By Hillel Kuttler
Originally published by Tabletmag.com
How Galilee Medical Center in the northern town of Nahariya is tackling COVID-19
This is the eight-step dressing regimen of Adham Abdalrazik, a nurse at the Galilee Medical Center in the northern Israel town of Nahariya, before seeing patients in this COVID-19 era. In a cramped supply room, he grabs a pair of thin shoe covers from a plastic bin and slips them over his feet. At the next bin, he pumps a sanitizer jug and cleans his hands. He continues to his left, progressively donning blue gloves, a blue gown, hair netting, an N95 mask, a face shield, and another pair of gloves.
Abdalrazik normally works in the hospital’s geriatrics department. But these are not normal times, so the geriatric patients were relocated from here to the internal medicine department three weeks earlier and a COVID-19 department was configured in its place. Abdalrazik’s patients now—three patients on this day—are solely those with COVID-19.
It is Wednesday, March 25, and we are in the department’s Yellow Zone. Abdalrazik’s patients are maybe 10 steps away in the hermetically sealed Red Zone. The department has 24 beds and nine rooms, including a six-bed room reserved for critical-care patients, of which there haven’t been any yet. Only five patients have been hospitalized here with COVID-19, all with mild cases of the highly contagious virus. Each patient has been young: a 49-year-old and the rest 23 to 29.
“Oh, Prince Charles now has coronavirus,” said Sharon Mann, who works in the hospital’s international-affairs department, of the news appearing on her smartphone.
A few buildings to the north, in the complex’s rehabilitation center, sits the COVID-19 department’s 30-bed intensive care unit. The unit is empty for now.
This is the calm before what the hospital’s medical officials expect, and what Israeli leaders have cautioned for weeks, will be the storm of this global pandemic.
“We have to prepare ourselves for much more,” said Dr. Masad Barhoum, GMC’s chief executive officer, who stopped in at the department during my visit. “This is just the opening stage.”
Walking between the two buildings on this glorious spring day, Mann and I follow a sidewalk along a narrow, interior road. A newly installed gate closes the road to vehicular traffic to keep it free for ambulances transporting COVID-19 patients. The patients are then taken inside via a recently constructed side door, a portal meant for them alone. Staff and non-COVID-19 patients access the building, the women’s health center, only through the main entrance.
The arrangement typifies the refitting of 37 existing wards throughout Israel, including in two psychiatric hospitals, with COVID-19 departments. There’s more to the approach than architecture. Physicians and nurses at the Nahariya hospital care directly for COVID-19 patients, of course—but rarely in immediate proximity. Nearly all of their communication with patients occurs through a window, using an intercom system. Patients are instructed in taking their own pulse, blood pressure, and temperature; if they can’t manage those tasks or are in any distress, the medical professionals don their garb and enter the Red Zone. Meals one way, and urine and stool samples the other way, are conveyed through separate slots that must be closed by the initiating person before the receiving person gains access. Adjacent to the supply room is a control room, where staff members monitor every bed, 24 hours a day, on multiple screens of closed-circuit television.
Abdalrazik calls this a “minimum-touch policy” for providing care while reducing the risk of his and his colleagues catching the virus, too. In 10 shifts since the COVID-19 department opened on March 13, Abdalrazik estimated venturing into the Red Zone just four times, most recently to take a patient for a CT scan.
He considers a question about whether, even wearing special coverings, he’s felt scared entering the Red Zone.
“Listen, it’s a fear, a stress, of being infected and then infecting my family or someone else,” Abdalrazik says by phone that evening while driving home to his wife and 8-year-old twins in Kafr Yasif. “But it’s my work and I have to do it properly, so I feel OK.”
The hands-nearly-off policy, explained Avi Ben Zaken, the Ministry of Health’s vice president for planning and construction, derives from a close monitoring of the then-emerging pandemic’s spread in China, South Korea, and Italy. Israeli officials were alarmed at the number of those countries’ medical professionals debilitated and even killed by the disease while delivering care, he said.
In designing its COVID-19 departments, Israel placed a high priority on protecting caregivers, Ben Zaken said. The idea, he continued, draws from the concept of telemedicine, which relies on video connectivity when professionals and patients are geographically apart.
Earlier this week, the Nahariya hospital became the country’s first in a pilot project to reinforce N95 masks with a rectangular sticker developed at Haifa’s Technion to neutralize nanoparticles bearing COVID-19.
Five days after inaugurating the COVID-19 department, the hospital opened a dedicated COVID-19 laboratory. The pending delivery of machinery able to run real-time PCR (polymerase chain reaction) technology will enable the handling of hundreds of COVID-19 tests daily, surpassing the current capacity of tens daily, said Mona Shehadeh, the doctor who heads the hospital’s laboratory department.
The COVID-19 laboratory is recruiting lab technicians with expertise in molecular biology. Three on staff fit the bill, supplemented by two medical students—and “we’ve put out the word to the universities” for qualified master’s and doctorate students, she said.
Israel’s strategy for managing the coronavirus crisis, insofar as facilities are concerned, encompasses another layer, Ben Zaken said: requisitioning hotels, already darkened by the tourism crash, for housing and treating patients with mild and moderate COVID-19 cases. That will be key should the number of COVID-19 patients requiring hospital ICU care grow unwieldy. Already, some with mild cases have been treated in hotels to test the efficacy of alternatives to hospital- and home-based care.
