Israeli doctors preparing for Italy, and hoping for Singapore

JORDAN MOSHE

This is according to Israeli doctor Arnon Afek, the deputy director general at Sheba Medical Center, who was part of a historic webinar broadcast live from Tel Hashomer late last week.

“There are reports that non-steroidal anti-inflammatories like ibuprofen may be harmful. Paracetamol has become the first choice, so use it where possible,” Afek said, pointing out that it is under continuing evaluation, and those who need to take such medications may do so if necessary.

The web discussion, hosted by Sheba, had almost 500 participants tuning in to hear eminent Israeli doctors share their knowledge and insights.

“We want to offer hope without boundaries to anyone who wishes to understand the global battle against Covid-19,” said discussion moderator Yoav Har-Even, the president and chief executive of Rafael Advanced Defense Systems.

“Israel is leading the effort in three phases,” said Sheba Director General Professor Yitshak Kreiss, “containment, mitigation, and the building up of treatment capacity. Every planning model we’ve used has said the same thing: prepare for Italy, and hope for Singapore. We are making Israel ready for anything.”

Containment, he said, involved the closure of borders a month ago, while mitigation entailed gradually implementing a nationwide shutdown. At the same time, Sheba and other medical facilities began increasing their capacity, upping the number of beds in intensive care as well as standard hospital beds, while evaluating the other levels of treatment available.

At the same time, provision has been made to accommodate those suffering from only mild bouts of the disease in hotels equipped to care for them.

“We found that leaving them at home wasn’t safe enough as it doesn’t help mitigate the situation,” Kreiss said. “We had to come up with another level of care which was neither home nor hospital, moving mild patients into hotels which can offer a light degree of medical care.”

Sheba has also geared up to handle the influx of patients, implementing measures to ensure that those infected don’t enter the hospital. This includes the establishment of an internal medicine unit a mile away from the main building for treating mild cases, and the construction of an underground facility for those in need of critical care. A special unit for infected psychiatric patients has also been created, as has a new triage system which physically separates those needing standard medical assistance from those who require care for the virus.

“We insist on running the hospital as it was before,” said Kreiss. “Our biggest challenge is to continue to provide regular medical care in parallel to our battle with corona.

“Sheba is still carrying out procedures, transplants, and ambulance services, making sure they work as before. Many more patients will die from non-corona issues than corona itself if we don’t.”

Differentiation is key to the hospital’s strategy. Patients who require virus-specific treatment are directed to one of the facilities from the designated emergency room, and kept well away from other patients.

Said Kreiss, “I don’t know where we’re headed. I know that our role is to provide the best medical care we can. We learned from Italy and China that this corona pneumonia is one we can treat, that it’s not so different to diseases we treat every day at our wards.

“The outcome, however, is dependent on our capacity, preparedness, endurance, staff protection, and spirit. We are determined to be the hub that will help Israel cope with the challenge, and to emerge from the outbreak stronger. I’m not sure what the price will be, but we can’t ask that question. We are preparing ourselves to make difficult decisions which may arise.”

Questions were fielded by Afek, Dr Galia Rahav, the head of the infectious disease unit and laboratories, and Dr Eldad Katorza, a senior physician in obstetrics and gynaecology.

According to Katorza, pregnant women are at no greater risk than other people, and should take standard precautions against the virus.

“As far as we know, the disease in pregnant women is no different to general population,” he said. “There is no evidence for outcomes like abortions or death, nor is there evidence of transmission of the virus in utero – not in the fluids, placenta, or foetus.”

Katorza said there was no reason to avoid delivery or breastfeeding.

Rahav insisted that treating the virus conservatively was the most effective way forward in the absence of any specific drug.

“Many centres are attempting to use HIV-type therapy,” she said. “I refuse to use it. The side effects are bad and include vomiting, increasing the risk of spreading the virus.” Others are experimenting with antibiotics and malaria treatments, and while they have reportedly yielded some results, their overall efficacy cannot be fully evaluated.

Rahav said that the use of antiretroviral treatment required extensive trials, but doubted their overall efficacy. “The most important thing is still to give fluids, follow up on the patient’s respiratory situation, and good nutrition.”

She is, however, optimistic about the discovery of a workable vaccine, and believes it will be ready within the next year (stressing that vaccines can typically take as long as eight years to be developed and rolled out).

The doctors feel confident in the measures being implemented in Israel and elsewhere.

“The health minister has taken the right steps,” said Rahav. “We have an increased number of cases, but this is mainly due to more tests being done.”

Afek said that Israel was open to sharing its medical knowledge and learning from other countries. “Such a threat should be turned into an opportunity. Innovation must be developed to address the situation,” he said.

“Our mission is to do whatever we can. We want to share knowledge and expertise, and use our innovation and brightest minds to do small things to change the pattern of the disease. We can stop it together even before we have a vaccine.”