the face of a large number of patients with winter illness alongside Corona, the hospital may have an operational problem. We have already taken all sorts of measures to prevent infection, such as closing the dining room, preventing staff from attending conferences, and more. "The absence of dozens of staff will not affect the hospital, but if it reaches hundreds, the situation will be more difficult."
Dr. Eran Rotman. "The numbers are relatively low," Photo: Oren Cohen
"Monitor the situation"
As information about the omicron accumulates, it is suggested that it is a highly contagious strain, but less deadly than the Delta.
According to Prof. Yoram Weiss, CEO of Hadassah, "We are seeing a gradual and slow increase in the number of critical patients, because this strain is more contagious, but less violent.
There is no doubt that the more patients there are, the more critically ill patients will be required to require hospitalization.
But if we were to see such an amount of people infected with the Delta strain, we would be in a bad situation.
"In Hadassah's hospitals we see a large load in the emergency department and in the inpatient wards. On the second day of this week we saw 100 more patients in the emergency room than usual - most of them suffering from the flu. My concern is that as the wave gets stronger, chronic patients "This is a mistake, because we are prepared to treat and identify patients with acute illnesses and separate them from Corona patients, so the hospital is a safe place."
There are claims that it is the flu, which mainly attacks the unvaccinated.
"Those who develop a critical illness are mostly unvaccinated. In general, statistically, patients who are vaccinated with two and certainly with three vaccines receive significant protection against a critical illness. We had 40 respirators in intensive care.This time we do not see it.
"As of mid-week, the corona ward at Hadassah has about 20 patients, three of whom are in critical condition, and another six in critical condition. There is no doubt that at this point in time, relative to the wave, it is calmer than in previous waves. The patients are difficult.
"The State of Israel has made a strategic decision, with which I agree, that life cannot be stopped. The economy and normal life must be maintained. After all, if we were now in the current state of infection without vaccines, Israel should have been shut down. But this virus threatens society as hospitals "Currently, I am in a situation where there is no danger that the hospitals will collapse and not be able to treat patients, so there is no reason to shut down the economy and life in the country."
"The fact that there are no restrictions does not necessarily mean that the thought is to infect everyone. You can always say 'let's do nothing', we will infect everyone, we will reach 3,000 patients a day - many of whom will be in a difficult or even critical condition - and the system will fail. The job of the government and the Ministry of Health is to monitor the situation and set the policy according to capabilities. We are currently facing this load. If there is no choice we will close the elective activity (surgery and non-urgent treatment; ".
Dr. Rotman of Beilinson believes that “eventually herd vitality will probably develop, as a side effect of life alongside the virus. At our hospital there is no stress and no panic, and there is no reason to create panic. There is readiness, and with it we will deal with this wave, no less well than we have dealt with the previous waves. Each wave brought with it its own uniqueness, and the law of the omicron is not like the law of the Delta. For me as a hospital, this strain will affect the hospital due to the amount of verified people who come to it for other reasons and turn out to be verified, and not in terms of the serious patients.
"The government must take into account, when making decisions, the other consequences for the population, at the economic and mental level - we must not forget that economics and the mind affect health. We saw the damage caused by the prolonged closure to Israeli students. Who does not contribute anything, but has to deal with the virus and live with it.Today the tools available to us are many and better than they were at the beginning of the crisis.There is a vaccine, there are drugs, and we have tools to deal with this wave.
Prof. Barhum from the hospital in Nahariya believes that there is no reason to publish the number of patients daily.
"The public is already tired, there is no point in scaring him anymore. This number of verified is passing him by. No matter if there are 50,000 patients or 30,000 patients - as long as there is no increase in the number of serious patients, it does not interest the public. It is really unnecessary.
"Once we wanted to stop the chain of infection, and we ran people for tests. Here we can not stop the infection, so it is worth leaving the tests and investing all our energies in convincing people to get vaccinated with a booster, and for those who need it - in the fourth dose."
When you say that it is impossible to stop the infection, are you talking about herd immunity?
"None of the experts say he has a goal of getting herd immunity. There is no such thing as herd immunity in the corona, because there are new strains all the time. We know the omicron spreads like wildfire, but in the end it causes a relatively mild disease, which I do not see following. An increase in our hospitalizations, and certainly not in the serious illness.
"We went through Hanukkah, Christmas, now the beginning of the year parties, and so far we have not seen a special increase in the number of serious patients. I expect the situation will not change."
Dr. Holy: “Even if the government is indecisive, the public should act responsibly.
