8 minute read
Healthcare: Dr. Yonatan Shapira
from ORAH SUMMER 2020
by CHW
HEALTHCARE:
THE H IN CHW
Dr. Yonatan Shapira
Dr. Yonatan Shapira was only a few months into his role as Head of the newly established Internal Medicine Department at The Shamir Medical Centre (Assaf Harofeh), when discussion around a possible pandemic began. As Israel set up a national Coronavirus emergency plan, The Shamir Medical Centre was among the first hospitals to establish a designated Coronavirus Unit, headed by Dr. Shapira.
Born in the United States, Dr. Shapira moved to Israel with his family at the age of 15. He pursued his passion for medicine at The Hebrew University - Hadassah Medical School, and completed his Internal Medicine residency at Shamir Medical Centre. As his career expanded, Dr. Shapira held several senior roles within Israel’s most prestigious hospitals. Dr. Shapira currently resides on a moshav in central Israel, and is the proud father of four.
Q: How did Shamir Medical Centre prepare for the Coronavirus and what actually transpired during the first few weeks of the pandemic?
At the end of February, we started preparing for COVID-19 by converting the Internal Medicine Department into the Coronavirus Unit. Yet, after hearing about the high rates of infection around the world, we quickly realized we needed to keep expanding. We transformed a second, adjacent department into another Coronavirus Unit, and then added another area. Therefore, by the end of March, we converted three departments within the hospital, in order to have the capacity to treat all of the COVID-19 patients admitted to the hospital. It definitely wasn’t business as usual! We worked 12-hour shifts and as such, needed support of additional doctors and nurses from other specialized departments. There was a point when we all felt like we were heading out to the battle fields.
Q: What were some of the main challenges you and your team encountered?
The biggest challenge for us was that we all had to deal with so many unknowns. We simply didn’t know what treatments might be best for the patients. We still don’t know exactly what works, but we definitely know more. At the beginning there were no recommended medications and we started using different treatments that proved to be successful elsewhere in the world, like Remdesivir, which is an antiviral drug that showed very promising results. We also started using plasma from people that were sick and recovered from COVID-19. It’s actually become one of the more popular treatments.
Putting on PPE before seeing patients at The Shamir Medical Centre (Assaf Harofeh)
Q: Have you had to adapt as new information and data about treatments became available?
So many changes have happened in real time! We’re not used to this kind of medicine. Usually we know what to do and have 97% of the information we need available. For example, the whole idea of how to oxygenate patients was critical. There was a big shift a few weeks after we started treating patients. At the beginning, the protocol was to place all difficult cases on a respirator. That’s what everyone did around the world and that’s what we did here. But then we realized, it’s actually not ideal, because it’s very hard to wean them off. Now we’re doing just the opposite- we actually try not to respirate our patients. On the one hand, you could say all of this is very exciting and interesting, especially as new articles are constantly coming out from the medical community around the world. However, on the other hand, it’s very difficult to stay on top of the most up-to-date discoveries while you’re in the midst of a pandemic, inundated with very ill patients.
Q: What was it like to treat patients in the midst of Israel’s full lock down?
We had to quickly adapt to a new way of connecting and communicating with our patients. It was very difficult while we’re dressed in full protective gear. Aside from the fact that you’re hot and sweaty, our patients could barely see us behind our face masks and shields. We came up with some creative ways to overcome the barriers. For instance, we printed name tags with pictures of our smiling faces! Our patients were very happy and told us it made a huge difference that they could ‘see’ who they were speaking with. One of the hardest aspects of this pandemic was that family members were not able to come and visit with our patients. It was heartbreaking to see so many lonely elderly patients, because their children were not allowed to be with them.
In fact, it was so difficult, we decided to rethink our entire approach. We realized if we could see patients and protect ourselves using full body gear, then so could family members. Obviously, we didn’t want to cause any harm, but it was so important to give families this option. We now allow up to two family members to suit up and go into the Coronavirus Unit, if they would like. Some families don’t feel comfortable doing this, but once they understand the severity of the situation, they usually do.
We also heavily relied on iPads, FaceTime and WhatsApp to connect our patients with their families. It made all the difference. I remember how happy and grateful the daughter of a patient was when I connected her to her father. Although her father was on a respirator and could not speak, his eyes lit up when he saw his daughter on the screen. It was a touching moment.
Spirits are high with hospital staff despite the global pandemic
Unfortunately, some patients didn’t survive, especially at the beginning of the pandemic, when there were so many unknowns. We still think about one of our younger patients who, sadly, passed away. Perhaps, if she were hospitalized a month later, we might have been able to save her life. As medical professionals, we’ve seen our fair share of tragedies and people passing away. This pandemic was exceptionally hard on our staff. It was impossible to beat the virus at the very beginning. We feel much better now, especially as the numbers of infected people eventually went down. The number of COVID-19 deaths remained under 300, when restrictions in Israel began to ease by mid-May.
Q: There is a lot of talk about a second wave of COVID-19 infections. What is your opinion? Will the health system be able to cope again, especially during the Flu Season?
It won’t be easy, but I believe we will be able to cope with it. Today, patients with mild or no symptoms are correctly being sent home and quarantined. Back in March, almost everyone was hospitalized. Before Coronavirus, nobody would have considered hospitalizing someone because of a cough. We have much more experience, especially in our emergency rooms and in our community health clinics. I think fewer people may be hospitalized, but the cases will likely be more severe. Thankfully, we have better treatments and techniques, and fewer patients need to be on a respirator.
We’re definitely thinking about the winter and flu season. It’s a real issue because we just don’t know, if a patient can get both the flu and Coronavirus. We don’t know if a patient with Coronavirus is protected against the flu or just the opposite. It’s all very fascinating, but we need to be prepared for the worst case scenario. We are trying to predict the number and prepare on a national level for what may be a very difficult winter season.
The good news is that elderly patients may fare much better than in the past, because they’re so well protected right now. I see that the older patients, in my own community, are protecting themselves. They take it very seriously, which is an important part of the overall solution to curbing the pandemic. Looking back, I feel a great deal of satisfaction; mainly, because we experienced a whole new way of practicing medicine. Doctors often rely on all kinds of algorithms and protocols, which they base their decisions on. Given the fact that there were so many unknowns during COVID-19, we needed to consider the particular situation and rely on our gut feeling. I personally believe in an individual approach. It makes it difficult, because the burden is on you and your decision making. On the other hand, I believe this is the right way to practice medicine. I also enjoyed working as part of a close-knit team. We always collaborated well, however, during this difficult period, teamwork became paramount.
Q: Were there any special patients that you will always remember from this period?
I firmly believe in connecting with patients. If we, as doctors, were unsure about what was unfolding at the outset of the pandemic, can you imagine what our patients were feeling? I remember there was a young man in his early thirties who was admitted in serious condition. He was so anxious, and kept thinking he was going to die. To be honest, he might have been right. We just didn’t know. I remember coming to his room every day and sitting with him. I didn’t even do much. I just kept telling him, ‘you’re going to be fine, you’re doing great. We’ll get through it.’ In the end, that’s what happened, but it could have ended differently. Encouragement and positive thinking make a huge difference.
From time to time, we encountered very difficult cases, but we have to be there for our patients and their families during the good moments and the bad moments. That’s what we do. It’s the essence of medicine and it became even more obvious for me during COVID-19. This is why we chose to be Medical Doctors and this is our ultimate mission in life.
