2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Israel entered the pandemic with fewer hospital resources, crowded wards and heavy pressures on professionals compared to other high-income countries. For example, the rate of hospitals beds was 2.2/1000 (compared to an average of 3.6/1000 on OECD countries and 4.1/1000 in European countries); bed occupancy rates reached more than 94% (compared to 75% on OECD average). Medical wards, particularly internal medicine, where COVID-19 patients are treated, were under even more severe shortages of beds and medical professionals. About 619 beds were located in ICUs (4.2%).
April 17, 2020: Since the COVID-19 outbreak, 300 ICU new beds were added. The plan is to increase it to 5,000 ICU beds, with the capacity for an additional 2,000 of lower grade beds, by August 1st, 2020, making 7,000 in total.
At the beginning of the COVID-19 outbreak the existing resources such as the bed complement, protective and curative equipment were sufficient, but it is unclear how long it will suffice. In the early stages of the pandemic, the MoH approached the Ministry of Finance and the Prime Minister's Office to obtain funds to increase physical resources to diagnose and treat COVID-19 patients (including protective equipment, medical equipment (e.g. ventilators), pharmaceuticals, medical supplies). However, most countries are already buying equipment, and supply is limited. In fact, some resources being used now are being withdrawn from the emergency warehouses.
The state comptroller warned that the country was not well prepared to cope with a pandemic. The MoH had records on the stock of its own emergency warehouses. But there was no record about the equipment available at hospital warehouses. Moreover, part of the stored equipment was damaged and could not be used.
The government is now attempting to increase the capacity to treat COVID-19 patients by converting geriatric hospitals into internal medicine (IM) wards. General hospitals also started expanding the capacity of IM treatment in surgical wards, to which patients had been discharged, and creating isolated areas in ICU units. The MoH further rented empty hotels to care for mild patients (all diagnosed cases were hospitalized). The plan is to convert more hotels into hospitals. In order to overcome the shortage of medical and protective equipment, the MoH approved the local production of diagnostic exams, ventilators robes, overalls and "N95" medical masks. According to a paper by the Israeli parliament’s research center, as of March 26, there were 2,173 ventilators in Israel; of those 708 were in use, 28 were not functional, and 1,437 were available for use (where this does not include machines in the possession of the IDF). In response to this study, the MoH said that in total there were 2,864 ventilators available for use in Israel (that included, amongst others, those available to the IDF).
There have not been specific efforts in Israel to build up public health capacity (e.g. increase tests, lab capacity, contact tracing ability including use of mobile apps) that are in preparation for the post-lockdown phase
10.5.2020 – Investments in physical infrastructure for potential future COVID-19 outbreaks
Four temporary COVID-19 medical wards are being built by the ministry of Defense in a hospital next to Tel Aviv. The wards are being built in preparation for future outbreaks of COVID-19. These wards are easily constructed and de-constructed, and when the are no longer needed, they can be easily transferred to other settings such as battle fields in wartime. These wards are planned to start operating within 6 weeks (by mid-June, 2020). The wards will have 206 ICU beds with capacity to add ventilators to all beds (https://www.haaretz.co.il/health/corona/LIVE-1.8834163#7010529071).
22.6.2020 - Reopening COVID-19 specific wards in hospitals
The increase of new daily COVID-19 diagnosed cases from 15 in late May (20.5.2020), to 307 in mid-June (19.6.2020) – has risen concerns of a COVID-19 'second outbreak wave'. The National Knowledge Center to Combating COVID-19 has warned policy makers to be more cautious with lifting physical distancing restrictions (https://www.gov.il/BlobFolder/reports/daily-report-21062020/he/daily-report_21062020.pdf).
The Ministry of Health has instructed numerous hospitals to reopen their specific COVID-19 wards, most of which were closed towards the end of April due to the low number of patients.
In addition, Israel's prime minister has declared, again, that no further alleviation of public restrictions will be made until the number of new cases per day is reduced, yet without a clear definition of the amount of accepted new cases.
15.10.2020 New COVID-19 wards built by the army
On September 12, the Israeli Defense Forces (IDF – the army) opened two COVID-19 wards at one of the hospitals in the north of the country (Rambam).
About 100 members of the military medical staff from all units, who have undergone appropriate training, are operating the two wards with the goal of offering more beds and workforce to treat COVID-19 patients. They are working at the newly built wards, which have been built in underground parking lots at the hospital. This is the first time the army has built hospital wards in Israel.