Lessons from the epidemiological investigation efforts during the COVID-19 epidemic in Israel

Abstract Background The COVID-19 pandemic caused a crisis in the Israeli healthcare system. The wave-like morbidity created an overload of epidemiological investigations, which led to delays and less than successful efforts to prevent infection. For this reason, Israel decided to mobilize the military for this purpose, creating a forced cooperation between the Ministry of Health (MOH) and the IDF, an expert in dealing with crises. Aim To examine the implications of the forced encounter between the IDF and the healthcare system, including both tensions and cooperation efforts. Methods Twenty in-depth interviews were carried out with MOH and IDF personnel in different roles at various levels towards the end of the second pandemic wave in Israel. Findings The findings present a dual picture of cooperation and mutual respect, side by side with contradictions and conflicts. The feeling that the IDF came in to ‘save the day’ placed the healthcare people in an inferior position. Clearly, there was no explicit plan for division of authority. It was clear to the healthcare staff that they have the authority as the professionals, and to the IDF people that they have it as the ‘saviors’ brought in for this purpose. The healthcare people did see the potential of the military force mobilized for this purpose, but felt they were asked for their opinion only initially, when the military personnel had to study the system. As soon as they became familiar with it, they were no longer asked for advice, and control was given to the IDF. The findings also show that the MOH’s qualitative professional approach often clashed with the IDF’s action-based approach. Conclusions The military was mobilized as a crisis expert in order to assist the healthcare system in managing said crisis, but in fact this assistance had many side effects. Managing expectations, division of authority and open, sharing communication may have been useful in preventing the conflicts and managing them. Key messages • It is important to be aware of the a-symmetrical power relations of the military-healthcare system interface in order to create effective work and true, coherent cooperation. • Management of expectations, organized division of authority and open, sharing communication may have assisted in preventing the conflicts raised and managing them.


Background:
The COVID-19 pandemic caused a crisis in the Israeli healthcare system. The wave-like morbidity created an overload of epidemiological investigations, which led to delays and less than successful efforts to prevent infection. For this reason, Israel decided to mobilize the military for this purpose, creating a forced cooperation between the Ministry of Health (MOH) and the IDF, an expert in dealing with crises. Aim: To examine the implications of the forced encounter between the IDF and the healthcare system, including both tensions and cooperation efforts. Methods: Twenty in-depth interviews were carried out with MOH and IDF personnel in different roles at various levels towards the end of the second pandemic wave in Israel.

Findings:
The findings present a dual picture of cooperation and mutual respect, side by side with contradictions and conflicts. The feeling that the IDF came in to 'save the day' placed the healthcare people in an inferior position. Clearly, there was no explicit plan for division of authority. It was clear to the healthcare staff that they have the authority as the professionals, and to the IDF people that they have it as the 'saviors' brought in for this purpose. The healthcare people did see the potential of the military force mobilized for this purpose, but felt they were asked for their opinion only initially, when the military personnel had to study the system. As soon as they became familiar with it, they were no longer asked for advice, and control was given to the IDF. The findings also show that the MOH's qualitative professional approach often clashed with the IDF's action-based approach.

Conclusions:
The military was mobilized as a crisis expert in order to assist the healthcare system in managing said crisis, but in fact this

Background:
The PSIC study (Prospective Study of Intensivists and COVID-19) monitored the intensivists working in one of the two COVID-19 hub hospitals in Central Italy over 2 years from April 2020. This study showed how mental health varies in relation to the stressors posed by the different pandemic phases.

Methods:
In 4 surveys corresponding to the 4 pandemic waves, the intensivists were invited to indicate changes in work activity and measure their state of mental health using standardized questionnaires administered via SurveyMonkey.

Results:
During the pandemic there was a change in occupational stressors that led to insomnia, anxiety, depression, burnout, job dissatisfaction, unhappiness and intention to quit. The predominant stressors in the first wave were fear of unprotected exposure, distrust of safety measures, and compassion fatigue from having to inform relatives of the adverse outcome of treatment. In the second and third waves the workload, the monotony due to always following only one type of patient, the isolation, and the lack of time to meditate were the more relevant factors. The fourth wave added the stress deriving from interacting with anti-vax patients Conclusions: Specific prevention strategies have been developed and applied for each of the stress factors identified. Excessive workload and lack of time for meditation originated from lack of staff were remedied with extraordinary temporary hires. The management of compassion fatigue and relations with anti-vax people were addressed with specific policies and training. The monotony and isolation in COVID-19 wards can only be resolved through employee turnover in ordinary departments.