Tireless Triage: How Israeli Community Medicine Prevents Omicron’s Submersion System

There has never been a disease in Israel on such a scale. With 1 in 20 citizens currently confirmed to be infected with the coronavirus and 10% of medical staff sick, what is enabling hospitals to adapt?

The collapse of services was averted thanks to Omicron’s reduced ability to cause serious illness, combined with the effect of new antiviral pills prescribed to the elderly and the high level of vaccinations, both of which reduce deterioration.

But there is another often overlooked factor. Israel has one of the strongest community medicine infrastructures in the world.

Hospitals are often referred to as the “front line” against the coronavirus. In reality, they are the last line of defense, which normally only comes into play after healthcare providers — or HMOs — have tried everything to get patients to fully recover at home.

HMOs had a stint in the spotlight when they hit turbo speed in Israel’s initial vaccination campaign, but have since garnered limited attention. Yet today they act as the ultimate in triage, keeping patients out of hospital unless absolutely necessary, while providing a range of home services that keep death rates down. in Israel modest despite high levels of infection.

Regardless of income level, every Israeli is a member of one of four HMOs, under the state’s national insurance program, and most basic services are free at the point of service. HMOs have huge networks of clinics, including in kibbutzim and other outlying communities, and in response to the pandemic are also offering telemedicine and e-medicine services. They have sophisticated digital recordkeeping – a strength that has helped make Israel a world leader in vaccine effectiveness statistics.

Illustrative Image: A woman using a laptop during an online consultation with her doctor during home quarantine. (iStock via Getty Images)

“HMOs are on the front line in the defense against the threat of the coronavirus, and community doctors and nurses are definitely joining the ranks of hospital staff as soldiers in this war,” said Dr. Tanya Cardash, chief of the Jerusalem area. for Maccabi Health Services.

“Hospitals play a vital role in managing those in serious condition, but the vast majority of Omicron patients are managed by their primary care physicians in the community,” Cardash said.

In fact, a simple change in the proportion of patients HMOs can keep at home would quickly cause a domino effect that could push hospitals beyond their limits — or require emergency measures like military reinforcements.

A medical worker gives a rapid COVID-19 antigen test to Israelis, at a testing center in Beit Hashmonai, January 16, 2022. (Yossi Aloni/Flash90)

Dr. Doron Dushnitzky, head of the coronavirus department at Leumit HMO, told The Times of Israel that the organization was working, but was heading towards the limit of its capacity.

“We’re at ninety percent of what we can handle, and if that ramps up and reaches the maximum capabilities of our employees, things could get too big,” Dushnitzky said.

“If we see this red flag, we will take emergency measures, for example by calling in the army [for reinforcements]. There are contingency plans that have not yet been put in place,” he said.

HMO staff are working many overtime hours to provide consultations for all of the newly diagnosed people flooding the booking systems, as well as providing ongoing care to many who are struggling to shake off the virus and who may well end up at hospital if not given intense supervision.

In the current wave, HMOs also have a new responsibility they haven’t had in the past: providing the new antiviral pills to elderly or at-risk patients who are diagnosed with the virus.

“At Maccabi [HMO] we have set up a special team that is helping primary care doctors treat coronavirus patients at home, including the delivery of antiviral drugs given to high-risk patients,” Cardash said.

Tanya Cardash, medical director of Maccabi healthcare provider in Jerusalem (courtesy of Tanya Cardash)

Meanwhile, Leumit’s Dushnitzky said the HMO was also dealing with a wave of flu infections.

“We are facing not only the coronavirus but also a lot of flus at the same time, which causes a comorbidity effect and increases the workload. Overall, the situation is stretching our abilities in everything from sales reps answering people on the phone to family physicians who are overwhelmed with patients,” he said.

“A lot of doctors, nurses and other staff have been very exhausted over the past few weeks, but we will continue to work as hard as we can,” he said.

According to epidemiologist Nadav Davidovitch, a professor at Ben-Gurion University and leader of the Israeli doctors’ union, the intense activity of HMOs during the Omicron wave reflects ever-increasing community attention in the fight against the coronavirus.

“Israel has very high infection rates, but we are doing well in terms of mortality and one of the main reasons is community health care, which guarantees the provision of health care by non-profit health funds. nonprofit that actually provides the full COVID treatment for 98% of people who test positive,” Davidovitch said.

“As the pandemic evolved, HMOs found more and more innovative ways to keep patients away from hospitals, and they became an important part of the pandemic response at increasing levels,” a- he added.

Professor Alex Weinreb, a health policy expert and director of research at the Taub Center, told The Times of Israel that the pandemic performance of HMOs highlights the role they play in normal times.

“The strong community health system is one of the ways we can maintain public health – measured by our high life expectancy – allowing us to spend much less of our GDP on health,” he said. .

Tell an urgent story

During a global pandemic, a small country produces research that helps guide health policy around the world. How effective are COVID-19 vaccines? After the first two injections, does a third dose help? What about a fourth?

When The Times of Israel began covering COVID-19, we had no idea our little beat would become such a central part of world history. Who could have known that Israel would be the first at almost every step in the history of vaccination – and generate the research so urgently needed today?

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