How the Israeli Medical Community Stops Omicron from Overwhelming the System

Never has there been a disease that has developed on such a scale in Israel. While one in twenty citizens is currently confirmed carrier of the coronavirus and that 10% of health personnel are themselves infected, what allows hospitals to withstand the shock?

The debacle in the care units was avoided thanks to a more lenient Omicron variant than the previous ones – it does not seem to cause serious complications from COVID-19 – and thanks to the new antiviral drugs now prescribed for the elderly, but thanks also at the high level of vaccination. Pills and vaccine reduce the risk of a severe form of the coronavirus.

There is, however, another factor that often seems overlooked: that Israel prides itself on having among the strongest infrastructures in the world in terms of community medicine.

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Hospitals are thus often referred to as “the front line” in the war against COVID-19. And they are really the last line of defence, the line that only arises after the health insurers – the HMOs – have tried, for their part, to implement all the palettes of possibilities offered in a way so that the sick can recover fully at home.

HMOs were briefly thrust into the spotlight when they carried out a high-speed initial vaccination campaign in Israel, but they have only recently attracted attention. And yet they are the ones in charge of the triage, keeping the sick out of hospitals unless it becomes absolutely necessary while providing them with a whole range of services at home – which allows the death rate to remain modest. despite the high number of people affected by the coronavirus.

Regardless of income, all Israelis are members of one of four health insurance funds under the state's national insurance program – and most basic services are free. The funds have huge networks of dispensaries, especially in the kibbutzim and other outlying communities. In response to the pandemic, they now also offer teleconsultations and other online medical services. They boast of their sophisticated digital registries – a strength that has helped make Israel a world leader in vaccine effectiveness statistics.

"Medicares are on the front line in the defense against the threat of coronavirus, and community doctors and nurses are joining the ranks of hospital workers in this war, there is no doubt about it," commented Tanya Cardash, physician and manager for the Jerusalem region of the Maccabi fund.

"Hospitals play a vital role in caring for all patients who are in serious condition, but the vast majority of patients who have contracted the Omicron variant are cared for by community physicians," Cardash continued. .

In fact, only a small change in the proportion of patients that health insurers are able to keep at home would quickly trigger a domino effect that would push hospitals beyond their limits – or require urgent action, as an army reinforcement.

Dr. Doron Dushnitzky, head of the coronavirus department at Leumit Medicare, told The Times of Israel that the organization was working — but was stretching thin.

“We are over 90% of what we can handle and if the number of infected people increases further and we find ourselves at the maximum of what the employees can do, then it will be too much to bear,” Dushnitzky added.

“If we see this red flag, we will take emergency action – for example, we will call in the army for reinforcement. There are plans, concerning emergency measures, which have not yet been put in place,” he explained.

Medicare staff are working many overtime hours to visit newly diagnosed Israelis flooding booking systems, and to provide ongoing care to the many citizens battling the virus and who could end up in the hospital without more supervision.

In the current wave, health insurance funds also have a whole new responsibility that they did not have in the past: to give antiviral drugs to the oldest people or those most vulnerable to the virus, and who have been contaminated.

"We have established a special team at Maccabi that supports doctors in caring for coronavirus patients at home, including delivering antiviral pills that are given to high-risk patients," Cardash said.

For his part, Dushnitzky, of Leumit, explained that his fund was also undergoing a wave of flu infections.

“We not only have to deal with the coronavirus but also many cases of influenza at the same time, which leads to a comorbidity effect and which also increases the workload. The situation as it is stretches our abilities to their limits in all areas, from sales reps answering patients over the phone to family physicians who are overwhelmed by the number of appointments,” he said.

"Many doctors, nurses and other employees have been really exhausted for a few weeks but we will continue to do our best," he said.

The intense activity of the checkouts during the Omicron wave reflects the growing focus on the fight against the coronavirus, comments for his part epidemiologist Nadav Davidovitch, professor at Ben Gurion University and one of the leaders. of the Israeli doctors' union.

“Israel has a very high infection rate but things are going well in terms of mortality; and one of the main reasons for this is community care, which ensures that health care will be provided by the funds which, in the end, also provide full anti-COVID treatment to 98% of Israelis who test positive for the disease. said Davidovitch.

“As the pandemic has evolved, credit unions have found increasingly innovative ways of keeping patients out of hospital and have become a key component in the pandemic response at different levels – from levels that continue to grow,” he added.

Professor Alex Weinreb, a health policy expert at the Taub Center, told The Times of Israel that the performance of health insurance funds during this pandemic highlights the role they play more generally with Israelis in non-pandemic periods.

“The strong community health system is one of the ways we maintain public safety – which is reflected in our high life expectancy – which also gives us the opportunity to spend much less in terms of GDP on the health,” he said.