It hurts when we see a part of the public around us that does not understand its part in preventing an epidemic.
Which does not maintain the wearing of masks, the social distance, which does not avoid gatherings.
This argument that 'allowed' to go to parties or performances or any other closed venue is terrible.
"The citizen also has a responsibility, and the feeling is that some citizens behave irresponsibly, without thinking about the people who are left to pay the price later - the patients and the caregivers. I am a Hapoel Beer Sheva football fan and go to all their games. In my risk management I chose not to go to the game. "He should do his risk management, and not be dependent on what this or that minister says at eight o'clock in the evening."
Dr. Shlomi Kodesh. "The system is hungry," Photo: Dudu Greenspan
"Not a simple dilemma"
In the last week, it was decided to give a fourth dose of vaccine to the at-risk population and to the employees of the health system.
Hospital administrators are convinced that the fourth dose can be beneficial, and have even announced that they will vaccinate themselves, to set an example for employees.
But while the immunization rate among medical staff is relatively high, there are still employees who refuse to be vaccinated.
They present managers with a difficult dilemma - the choice between the employee's right to his body and the need to protect patients from infection.
"98 percent of our medical staff are vaccinated with three doses," says Prof. Weiss of Hadassah, "but I guess it will be more difficult to get them vaccinated with the fourth vaccine. Get vaccinated - to protect myself and to set a personal example. "
Prof. Hezi Levy said in an interview with Shishvat that staff members should be required to be vaccinated, and not - they will go on vacation.
"We obliged the staff to get vaccinated in the first, second and third doses. We were aggressive, and did not give them the right to choose. I do not know if we will oblige them in the fourth vaccine as well. In the first stage we will try to convince them. That the workers will be vaccinated. "
Prof. Yoram Weiss.
"Patients are difficult - mostly unvaccinated", Photo: Oren Ben Hakon
At Laniado Hospital, only 80 percent of the workers were vaccinated with the booster vaccine.
"I can not force people to get vaccinated," says CEO Nadav Chen, "and the state does not allow me to impose sanctions on a staff member who does not want to get vaccinated.
The vast majority of medical staff members are vaccinated;
The problem is with farm workers.
"People now ask me why to get vaccinated again for the fourth time. I see people here who come on dialysis three or four times a week, each time for a few hours, for years, because they understand that this is what will save them. So if I am asked once every six months to get vaccinated "For my family, for myself, for my children - I will do it, because it is the best solution we have."
Nadav Chen.
"Sanctions cannot be imposed", Photo: Efrat Eshel
Dr. Muscat: “The issue of the obligation to vaccinate is complex in practical, ethical and legal terms.
Without legislation I can not force a staff member to get vaccinated, and the ethical issue is not simple, because a person is a master in his own right.
93 percent of the staff at Meir Hospital are vaccinated, and those who are not, must present a negative test every three days, in accordance with the instructions of the Ministry of Health.
"We have no vaccine opponents in the hospital; those who are not vaccinated, it is for health or temporary reasons, like pregnant women who are afraid, even though they have shown that the vaccine is safe during pregnancy. The rate of vaccinated doctors three times is almost 100 percent. .
"Yes, even in the health care system there are people who are not vaccinated out of ideology," says Dr. Rotman of Beilinson.
I can not deny them the right to their bodies. "
Prof. Barhum is more determined.
"Over 92 percent of the hospital staff are vaccinated or recovering, but there are also staff members who are not vaccinated out of ideology, and also those who are unwilling to be tested and create a problem for us. I am in contact with the Ministry of Health and the Civil Service Commission about possible ways to deal with them.
"I can take them on vacation for a start, but then I break my head over how to continue this vacation, because it's not always allowed to take them on vacation.
On the other hand, you can not allow them to work with patients and endanger them.
"This is an event that needs to find a way to manage at the government level and not at the level of one hospital, and the government needs to find a solution for such employees."
Prof. Masad Barhum.
"I do not want people to lighten their heads", Photo: Ancho Gush - Ginny
"Abrasive work"
Hospital administrators tell of worn-out staff members, who are barely able to go on vacations.
"People who go into these wards are dealing with families in frail situations, and cannot be with families and patients fully, because they need protection," says Prof. Kodesh Masuroka.
"It's a voucher. We have determined that the staff treating corona patients in the inpatient wards will be replaced every three months and move to a regular inpatient ward.
