(JTA) — When it became clear that the COVID-19 pandemic would reach Israel, Elli Rosenberg was one of a small number of medical professionals at the Soroka Medical Center in Beersheva to answer a call for volunteers to treat the sick.
Rosenberg, a clinical immunologist who works as an internist at Soroka, now runs the coronavirus unit there. As of Thursday, his hospital — the largest in southern Israel — had 14 confirmed coronavirus patients.
Rosenberg spoke with the Jewish Telegraphic Agency about the unique elements and challenges of caring for coronavirus patients, Israel’s handling of the pandemic and the changes that ordinary people should make in their lives to reduce the risk of infection.
This conversation has been edited for length.
JTA: Were you prepared for this?
Rosenberg: We imagined this day might come, but we never really translated that into operational contingencies. Everything is new here. Setting up an isolation unit for patients with this disease has definitely been a challenge. The last two weeks have been a learning process and a training process for something that might get much worse very quickly.
What did you do on Day 1?
When the first patient was admitted to our unit, I remember suiting up and getting into all the layers of protective gear and entering an airlock that separates the clear zone from the infected zone. It was an astronaut-like experience. As I held the door of the airlock, I felt, wow, I’m stepping into the unknown and taking part in something that’s a worldwide challenge. It was a mixture of fear and excitement and a reminder of why I chose to do what I do. Then I walked into the unit, approached the patient and introduced myself.
How do you provide care given the risk of contagion?
Our unit is divided into two sections: the confirmed corona section, where everyone who has the same disease can interact, and another unit for patients with high suspicion of corona where each patient is isolated in his or her room until they receive test results.
What we’re trying to do is maximize patient care with minimal staff exposure. Technology helps. A coin-sized monitor taped to their chest — developed by an Israeli startup company — continuously transmits vital signs by Bluetooth to our control center. We also have tablets for the patients that measure their temperature and can serve as a stethoscope. Students and faculty from the engineering department at Ben-Gurion University of the Negev are building a telemedicine robot to our specifications.
What is the course of treatment?
There is no evidence-based treatment yet. There’s a lot of research being carried out right now around the world on various forms of medication that interfere with the virus’s ability to impede the inflammatory response the virus may cause, or the virus’s ability to attach to DNA. We’re basing what we do on developing supportive care, usually with oxygen, and waiting for the patient’s own immune response to kick in and eliminate the virus.
How long does it typically take for patients to get through coronavirus?
Between several days and a few weeks. That’s the challenge with this disease. If there’s an influx of patients that require hospitalization for long stays, that might overwhelm the health care system’s capacity. There won’t be enough beds, there won’t be enough staff, there won’t be enough respirators. That’s the real concern. We’re trying our best to prepare for an uncontrollable wave of patients.
How are the patients managing the emotional burden of isolation with coronavirus?
It’s very difficult. The uncertainty is very intense. They don’t know what the course of their disease will be. They don’t know how long they will be hospitalized. Every cough, every fever, every change in their oxygen saturation level is usually a cause of a lot of stress. The cough and shortness of breath are nasty. The isolation from family is very difficult. They’re essentially locked in. It’s a very unsettling experience. Using telemedicine, they speak daily with a social worker to try to vent their feelings, their concerns, their fears.
We understand the emotional impact of being there with them is crucial, and that’s why we see every patient every day face to face even if there’s not a medical necessity for it. I think they feel much more secure when we’re in there with them. The human contact, putting a comforting hand on their shoulder, has a psychological impact.
We’ve been blessed with patients who are very positive. They eat their meals together in a common dining room, they’re playing board games together, building puzzles, helping each other pass the time.
Dr. Elli Rosenberg, a clinical immunologist at Soroka Medical Center in Beersheva, Israel, is managing his hospital’s medical response to the coronavirus.
(Courtesy Elli Rosenberg)
Are you well-staffed for coronavirus?
Staff is a weak point. We started this epidemic when the Israeli health care system is generally understaffed. Right now our unit is based on volunteers — people that expressed a willingness to take part in this. We’re not forcing anybody. There is a lot of concern among all lines of work in the hospital — ranging from doctors and nurses to radiology technicians and orderlies and maintenance staff.
In the beginning, there were no maintenance workers willing to enter the unit to mop the floors, clean the bathrooms, empty the garbage cans. Only after I lectured them and promised to go in with them and help them out did two workers agree to go into the unit. They were petrified in the beginning, but once they were inside and met the patients and saw that it’s not as bad as they imagined, they did their job very well and agreed to volunteer to join our team.
What are the greatest risks to you and your staff?
The true front lines are the people working in emergency rooms. Any patient that walks in potentially has corona, and the staff there doesn’t have the ability to protect themselves from every single patient. That uncertainty increases the risk of accidental exposure. In our unit, there’s no uncertainty.
Do you check yourself or your staff for the virus?
No. The protocol is that as long as we feel well we’re not tested on a routine basis. If any of us develops fever or respiratory symptoms suggestive of the disease, we’ll obviously test. The consequence of positive results among any of our staff would be quarantine for everybody. And that has extensive repercussions, so we’re hoping we all stay healthy.
I have extensively limited my exposure to other wards in the hospital. I canceled all my outpatient clinics. Our unit has to be specially cared for so as not to expose to potential infection. I’m also limiting my exposure to places where I might contract the virus. I haven’t been in stores, I haven’t gone to shul.
We’re also developing written protocols for how the unit should function if I am neutralized because of illness or quarantine.
What does your family say about your work?
I think they understand the importance of what I’m involved in. My 12-year-old daughter specifically pointed out that she’s proud of me, which moved me greatly.
What do you tell your family about how to stay safe?
Wash hands very frequently. Don’t touch your face. Try not to come into physical contact with other people. Try to limit your distance to anybody outside of the family to 2 meters (about 6 feet). In my house, there have been extensive changes in dining etiquette. There’s no more drinking straight from the milk carton or sharing spoons. That’s been a major change in our household.
I have been limiting myself to very little physical contact with my wife or my children. They’ve decreased their social contacts extensively. We don’t let them have sleepovers with friends, even though theoretically it is allowed. I feel they should take the required actions a step further because of my exposure. I’ve told my 16-year-old daughter and her boyfriend to stay 2 meters apart.
What’s your take on Israel’s handling of the pandemic?
I’ve gone through a swing of the pendulum. In the beginning, I thought this was handled way too aggressively and that the measures the government decided on were extreme. As time progressed, especially with examples coming in from different countries around the world of how governments responded and what the consequences were — for better and for worse — I slowly shifted to the point right now where I hope we’re not too late with the actions we’re taking. If we want to beat this, social distancing and personal hygiene and increased testing have to be implemented and enforced at the highest level, and I feel we’re not there yet.
How long do you think this will last, and how bad will it get?
Nobody really knows. I’m mentally preparing for a few months. I’m also preparing for a situation where it gets worse before it gets better. We’re trying to make the most out of the resources we have, to maximize our ability to provide care in the event that this turns out to be very significant. Will we be overwhelmed, will we find ourselves in a similar position to what’s happening unfortunately in Italy, where doctors are making horrible choices of who to treat and who to turn away? I dread that possibility. We’re trying to do the best with what we have to avoid that situation.
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