The MDA (the national EMS organization) is the first point of contact for people who developed symptoms and have either returned from abroad, or had contact with a diagnosed patient, or had severe symptoms, as the MDA is in charge of COVID-19 diagnostic tests. The MoH and the health plans’ primary care services have their own hot-lines to provide information and instructions. For quarantined symptomatic individuals, the MDA comes to their homes to collect the samples for the test; otherwise non-quarantined individuals can go to “drive-through” stations to have the test done. Apart from the diagnostic test, no other triage is done. Hospitals and HPs report on a daily base to the MoH the number of COVID-19 patients in hospitals, hotels or at home.
Patient care pathways have evolved along with the evolution of the pandemic and the capacity of response of the healthcare system. According to a protocol (see below) in effect until mid-March, all diagnosed patients were taken to the hospital. However, as of the end of March, mild cases were sent to the designated hotels (default) or to stay at home (depending on vacancies in those facilities), in which case HPs are in charge of following up. Patients with severe symptoms were sent to hospitals and kept in a dedicated department for COVID-19 patients. Treatment and discharge protocols are updated periodically, and there is no evidence to date of rationing care for COVID-19 patients.
A Long-term care facility (LTCF) resident suspected of being infected by COVID-19 is immediately tested and sent to quarantine until s/he is confirmed positive. During the quarantine period, the resident is moved to a separate COVID-19 unit within the LTCF. Positive cases in severe health conditions are taken to medical wards at general hospitals and those with mild symptoms are moved to hotels rented by the MoH to treat mild COVID-19 patients.
The Ministry of Health instructed all health providers to treat any person with Covid19 symptoms, regardless of insurance status. In case of an uninsured patient, Covid19 treatment shall be provided free of charge to the patient (Ministry of Health, 13.04.). Nevertheless, there are reporting that uninsured patients are rejected or asked for payment by health care providers.
The Ministry of Health has been arranging accommodation in some cases, in which persons with light Covid19-infections lacked any option for self-isolation. These options are principally open also to migrants (round table 24.03., MoH 14.4.).
NGO-run walk in clinics have reduced their activities to essential services and adapted their mode of operation. They have asked for extra equipment, protective gear and medicines from the government.
28.10.2020 Referral or transfer of COVID-19 patients between hospitals within the country
On September 16, the MoH announced the implementation of the “Mutual Responsibility” plan, which plans and organizes the transfer of patients from hospitals where bed occupancy has reached its maximum to hospitals with available capacity. In September, 140 patients were transferred from hospitals in Jerusalem and the north of the country to hospitals in the center and the south. This plan was implemented due to hospitals reaching their capacities for COVID-19 patients. Possible reasons for reaching the limit were (1) that these hospitals serve large shares of ultra-orthodox Jewish and Arab populations (which have had relatively higher rates of infection). (2) Some of these hospitals, especially those in the north, are small and have limited capacity in general, including for COVID-19 patients. (3) There are lower rates of hospital beds per population in the periphery of the country (northern and southern regions) than in the center of Israel.
The “hospital advisory board” (also known as “the barometer”) published a report warning that there were not enough referrals of severely ill patients among hospitals based on bed capacity. Patients are sometimes transferred from ICU wards to internal medicine wards within the same hospital due to a lack of ICU capacity, instead of being transferred to another hospital with available beds. These patients are treated under supervision of anesthesiologists and IM specialists. It is important to note that this suboptimal hospital resource use occurs nearly every winter with influenza patients and is a consequence of a shortage of ICU beds and workforce, particularly in the previously mentioned peripheral areas.
In order to support this organized transfer of patients from full hospitals to others with more capacity, hospitals have created a national database that relies on constantly updated data about hospital bed and ICU bed capacity and utilization. This database enables coordination and management of hospital bed capacity at a nationwide level, e.g. opening new COVID-19 wards, and facilitating transfer of patients from one hospital to another, if capacity is reached.