"Now, after a turnover in seven departments, we are starting the round again, with the first team that was in the Corona department. The problem is that in intensive care I only have the option to switch between two teams, and each of them works a full year in Corona intensive care. It is difficult. Mortality of young people and accompanying families in the most difficult situations, and they do so out of a mission, it is impossible not to appreciate them for it.
"I do not understand how it is possible to be a Corona denier after you see an unvaccinated 40-year-old man who died of Corona, and his family is broken. We have seen painful human stories here in the last two years, and you can not help but get vaccinated after seeing what the disease does."
"We have a great team, but we are all exhausted," adds Prof. Barhum.
"This work is abrasive and mentally difficult. People here are traumatized by the deaths they have seen in the Corona wards, and yet they continue to provide service and want to work."
Dr. Muscat: “Our staff members have been fighting heroically for two years, and we help them maintain mental immunity and make replacements as possible.
But it is not possible to make a substitution in the emergency department (emergency department) or in intensive care, and the staff comes to burnout and exhaustion.
They will face this wave, and also another wave, if it comes.
But the physical load and the mental load are very annoying. "
Dr. Yaron Muscat. "Corona patients are discovered by accident", Photo: Oren Cohen
According to Prof. Kodesh, the Ministry of Health has added about 50 doctors and about 150 nurses to Soroka in the past year.
"It helps a lot, but we were in short supply even before the corona, so we constantly need more. There is no doubt that the combination of significant winter and corona will challenge us in terms of manpower. I can not imagine how we would have done it without this addition, but it does not answer To the possibility of hundreds of patients.
"I need more manpower, more intensive care beds and more Acmo devices. But no one will be able to train manpower to handle the current wave. If these devices were increased in the second wave, we would not be in the situation we are in today. I can not live on the island. Certainty and hope that if there is a corona, more nurses will come to me.
"The system is hungry, and it is impossible to leave it on the scales and deal with a fifth wave. After all, another virus or bacterium will arrive tomorrow, and again the system will be in short supply. I, as the main hospital in the south, need at least another 200 beds for real Negev residents.
"The Ministry of Health is asking me to open a pediatric ward for Corona patients. But the pediatric wards at Soroka work almost 100 percent of the year, and I have no other pediatric ward. "Another of the hospital. We need to create a little more redundancy in the system, which will be where to take manpower from."
The corona ward at Soroka Hospital, during the fourth wave.
"We have faced very heavy loads in the past, and we have known how to move resources from one place to another," Photo: Dudu Greenspan
"Every employee is significant"
Hadassah and Laniado Hospitals are privately owned public hospitals, which do not receive a current budget for instrumentation and equipment from the Ministry of Health, but are rewarded for performing actual clinical operations.
They provide health services to the entire population, and feed on donations or private health services.
"The thing we lack most in Laniado is manpower, because we have soul machines," says Nadav Chen.
"Every worker is significant, but the addition of devices we received in previous waves is like a drop in the ocean. Even so, the system has been starving for years, so this thing does not close the gaps of the corona, but hardly closes the gaps from years past.
"At the end of December we received from the Ministry of Health the budget for deficiencies created in 2021, but we have not yet received financial assistance for 2022, and we have not received a budget to deal with the new wave. We need to prepare to open a corona "Get service in the rooms and not in the hallway. The quick tests are also starting to run out."
Prof. Weiss: "Unlike a government hospital that receives allocations of beds and standards of nurses and doctors - Hadassah, as a public hospital, a little shorter in money. Therefore, for years, we are under-budgeted compared to government hospitals. What determines our hospital.
"Either way, the medical staffs are very exhausted. This is the fifth wave they are required to mobilize to treat, and it's a little more intense because it comes alongside normal winter illnesses, which stretches the system. Support our team and understand the exhaustion and help in what is possible, and we will do it.
"I hope that the Ministry of Health will also mobilize and help with the budget for manpower and equipment. We are already beginning to feel the pressure to use medical protective equipment such as masks and robes. I assume there will be a relative lack, so care must be taken to have enough such equipment in stock."
Did you request additional equipment and personnel from the Ministry of Health?
"I have drawn the attention of the CEO.
We purchase equipment alone, but the manpower comes from Ministry of Health facilities.
"What hurts hospitals is not necessarily an increase in the number of serious patients, but a shortage of medical staff, which is created as a result of infections or isolation."
Is there cooperation between the hospitals regarding the corona? In previous waves it was crowded in Jerusalem, compared to other cities.
