Two new studies - one from Britain and the other from Israel - have recently clarified the deadly meaning of the same burden for patients, especially Covid-19 patients
Two weeks ago, the breathing machine tube of Moshe Harzi, 47 years old from Tel Aviv, disconnected, without the medical staff noticing the malfunction in time. The reason according to the hospital?
"Given the multitude of alerts at the same time, the staff who were busy responding to emergency alerts from other patients managed to evacuate and identify what happened only after a few minutes."[1]
Yesterday a patient died in an ambulance, because no hospital could be found where she could be taken. The CEO of MDA reported that -
"Patients wait for hours in ambulances. Today a patient from a nursing home died in an ambulance because hospitals did not want to accept her."[2]
These are just two cases out of many others that don't receive media attention because they are not as dramatic. The doctor who does not arrive on time for the patient, the nurse who cannot give the patient personal attention because she is running between ten different beds. The medical staff who were transferred from other departments and are not sufficiently skilled in treating Covid-19 patients or operating the devices in the emergency department.
How do I know that this is only a part of many cases? Because two new studies - one from the UK and the other from Israel - have recently clarified the deadly meaning of the same load for patients, especially Covid-19 patients.
The first study surveyed almost 7,000 patients admitted to UK hospitals in the past year due to suspected or confirmed infection with the corona virus. The researchers looked at the number of beds and the ability to operate the ventilators, compared to the total mortality among that subpopulation. The results were clear: as the number of beds staffed with ventilators increases - a sign of the burden on the hospital - so does the risk of mortality for the hospitalized. This is not a marginal increase in risk. When the occupancy in the hospital reaches 69 percent, the risk of death from the corona virus increases by XNUMX percent[3].
The second study comes from a collaboration between researchers at Tel Aviv University, the Weizmann Institute and the Technion. The researchers analyzed the data obtained from 19,336 corona patients who were hospitalized in Israel between July 2020 and January 2021. They showed that even under a moderate load - five hundred hospitalized in hospitals throughout the country - the mortality rate of the patients increased significantly compared to the situation where the number of patients was lower. For comparison: between mid-October and early November, when the number of hospitalized patients dropped dramatically, the mortality rate over 14 days was 10.3 percent. But when the burden increased between mid-December and early January, that death rate jumped to 27.9 percent.[4].
We will emphasize (as the researchers themselves do in the article) that it is always possible that the increase in mortality is a result of the spread of the new strains of the virus. You decide if it encourages you. However, the researchers claim that there is no evidence of the existence of a more deadly species in Israel. Here they may be wrong, as there is preliminary evidence that the British strain is thirty percent more lethal than its predecessors [5]. But the fact that we see the same pattern of an increase in the death rate alongside an increase in the number of hospitalizations also in the period of September-October, when the new strain has not yet arrived in Israel, indicates that the model is accurate - and that the death rate does increase in direct proportion to the level of load in the hospitals.
Similar results - but milder - came from a study conducted at the end of December in Belgium, where 13,612 hospitalized patients with Covid-19 were surveyed. There, too, the researchers discovered that in a situation where the emergency room experienced an excessive load, the mortality rate in the emergency room increased from 21 percent to 27 percent [6].
To put things in their full context, we will be fair and point out that two previous studies - one from the UK and one from Australia - showed that there is no connection between emergency room occupancy and the mortality rate. However, these two studies were much smaller: one was conducted on 52 patients, and the other on only 204 patients.[7] [8]. These are tiny numbers compared to the thousands of patients on which the other three studies I described were conducted, so I tend to trust the newer and much larger studies more - what's more, the results coming from them seem more logical.
The meaning of the new studies is that you don't have to wait for a 'collapse' situation - and it doesn't matter how you define the term - to see the negative effects on the corona patients. It's also not worth trying to reach herd resistance, as some people suggest, because the death rate will rise steeply as the number of patients arriving at the hospitals increases. And probably not only patients with covid-19. What about the death rate of the patients with other diseases, who cannot receive adequate treatment from the exhausted medical staff? There are no data about it yet, but the managers of the neurology departments, for example, are already complaining that "we are reducing our manpower and resources are being diverted to the treatment of corona patients - in a short time there will be a lack of crazy people in neurology beds"[9]. One can only hope that the patients in those wards are not harmed by the excessive load.
These results are not encouraging for the corona patients arriving at the hospitals in the next two weeks, before the load (not the infection rate, which has already started to decrease[10]) will start to decrease due to the closure. According to the data of the Ministry of Health from January 25th, in hospitals such as Sourasky, the Scottish and the Meynai Yehusha, the occupancy already exceeds 96 percent. In Shaare Zedek and Sheba it reaches approximately 93 percent. And in Kaplan, Laniado, Rambam, Hillel Yaffe, Rabin K. Bilinson and Nahariya it ranges between 81 and 90 percent [11]. According to Globes data, the situation is even worse: the occupancy of the corona wards at the Herzog and Neyado Hospital has already reached 95 percent, and at Hadassah it is 'only' at XNUMX percent [12]. According to some of the testimonies, this is also a failure of the Ministry of Health, which does not regulate the number of critically ill patients in the various hospitals[13].
In conclusion: it seems clear that the death rate increases as the hospitals fill up. Want to stop the increase in the death rate? Get vaccinated if you can, and if not - follow the quarantine guidelines. Yes, I follow the instructions of the Ministry of Health. No, I'm not a goat (despite my intense love of lettuce). Protect yourselves and the weak in society, and we will also get through this wave together.
Successfully!
[1] https://www.israelhayom.co.il/article/842839
[2] https://www.inn.co.il/news/465425
[3] https://www.medrxiv.org/content/10.1101/2021.01.11.21249461v2.full.pdf
[4] https://www.medrxiv.org/content/10.1101/2021.01.11.21249526v1.full.pdf
[5] https://www.washingtonpost.com/world/europe/uk-variant-covid-mortality/2021/01/22/86023180-5cd6-11eb-a849-6f9423a75ffd_story.html
[6] https://www.sciencedirect.com/science/article/pii/S2666776220300193
[7] https://pubmed.ncbi.nlm.nih.gov/33117831/
[8] https://www.mja.com.au/journal/2020/outcomes-covid-19-patients-admitted-australian-intensive-care-units-during-early-phase
[9] https://doctorsonly.co.il/2021/01/218884/
[10] https://doctorsonly.co.il/2021/01/218902/
[11] https://datadashboard.health.gov.il/COVID-19/general
[12] https://www.globes.co.il/news/article.aspx?did=1001357668
[13] https://www.israelhayom.co.il/article/842839
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