Is this the optimal mode of care?
Is this the optimal mode of care? Rambam hospital

Where’s the best place to treat coronavirus patients – at hospital, or at home? Following the media furor surrounding what turned out to be fabricated reports that the Belzer Rebbe was treated in his home for coronavirus by Hadassah hospital staff using Hadassah medical equipment, former director-general of the Health Minister, Professor Gabi Barbash, weighed in on the question of home treatment versus hospital treatment, and expressed his view that the way the health system is currently treating many coronavirus carriers should be rethought.

“I’m not at all sure that the way we categorize patients, using a cutoff line of 93% oxygen saturation to determine who is seriously ill, is the right one,” he told Kan Reshet Bet on Tuesday. “I think it’s possible that this way of looking at things is causing us to hospitalize more people than is necessary, and that it would be better to treat them in the community [i.e. at home] if the health system was set up in such a way that this was possible.”

Prof. Barbash then noted that, “The haredim are succeeding with this model, however,” referring not only to reports regarding the Belzer Rebbe, who was treated by a private specialist, but also to other reports that have been confirmed by haredi sources. These reports describe how hundreds of privately-owned ventilators are being lent out (at no charge) to coronavirus patients, thus enabling them to remain at home, with or without constant medical supervision as the case demands, with the double benefit of keeping them out of hospital and taking the pressure off hospital wards.

“If I [had coronavirus and] had a doctor visit me at home and he ascertained that I wasn’t about to [deteriorate sharply], and he gave me an oxygen ventilation system, then I would much rather remain at home and not go into hospital,” Barbash said. “The haredim have set up an improvised system of their own, and when I look at it, I wonder what would happen if the public health clinics could set up something similar, with patients only being taken to hospital if they deteriorate. I think it’s quite possible that those with oxygen levels between 89% and 93% would receive better treatment at home, and they would also not be contributing to hospital overcrowding. We really should be funding doctors and nurses to make house calls,” he added, in order to make community care more feasible.

Professor Barbash also noted the disparity in costs if home treatment was a more viable option. “Treatment at home costs, let’s say, around a thousand shekels a day. But it costs four thousand shekels a day to treat a patient in hospital. And people are being dumped in wards like zombies. The staff keep their distance and the patients are isolated from their families and all they see are masks. I think we should be asking ourselves all these questions.”

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