Cast your mind back to life BC – Before Coronavirus - when we knew nothing about lockdowns, flattened curves, social distancing or herd immunity. We might have heard some reports about a new virus in China that was unlikely, we were told, to spread much further. But then it did, and the Israeli government was quick to impose strict measures, which seemed to work as the curve flattened and the number of new cases decreased through May. By the end of the month several coronavirus wards were closed. Restrictions were eased, slowly and cautiously at first, and then with seemingly breakneck speed. There has since been a spike in cases and at the time of writing, for the first time the number of new cases recorded in one day is higher than it has been since April.
The Samson Assuta Ashdod University Hospital is Israel's newest public hospital. Dr. Debra Gershov West has been the head of the Emergency Department since the hospital opened in November 2017. From the beginning of the pandemic her department has been on the front line, serving the emergency medical needs of the half million residents of the Ashdod region of Israel. I spoke to her in mid-June in an effort to understand what is happening now, and how the general public should approach the future.
Is the uptick in cases a second wave, or a continuation of the original outbreak, and is the rise predictable as the lockdown and other restrictions are eased?
Dr. Gershov West: It is most likely a resurgence of the virus that is still prevalent and hasn't swept through the whole population – it hasn't yet created herd immunity. The current increase in positive diagnoses does seem to be a consequence of the lightening up of restrictions and lax adherence to social distancing.
Located close to the Gaza Strip, Ashdod has suffered multiple rocket attacks over the years and the hospital was built with a unique bomb shelter design that protects patients and staff from missile attacks and chemical warfare.Did that reality help staff at Assuta Ashdod to prepare for the pandemic?
The emergency services throughout Israel are constantly prepared for a mass casualty event and know how to respond quickly. By coincidence, here at the hospital we were planning to have some drills and exercises from March to May to prepare for a potential biological war. The aim was to prepare ourselves and then test our level of preparedness. We could not have imagined that we would actually face something of the magnitude and unpredictability of coronavirus, which is a kind of biological war. As it unfolded, we were forced to get prepared in a very short time frame, whilst facing an unknown entity. The whole team stepped up to the challenge, and I think we passed the test with flying colors.
Southern cities didn't have as many cases as Tel Aviv and Jerusalem. We treated 76 patients whose ages ranged from 17 to 90, and we had one fatality. The most challenging aspect is dealing with a disease we are not familiar with and one in which our understanding is continually evolving. There is a lot of cooperation and sharing of experiences between doctors all over the world which has been really informative and helpful.
Assuta Ashdod closed its coronavirus ward at the end of April and so far there hasn't been a rise in the number of infected patients requiring hospitalization there. How does the hospital remain on alert?
We have not let our guard down. We had a pretty intensive trial run; the processes have been established, the protocols prepared and much of the equipment purchased. I can't vouch for all the hospitals in the country, but the preparation in Assuta Ashdod was very intensive and extensive. Once the situation settled down and coronavirus patients were being discharged, we regrouped and reviewed the functioning and preparedness of every department and every facility - individually, as well as the hospital as a whole. We are now concentrating on areas where we feel there was still room for improvement.
As we hear about the rise in new cases, the average Israeli could be forgiven for wondering if the easing of restrictions should have been more gradual, or even if the lockdown should have continued for a while longer.
This is my personal rather than professional opinion, but I think the toll that individuals were paying was very high and people were reaching breaking point both in terms of their ability to continue to tolerate social isolation and to survive economically.
We saw this reflected in the emergency department. We saw fewer trauma cases – there were fewer stabbings, work-related accidents, and high energy car accidents. But we have seen anxiety attacks and even attempted suicides in completely normative people who have lost their jobs and don't know how they will manage to feed their families.
Coronavirus seems to be something we are going to have to live with at least until there is a vaccine and possibly beyond that. Do you think the public has received clear enough messages from the government?
I think there are some messages that have been made crystal clear: hand hygiene is essential; wearing masks in public will limit the spread of the virus and can save lives; and keeping a distance of two meters from other people. However I think that society, especially in Israel, responds better to an "all or nothing" policy rather than to mixed messages and the messages we are receiving about the opening or closure of educational facilities and public places are less clear.
Once the restrictions were eased many, especially the youth, just threw caution to the wind and stopped all precautions except, perhaps, wearing masks in very public places. I think that the critical precautions – mask wearing, hand washing, social distancing - and the potential consequences of not heeding to them, could and should have been emphasized more in campaigns directed at teenagers and young adults in particular.
Are there any guidelines and messages you would like to convey, particularly to those who are considered to be in the higher risk categories?
Be cautious, stay informed, but don't be afraid. I can't emphasize enough the importance of continuing to seek and receive timely medical attention. The hospitals and medical clinics are equipped to keep you safe as well as protected from each other. The unseen victims of the coronavirus have been the patients who delayed seeking medical attention and are paying the price, be it uncontrolled blood pressure or diabetes, to fractures from falls after deconditioning. In the Emergency Department we continue to treat illnesses and injuries that could probably have been avoided. This is the true "second wave" in my opinion; the aftermath of illnesses particularly amongst the elderly. We cannot afford to let this happen again.
Whilst we strongly encourage everyone in high risk groups, both young and old, to continue with all the precautions without cutting corners, it is equally important to reengage in life – exercise, fresh air, good nutrition, maintain an active involvement in society and seek medical care whenever needed without hesitation.