Earlier this month I was in Israel, one of the last foreigners allowed in without first having to prove how I could lock myself in a room for a fortnight. I was there to cover the election and stayed on for a few days to look at the Israeli health-tech scene.
I was still there when Benjamin Netanyahu began implementing what he called “harsh” measures to contain the spread of the Covid-19 coronavirus, including banning large gatherings and ordering all Israelis returning from much of Europe to self-isolate for 14 days. He said he had told officials to “over-prepare”.
Bibi bravura is nothing new but I was struck by his statement that “Israel is in the best situation of all other countries, together with another two or three Western countries”. In other words, Israel was as well-placed as any for the coronavirus.
Yet that’s not the impression I was getting from researching the Israeli healthcare system. Everything suggested the opposite, that the Israeli healthcare system was itself sick.
When he instituted a blanket ban on entry this week, which included the UK, the world coughed and spluttered, calling it draconian, but it makes perfect sense if the Israeli healthcare system simply couldn’t cope.
Few outside Israel know that thousands of patients a year are dying from infections in Israeli hospitals, which are the most over-crowded in the developed world.
The mortality rate from infections in Israeli hospitals is 38 deaths per 100,000 patients, by far the worst among economically advanced nations, according to the Organisation for Economic Co-operation and Development (OECD). The United States is second-worst with 22 deaths per 100,000.
Critics, of which there are many, say this is a symptom of chronic under-investment by politicians who don’t see past the short-term. They have a point. Government funding has fallen from 75 percent of total health expenditure to 65 percent.
This shows in the figures and on the ground. Forty years ago, hospital capacity was 3.3 beds per 1,000 residents. Today it is just 1.7 beds. As a result, Israeli hospitals have a 94 percent average occupancy rate, by far the highest in the developed world.
Not only are they over-crowded, Israel’s hospitals are also under-staffed, leading to huge pressures on those that remain. Dr Erel Buchinsky, who previously headed the medical residents’ association, says he regularly works 26-hour shifts.
In a recent Facebook post that has since gone viral (pardon the adjective…) he compared it to working in a “mass-casualty event,” in which over-stretched doctors have to prioritise those more likely to live over those more likely to die.
For Israelis who don’t pay through the nose for deluxe service, this means scandalously long waiting times. At a hospital in Tiberias, you have to wait more than two years to have your tonsils out. Finally politicians seem to be noticing, because it is affecting them too.
Former foreign minister Avigdor Lieberman’s mother was told she would have to wait four months for an MRI scan recently. “After four months, a person does not need an MRI scan,” he said. “Either they’ve recovered or, God forbid, they’re dead.”
This week, as we moved from “containment” to “delay” in the UK, we learned that the idea behind “delay” is to push the peak of the outbreak back to the spring, to avoid the annual winter pressures on the NHS, and to flatten the peak of the curve, to spread the cases out over time. It is all, we are told, designed to help hospitals cope.
These are exactly the same considerations behind Israel’s early and somewhat brutal decision to shut its borders – the creaking Israeli healthcare infrastructure gave it no choice.
Israelis know only too well the state of their healthcare system and are quick to take steps to avoid hospital. While I was there, 70,000 Israelis were already in self-quarantine.
As a people, they are used to dealing with emergencies, but their enemy has always been neighbouring states or terrorist groups, the fear of missiles and rockets. Now the fear is of door handles, kitchen surfaces and friends coming over for dinner. After this outbreak fades, I hope they realise that under-investment in infrastructure is just as deadly.