COVID-19 toll on Israel’s health much higher than reported – data, experts

“As we approach one year since the beginning of the pandemic, we are starting to have a clearer picture of some of its effects, especially during the first and second waves,” Prof. Jonathan Halevy, president of the Shaare Zedek Medical Center, explained.

Halevy emphasized that they have consistently witnessed how, as the virus raged, Israelis became more hesitant to go to the emergency room.

“While we do not have exact numbers yet, we know that some 20 or 30% less strokes were treated in Israel this year compared to the previous years. It is important to highlight that there is a specific window of time to effectively treat strokes, four to sixteen hours according to the procedure. What happened to these people? They probably still made their way to the hospital at some point, but too late, which translates in permanent disabilities,” he said.

“If we consider cardiology, we look at a similar situation. There are about four hours to successfully treat a heart attack after its first symptoms,” he added.

According to Halevy, in the most recent months the people’s fears might have been partially placated as hospitals developed very strict procedures to separate suspected COVID-19 patients from regular ones, reassuring the public about the facilities’ safety. But in December 2020 Shaare Zedek’s ER still registered some 20% cases less compared to the previous year.

“Now we know that sometimes people go to the emergency room without a real need for it, but it is obviously hard to know whether this was the case,” the professor said.

Halevy added that similar trends can be noticed also about ambulatorial services, elective surgeries, early detection tests as well as issues in the field of mental health.

“For all of those, we are going to see the consequences,” Halevy concluded. “My message to the public is that there is a higher chance to get infected in a crowded supermarket than at a hospital.”

However, people’s weariness of visiting health facilities is not the only way COVID-19 has negative impacted Israel’s health.

“The Israeli healthcare system had been neglected for many years when the pandemic hit,” Dr. Gadi Segal, head of the Internal Medicine Department at Sheba Medical Center pointed out. “The system was already lacking the beds and the manpower to properly care for the elderly and for patients carrying chronic diseases.”

With the pandemic and half of the internal medicine beds converted into COVID-19 beds, the situation has just deteriorated, the doctor said.

“The Treasury has not been providing enough resources for public hospitals for years, the nominal numbers of bed has not increased since 1997 and Israel is very behind compared to other OECD countries in terms of numbers of doctors and nurses. This translates into lack of proper attention to the patients and the need to discharge them too fast,” Segal added.

The result is that now more than ever, physicians are forced to send home patients who could benefit from a longer hospitalization.

“Let’s say a patient suffering from an infectious disease befits from receiving intra-venous antibiotics. We might need to switch to oral medication too soon in order to discharge them,” the doctor explained.

In addition, as a consequence of COVID, many rehabilitation centers have turned into coronavirus facilities, and patients in need of rehabilitation are kept in the hospital too long.

“This also has a cost, in terms of cross-infections and other complications they might suffer from,” Segal said.

“In the long run, all these problems turn into an increase mortality of elderly patients and people with chronic illnesses,” he pointed out.

On December 31, the Central Bureau of Statistics released a short report on the Israeli population at the eve of 2021, estimating that around 50,000 individuals had passed away in 2020. Similar reports from the previous three years approximated that the number of deaths stood at about 45,000. As of January 1, some 3,338 people had succumbed from the virus in the country. While the precise data are not available yet, the discrepancy of some 1,500 people is likely no coincidence.

As an effect of the pandemic, countries all over the world are now looking into the phenomenon of “excess mortality.” The term refers to the general number of deaths from all causes that are above and beyond what is would have been expected under normal conditions. During the year 2020, more people have died compared to what happened in previous years in many if not most nations. And in most cases the official coronavirus death count only covers part of those additional victims.

For example, according to a chart published by The Economist, in the period between March 8, 2020 and January 9, 2021 the United States registered some 448,550 excessive deaths. However, only 360,370 of them were officially attributed to the virus. Over a similar period, Brazil reported 190,780 people succumbing to COVID-19, but 217,670 excessive deaths. From February 26 to October 27, Italy had 36,960 coronavirus victims, and 63,650 excessive deaths.

A CBS report looking into the issue in Israel published at the beginning of December found that some 40,315 people had died as of the end of October, about 9% more than in 2019. However, while up until the first trimester of 2020 the death rate was actually lower than in previous years, and in the second one just slightly higher, during the period between August and October the mortality rate dramatically increased.  

According to the report, coronavirus deaths cover about 94% of the excess mortality in the first ten months of 2020, but while in the case of people under the age of 69 the victims of the virus are actually higher than the excess deaths, suggesting that mortality from other causes – for example, car accidents – was reduced, for people over the age of 70 excessive deaths significantly exceeded the official coronavirus count.

A full picture of the consequences of the pandemic on Israel’s health system, in terms of deaths but also of other issues, from disabilities to mental health will take months, if not years to quantify.