Brazilian doctor in Israel: ‘Most critically ill patients have not been vaccinated’

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Israel is going through its worst moment since the Covid-19 pandemic began: with the advancement of the omicron variant, the country had more than 100,000 new cases and 90 deaths registered in a single day, between the end of January and the beginning. of February this year.

In previous waves, the highest numbers had been 11,000 new infections (as of September 2021) and 64 deaths (as of January 2021) in 24 hours. The data are from Our World In Data, a website that compiles statistics on the pandemic.

But what explains this scenario in the nation that had one of the pioneering and most successful vaccination campaigns against Covid-19?

For Brazilian doctor Julie Schleifer, who has been working on the front lines in Israel since the beginning of the pandemic, the current situation in the country can be explained by a series of factors, starting with the portion of the population that has not yet completed the vaccination schedule – from just over 9.2 million Israeli citizens, 5.1 million took all three doses.

“From what we observe in practice and in official data, the vast majority of critically ill patients are not vaccinated”, he reports.

In conversation with BBC News Brasil, Schleifer reports his experience over the last two years and lists the lessons learned during the pandemic.

unexpected experience

The Brazilian doctor, 41, says she had contact with a patient who had Covid right at the beginning of the pandemic, back in March 2020.

“With that, I had to be in isolation immediately, because there weren’t many exams available”, he says.

“As I had access to a computer in my room, one of the directors of the place where I work asked me to do remote monitoring of people with Covid, who at the time were isolated in hotels. Imagine, at the beginning we saw 150 patients and we thought it was absurd” , remember.

Schleifer works for Clalit Health Services, one of four “health plans” available in Israel. In the country, all citizens are required to have medical insurance.

Clalit serves about 4.5 million people, practically half of the Israeli population, according to the expert.

“This first task, getting in touch with patients, made me develop an experience with Covid that few professionals had at that time”, he reports.

With that, the Brazilian became one of the directors of the company’s response to the pandemic. She oversees the northern part of Israel, one of eight zones in which health services are divided in the country.

She and her team follow around 800,000 individuals, in a territorial band that covers the city of Tel Aviv and reaches the outskirts of Haifa.

“We make phone calls, check the information of patients with Covid, see if they need any antivirals, if they can be discharged…”, he exemplifies.

A Tsunami Caused by the Omicron

For Schleifer, the last two years have proved that Covid can always surprise.

“It seems that the coronavirus brings a new surprise. With each wave, we discover something new, which we had not seen until then”, he highlights.

As in many parts of the planet, Israel was also affected by the ômicron variant. The numbers of cases, hospitalizations and deaths recently recorded far exceed what happened in other periods of crisis there, especially in the months of September 2020 and January 2021.

“When the first news of the omicron appeared and there was speculation about the possibility of having 80 thousand infected per day, we thought it was impossible to reach such a high number”, says the doctor.

“Because we passed 100,000 new cases a day at the end of January.”

“And we must consider that Israel is a relatively small country. Therefore, having more than 70,000 daily diagnoses represents a challenge for the health system, even if a smaller proportion of patients have complications”, he adds.

As of February, records of new infections have fallen again – on 2/2, 62,000 diagnoses of Covid were made in Israel.

The same effect, however, has not yet been observed in deaths from the disease, which continue to rise, even though the death rate in relation to the number of new cases is proportionately lower than in previous waves.

Israel even came to be among the countries with the highest mortality per million inhabitants in these first weeks of 2022.

“We know that there is a mismatch of a few days in the curves of cases and deaths. We hope, therefore, that deaths begin to decrease soon”, analyzes the expert.

The power of vaccines

Schleifer points out that the damage was only greater thanks to the vaccination against Covid. And that becomes clear when she cites official data from the Israeli Ministry of Health.

“In people over 60, we have 375 critically ill patients who were not vaccinated every 100,000 inhabitants. Among those vaccinated, this number drops to 31 patients per 100,000”, calculates the doctor.

In other words: in the older population of Israel, the risk of complications from Covid is 12 times higher among those who have not taken the three doses of the immunizer.

“In those under 60, this rate is 5 patients per 100,000 among unvaccinated and 1.5 among vaccinated”, he adds.

Although Israel was a pioneer in the distribution and application of immunizations against Covid, and even led the discussions on the need for a third dose, the numbers of new vaccinates grew more slowly in the second half of 2021 and in the beginning of 2022.

To give you an idea, 62% of Israelis had received at least one dose in July last year. Now in February, this index is at 72%.

The Brazilian doctor believes that the country should have carried out more targeted and adapted communication campaigns for some parts of the population.

“We see that some people are more resistant to vaccines and other layers had a high rate of contamination early on in the pandemic, such as ultra-Orthodox Jews”, he quotes.

“The other day I was talking to an Arab doctor and he told me that, within the community, there is a family hierarchy that highly respects the decision of grandparents and grandparents. take the doses”, he continues.

“It would be interesting to have more targeted campaigns, to clear up the doubts that each of these groups presents”, he suggests.

Perspectives and lessons learned

The Brazilian doctor says that the other restrictive measures, such as the ban on gatherings and the use of masks, are currently under discussion in Israel.

“We have the ‘green pass’ [passaporte verde], which is valid for those who took the third dose or had Covid and recovered. This document is required to enter many places, such as restaurants and malls. The use of masks in closed places is also recommended,” he says.

“But now, with so many people infected for the second time, the ‘green pass’ seems to lose some sense, but there is still no decision on whether it will be kept or abandoned.”

Schleifer sees another significant change that has started to happen recently: Many Covid patients who previously had to stay in hospitals are now being treated at home, with remote monitoring.

“Israel’s health system managed to structure itself to leave the patient in its community. He is hospitalized at home, but under the care of doctors and nurses, who follow up on the internet”, he details.

“This was a solution to not overload the hospitals even more.”

With so many changes in knowledge about the disease and in the forms of prevention and treatment, the Brazilian doctor hopes that the natural evolution of the virus will make it less dangerous in the near future.

“I hope we are not surprised by a new variant of the coronavirus that is even more dangerous and contagious,” he says.

“But this pandemic has shown us that we need to be flexible and dynamic, especially when it comes to health and education. It may be necessary to change plans, adapt and create new conditions according to reality.”

“Covid gave us a hell of a scare and I hope that we learn from all the mistakes to be better prepared for the next health crisis that appears”, he concludes.

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