The first 11 Israelis with COVID-19, all passengers aboard the Diamond Princess cruise ship docked in Japan, were brought to Ramat Gan’s Tel Hashomer Hospital in late February. This Thursday, a geriatric center in Rishon LeZion will become the last of the country’s 37 COVID-19 departments to open.
At that point, Israel will have 15,000 beds for COVID-19 patients, including 5,000 beds for ICU patients, Ben Zaken said.
As of Tuesday, 4,831 Israelis have tested positive for the coronavirus, 83 being ICU patients. Seventeen people have died, nearly all elderly, including three people at one Jerusalem assisted-living facility.
The numbers have been multiplying rapidly in Israel, as they have worldwide. On March 13, the day Nahariya inaugurated its dedicated COVID-19 department, 143 people across Israel had contracted the virus, six were in the ICU and none had died.
As the trend worsens, the Health Ministry’s restrictions on movement grow ever more severe. An hour after I returned from reporting at the hospital last Wednesday, new rules took effect. Aside from buying food or medications, or reaching jobs, people were henceforth prohibited from venturing farther than 100 yards from home, with violations incurring fines. All shops (aside from grocery stores and pharmacies) were ordered closed—even the hundreds of outdoor food stalls at the Carmel Market in Tel Aviv and Machne Yehuda in Jerusalem tend to be cramped with shoppers.
Sequestration is the new norm, and compliance has improved dramatically, despite well-reported violations in secular Tel Aviv and Haredi neighborhoods in Jerusalem and Bnai Brak. This week, 1,000 Israel Defense Force soldiers began supplementing the police to enforce the stay-at-home rules, and roadblocks were introduced.
Life is tightened further, for the first time since last Thursday’s announcement of an incoming emergency national-unity government in which Blue and White leader Benny Gantz, a former IDF chief of staff, will become defense minister and serve as rival Benjamin Netanyahu’s deputy prime minister. Unemployment has hit 20%.
The new restrictions, announced Monday night, include forbidding gatherings of more than two people (down from 10 previously and, before that, 100) and prohibiting Seder attendance outside one’s household. Minyanim (prayer quorums) that had been allowed at the bare-minimum participation of 10 were similarly outlawed.
The Nahariya hospital already prohibits visitors. Its small, normally bustling food court was nearly still during my visit, yet it presented mixed messages. A pharmacy advertised masks and a coffee shop offered a limited takeout menu. But a small bakery’s borekas were displayed on a cart, where any customer could touch them; at a bakery across town that morning, I noticed a masked employee holding a pincer behind a newly roped-off area, prepared to take orders. Gone was the establishment’s self-service system.
The No. 48 bus I rode back from the hospital that afternoon was empty, just as the No. 367 bus had been in the morning. The seats immediately behind and across from each driver were cordoned off by tape, crime-scene-like. Personal safety, personal space, are paramount now. As I left the hospital’s grounds, a guard standing next to one of two security magnetometers sprayed the counter and wiped it dry.
There’s just no telling where the germs reside and who’ll fall victim next. Yael Nehmad, an industrial engineer, was released last Tuesday from a 10-day hospitalization in Tzfat’s Ziv Medical Center, still unsure whether she contracted COVID-19 during her four-day ski trip in Bulgaria beginning March 5 or even before leaving Israel.
Nehmad is just 30 years old. When American and Israeli health experts state these days that people of any age are susceptible, someone usually healthy like Nehmad is whom they mean. She is coronavirus case No. 192, more than 4,000 Israeli positives ago.
At 3 a.m. on March 10, 12 hours after returning from Bulgaria with her husband and four friends, she awoke with a fever, called Magen David Adom (Israel’s Red Cross) and was told to self-quarantine. Nehmad was wracked with pain and felt progressively weaker. Her temperature rose to a high of 101.3 Fahrenheit. Three days later, on Friday afternoon, MDA paramedics came to her home in the northern town of Karmiel to administer a COVID-19 test. By then, she felt much better. Hours later, Nehmad was notified of testing positive, and that Saturday night an ambulance took her to the hospital. Her two children were born there.
Even during Nehmad’s hospitalization, coronavirus drama continued back home. Her 3-year-old daughter, Mia, had been coughing. Mia was tested. The negative result relaxed Nehmad and her husband, along with the antsy parents of children in Mia’s day care program—“a justifiable fear,” Nehmad said.
By the time Nehmad left Ziv, she had six other patients for roommates, including a 22-year-old paramedic who likely contracted the virus during his stay in Italy. He “was like a medical staffer” to his fellow patients, Nehmad said. Because the seven patients felt fine, Ziv’s physicians and nurses ventured in only to take X-rays and to tend to someone with mild breathing difficulty. An employee sanitized the room while the patients sat outside in a private yard.
Nehmad, a self-described calm person—“I know my body,” she said—remained composed throughout the two weeks post-Bulgaria. At Ziv, she wrote each night in her journal and shared the entries with friends and relatives.
Of the crisis that shows no signs of abating, Nehmad said she’d advise people to take a deep breath. “Everyone thinks [testing positive for COVID-19] is a catastrophe, and the public is panicking because the government is urging everyone to stay home and not spread it,” she said.
“We must listen to instructions to not get infected, but don’t think that it’s the end of the world. For most of us, it’s like the regular flu. We must maintain our optimism. Panicking isn’t good for anyone.”