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Israel marked its first death from COVID-19 on March 20, 2020 – Arie Even, an 88-year-old Holocaust survivor from Jerusalem, died at Shaare Zedek Medical Center after being infected and his condition deteriorated. In the days leading up to her death, in which each infection was assigned a personal number, Even was designated “case number 45”.
At the end of that month, 19 more people died. 203 others died last April. In the year since the first case, more than 700,000 Israelis have tested positive for the virus, while on Sunday the death toll topped 6,000, or about 15% of the number of people who die from all causes in the past. ‘a normal year.
Coronavirus mortality statistics over the past year have shown different trends. The reasons for the changes are many and varied. They reflect the learning curve for dealing with the crisis, the lockdowns, the stress on hospitals, the impact of strains that have entered Israel and of course the three-month vaccination campaign.
The third wave of coronavirus in Israel has resulted in record rates of infection, severe cases and death, as well as the third lockdown. January was the hardest month in the pandemic in Israel, with 1,444 deaths, and although that number fell to 900 in February, it remained the third highest monthly toll after January and all 957 deaths last October.
At Jerusalem’s Hadassah University Hospital, Ein Karem, one of the busiest hospitals to treat the coronavirus, staff members recently began analyzing the results of the 4,000 COVID-19 patients he treated in over the past year, including fatal cases.
“We checked the medical records of 150 coronavirus deaths to examine how many of them died from complications of the disease and how many were coronavirus patients who died from other causes,” said Prof Dror Mevorach, chief from the Hadassah Ein Karem Coronavirus Unit. “We saw a big increase in mortality during the third wave, when 90% of them had the British strain.”
The explanation for the increase in infection and mortality is attributed by many health system officials and the Department of Health to the arrival and spread of the UK variant, which is known to be markedly more infectious than the strain that was common here until then. The British strain, which now accounts for 90% of confirmed cases, skyrocketed the number of daily cases and the infection rate, from December, to new records, and in turn, severe cases, and then death rates have increased. The spread of the most contagious British strain has not only had a statistical but also a clinical impact, expressed in more severe symptoms and a faster rate of decline.
Mevorach said there are many factors behind the surge in deaths in early 2021, combining a wider spread due to the British strain, more severe cases and the resulting stress for hospitals. “While the inpatient death rate was around 6.5 percent in the first and second waves, that figure rose to over 10 percent in the third wave,” he said. . “We have seen many people with very serious illnesses. Some have waited too long at home to get to the hospital. For others, it has grown very quickly.
Strains take over
The British strain, which is more contagious and likely more destructive, reached Israel in late 2020 and began to spread rapidly. Now responsible for 90% of new cases, it is generating a lot of interest in the health system. However, it was preceded by another mutation – called D614G – which includes changes in the protein surrounding the virus. An article published in the journal Nature last October described the D614G mutation as being more aggressive in virus replication “in human lung cells … and primary tissues of the human airways”.
“In the results of our samples, we clearly saw the processes of mutations taking over and dominating,” Mevorach said. “We saw a marked increase from February of last year to the summer of the D614G variant taking over in many countries. It is a dominant mutation but less significant with regard to morbidity and infection. From last November we saw the dominant trend for the British strain. There are many mutations out there, but what ultimately matters is whether or not they dominate. If there is a more aggressive strain but its presence is negligible, it has no dramatic effect on morbidity.
Impact of vaccination
Health system experts agree that vaccinations are effective and have a decisive impact on morbidity. Health maintenance organizations have published numerous results confirming this position. “It started with patients 60 and over, who had the highest death rates,” Mevorach said of the declining morbidity, “and now it’s common in more and more populations. . ”
Mevorach said the change in the age distribution among patients does not indicate that the virus is targeting young people or that young people are sicker, but rather that there has been a reduction in infection rates in people. 60 years and over. “It’s not that 40-year-olds suddenly started dying and the disease changed,” he said. “When we compared the average age of the patients, we found it to be between 50 and 53 years old. We just saw in the third wave a lot more patients, so the number of young people increased. The risk of death remains with the elderly.
Die in rehab
According to statistics from the Ministry of Health, 929 Israelis died from the coronavirus between February 4 and March 9. The average victim was 75 years old, up from 82 in the first two waves. The median age was 77, compared to 79 in previous waves. Of the victims, 582 had not yet received a vaccine, 211 had received their first vaccine, 45 died within a week of their second injection, and 91 died a week or more after the second injection. There has been a steady and steep drop in the number of daily deaths from the peak, when 76 people died in one day on January 24, to around 15 a day now.
Israel’s R factor – the number of people infected by a person infected with COVID – has dropped to 0.78, a low of five months, according to a military intelligence report released on Sunday. patients – there is more agreement on what can work best, ”said the director of a coronavirus intensive care unit at a central Israeli hospital. “We understand today that there is still no way to control the disease with antiviral therapy, and we need to care for patients whose condition worsens even with treatment. We do this primarily by using anti-inflammatory drugs. However, there is still no unified protocol or complete agreement between doctors regarding the dosage and schedule of treatments. ”
The director said it appears the vaccinations are a very significant milestone and his staff are seeing a very significant drop in severe cases and a change in the age distribution. “The patients are younger, and we understand that the important therapeutic steps must occur at an early stage, before the lung infection worsens, and that the disease requires a series of treatments even after the patient leaves. the service for further rehabilitation, ”he said. “The rehabilitation department is now caring for patients who come in with a deeper and more serious illness than they were used to. We are therefore seeing continued mortality in rehabilitation patients, sometimes due to other infectious diseases. ”
According to statistics from the Ministry of Health, 626 Israelis are currently in serious condition – up from 750 two weeks ago. As of Saturday, 773 people tested positive for the virus, after 2.9% of tests performed came back positive. At the end of February, the Ministry of Health recorded an increase in the R factor from 0.83 to 0.9 in two days. The increase began about two weeks after the reopening of preschools and lower grades in areas with the lowest infection rate, and a few days after the second stage of the reopening began with a greater number of ‘children in school and the reopening of stores. expected after release from lockdown, increasing exposure to the virus. The spread of the British and South African variants and the lack of vaccination for children under 16 has refocused the attention of health professionals on the education system. Due to the high vaccination rate among the adult population, the makeup of those infected and critically ill in Israel has changed over the past month. Children and adolescents aged 0 to 19 made up more than 43 percent of all new patients, and those aged 20 to 39 made up 35 percent.
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