"Hadassah and Shaare Zedek cooperate and share the load. In the past, busy hospitals have sought to perform secondary regulation (transferring a hospitalized patient to another hospital, to alleviate the load; BA) and transfer a patient who has been admitted to another hospital, the Ministry of Health handles.
"I, as the director of Hadassah Ein Kerem and most recently as the CEO of Hadassah, avoided deviations from the beginning so as not to endanger them during the transfer.
In previous waves, there was a problem in Jerusalem, when many residents did not maintain social distance and the use of masks.
At first the immunization rates were also low.
Today the picture in the city is similar to the general picture in the country.
"We set up a joint working group between MDA, Hadassah and Shaare Zedek, to help each other.
"At the moment there is a congestion in the emergency rooms, and MDA is regulating the ambulances between the hospitals. Our intention is that the hospitals in Jerusalem will do everything to help the population in the city."
Of the six hospitals, Belniado and Nahariya, there are no Acmo devices.
"In previous waves, we asked the Ministry of Health for two devices, and we are still waiting for approval," says Prof. Barhum from Nahariya.
"In the fourth wave, I had to transfer 15 corona patients in critical condition to other hospitals, in order to connect to Akmo. The highlight was when we transferred a corona patient in critical condition to Hadassah on Yom Kippur evening."
According to Nadav Chen, "Even if we receive a permit to operate an Akmo device, Belniado does not have a manpower skilled in operating it. It is also not easy to recruit, because there are not many of them in the country."
Vaccinated in the fourth dose at the United Health Insurance Fund, this week.
"This is the best solution we have," Photo: Oren Ben Hakon
"Attrition war"
According to the executives, the new drug for the treatment of Corona, Paxlobide, which is supposed to prevent a serious illness, is already available in the HMO clinics, and the second drug - Molnofirvir - will be available soon.
"התרופה ניתנת בעיקר בקהילה, לחולים יחסית קלים, וזה יתרון", מדגיש פרופ' קודש. "כי מי שמקבל אותה אמור לא לפתח תחלואה קשה ולא להגיע אלינו בכל מקרה".
פרופ' וייס: "הפקסלוביד, שמיוצרת על ידי פייזר, זוכה לביקוש עולמי עצום, והחברה כנראה לא מסוגלת כרגע לייצר מלאי שיספק את כל הביקוש. לכן כל רשויות הבריאות בעולם קבעו שחולים מבוגרים עם גורמי סיכון יזכו לעדיפות על פני צעירים בריאים ומחוסנים, שהסיכוי שלהם לחלות קשה מקורונה נמוך יותר. התרופה ניתנת גם בקהילה וגם בבתי החולים".
איך נעבור את הגל הזה?
ד"ר רוטמן, בילינסון: "אני יכול להביע תקווה שהגל הזה, כמו שהוא עולה מהר – גם יירד מהר. אולי, בזכות ההדבקה המאוד רחבה של האומיקרון, כן תהיה סוף־סוף חסינות העדר המיוחלת. אני מקווה שנצליח לשמור את אנשי הצוות שלנו בצורה המיטבית, כדי שגם אחרי הגל הזה נוכל להמשיך לתת שירות רפואי בכל תחום שיידרש בצורה הטובה ביותר. כי מערכת הבריאות שבעה מקורונה".
נדב חן, לניאדו: "מה שלמדתי זה שצריך להישאר דרוכים כל הזמן, להיערך ולא ליצור ציפיות שווא, כי זה עלול לפגוע במורל. הממשלה אומרת את זה, אבל צריך להפנים. אנחנו נמצאים במלחמה התשה שלוקחת הרבה זמן, ובחזית יש חיילים כל הזמן. לא צריך לתמוך בחיילים רק בזמן המלחמה, אלא גם בין המלחמות - במתן מכשור, בדיקות ואמצעים כלכלים ותודעתיים. הרי בית החולים תמיד ממשיך לעבוד, ללא קשר לקורונה".
Prof. Barhum, Nahariya: "I do not want people to lighten their heads and say everything is fine, but we will get through this wave. The virus is not violent, as it is contagious. Those who will suffer from it are mainly adults with breathing problems or serious illnesses, who will come to our hospital. "We are not afraid of this strain as much as the next strain, which may be vaccine-resistant. I wish there was no other one at all."
Dr. Muscat, Meir: “This wave will afflict hospitals in two ways.
The first is corona patients who will be hospitalized for reasons other than corona, and will need isolation;
And the second - a large amount of isolation among the medical staff, which would be very oppressive.
But I do not think we will be in an impossible load of severe corona patients.
I really hope not. "
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