Israeli Charity Treats Ultra-Orthodox Virus Patients at Home
Israeli Charity Treats Ultra-Orthodox Virus Patients at Home
JERUSALEM — When the elderly father of an ultra-Orthodox radio personality in Israel contracted the coronavirus recently, his family dreaded the prospect of his entering an isolated hospital ward and possibly never coming out.
So the broadcaster made a round of calls that turned up an alternative.
A small charity was offering an under-the-radar service treating mostly ultra-Orthodox and older Covid-19 patients in their homes, even in severe cases where health experts say it could endanger lives. Drawing on the services of a few doctors — and dozens of volunteers, most without medical training — it was operating out of a basement in Mea Shearim, a Jerusalem stronghold of the most extreme anti-Zionist Jewish sects that shun cooperation with the state.
Hundreds had already turned to the charity for care out of a sense that remaining with family — and avoiding public hospitals — outweighed the risks. But the project was also tinged with a general distrust of government among the ultra-Orthodox community, which appears to be increasingly going it alone in handling the pandemic and many other aspects of daily life.
Since the home-care initiative was reported by Israel’s N12 news service this week, health officials and experts have responded with a mix of condemnation and curiosity. One leading epidemiologist was among those who said the approach could help ease the burden on hospitals.
The debate comes as Israel is under its second national lockdown after daily infection and death rates soared to among the highest in the world, and ultra-Orthodox areas top the virus hot spots. Health officials say that about 50 percent of those aged over 65 and under 18 who are infected in Israel are from the ultra-Orthodox community, though it makes up no more than 13 percent of the country’s nine million citizens.
And the actual infection numbers may be even higher: The charity does not report coronavirus cases to the authorities, which may be skewing the national virus data on which policymakers base their decisions.
Dr. Sharon Elrai-Price, a senior Health Ministry official, denounced the operation as a “dangerous” departure and said the ministry was looking into the legality of some aspects of it.
Dr. Ran Balicer, an Israeli health care official who advises the government on the pandemic, called the charity “a gamble.” A coronavirus patient’s condition can deteriorate rapidly, he said, adding it was “hard to predict a moment of no return for people who might have survived had they reached the hospital in time.”
But Dr. Gabriel Barbash, a leading Israeli professor of epidemiology, is among those who view the charity’s approach as a possible way to ease the load on hospitals and worthy of further study. Other advocates insist that even in severe cases, a calm home environment can aid recovery.
Yitzhak Markovitz, a member of a small Hasidic sect, started the at-home care service about six months ago through his charity, Hasdei Amram. He said his patients generally avoided taking government Covid-19 tests to evade official attention and pressure to go to hospitals, adding that those factors are also why he does not report cases to the authorities.
The charity offers a limited range of treatments compared with a hospital, providing only oxygen support, medication and close monitoring by a doctor. Its services are not exclusively for the ultra-Orthodox, though most patients do come from that community.
The hardest part, Mr. Markovitz said, is recruiting doctors because they fear being investigated should anything go wrong.
The ultra-Orthodox community has long kept itself apart in an effort to shield members from outside influences. But their ways have riled many other Israelis.
Its school system operates independently of the Education Ministry. Many ultra-Orthodox men study the Torah full-time instead of working in paid jobs, and they receive government stipends to remain in seminaries while being largely exempted from mandatory military service. Many from the community live in almost exclusively ultra-Orthodox cities and West Bank settlements.
And now, their independent approach to dealing with the pandemic is exacerbating the country’s religious-secular divide.
Gilad Malach, who directs the ultra-Orthodox program at the Israel Democracy Institute, an independent think tank, said the second wave of the country’s coronavirus outbreak, which began this summer, was “a microcosm of the whole story of the Haredim” in Israel, referring to the ultra-Orthodox.
“They cannot be a state within a state,” he said. “If 50 percent of the sick are Haredim, it affects the whole country.”
“There is a huge amount of anger and criticism over their behavior among the general population,” he added. “So we are both linked to one another but more alienated from each other.”
Many Israelis blame the community for the country’s second full lockdown after ultra-Orthodox politicians used their political clout to thwart plans for more limited local lockdowns that would have targeted their towns. And while some ultra-Orthodox rabbis have urged compliance with government regulations against large gatherings, others have flouted them, relying more on the power of prayer.
Having large families crammed into typically small apartments has contributed to the high infection rates within the community. The independent Haredi school system has remained at least partly open while state schools have been closed.
And as in Brooklyn, inter-communal tensions have been fueled by scenes of large weddings, funerals and religious gatherings in ultra-Orthodox communities. Police enforcement has been erratic and has led to clashes.
Still, national infection rates in Israel have fallen under the lockdown restrictions, some of which are expected to be eased on Sunday.
Although Mr. Markovitz’s service began with treating cases in Mea Shearim, it soon spread to other ultra-Orthodox neighborhoods in Jerusalem and other cities. Supporters claim amazing recovery rates, far exceeding the national ones for older people.
Mr. Markovitz said that only about 20 of his 2,000 cases had ended up in the hospital and that only a fraction of those 20 ultimately died.
“What we see from this whole experience,” he said, “is that when a person is in good mood and spirits, that’s when the situation improves.”
But critics say the project’s data is unreliable.
Mr. Markovitz said he had begun keeping a register of patients only over the last month and that he currently had about 500 receiving care. He and a volunteer said that up to 170 of them had blood oxygen levels below the point at which health experts would advise hospitalization.
Families pay 1,000 shekels (just under $300) for a private visit from a doctor who takes blood samples and sends them to a private lab for testing. The price includes follow-up monitoring by the doctor, mostly remotely.
Volunteers, who are mostly seminary students, wear protective clothing to deliver drugs and donated equipment, including devices for measuring blood oxygen levels and oxygen generators. Young family members who are prepared to risk infection help care for the patient.
Patients who require intubation are transferred to Israel’s hospitals, which are currently treating about 800 virus cases.
A few other organizations in Israel offer some at-home health care services for coronavirus patients, though no other operations on the scale of Mr. Markovitz’s have come to light since the pandemic struck.
Yad Sarah, Israel’s largest volunteer organization for health and home care services, has been providing oxygen devices. The public health system offers some degree of home care for mild cases. And a private clinic associated with a major Tel Aviv hospital offers high-end home treatment for wealthy virus patients at a hefty cost, according to Israeli media reports.
For Avi Mimran, a popular presenter on the ultra-Orthodox Kol Hai radio station, what mattered was saving his father. Yitzhak Mimran, 85, was running a fever and tested positive for the virus a few weeks ago.
Within an hour of calling Mr. Markovitz’s charity, Mr. Mimran said, a doctor was at his father’s door. The fever and some breathing problems persisted for about a week. The doctor stayed in touch twice a day, and three granddaughters tended to him.
Because he had been tested, health officials also called to check on him. Within a couple of weeks, he seemed to be feeling better.
“In the hospital corona ward, people are isolated, alone and without family,” Mr. Mimran said. “They are completely cut off and that’s what kills.”
Mr. Markovitz insisted that his efforts were not driven by ideology or anti-Zionist sentiment.
“We are only about saving lives,” he said.