Despite all this, for some years the public health care system has been neglected and subjected to budget cuts that affect its ability to provide the best treatment. Over the years, the effect of budget cuts, staff cuts, and a lack of hospital beds could have been mitigated through proper use of existing resources.

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During the COVID pandemic, we have watched the concept of providing the best treatment with limited resources collapse. The lack of beds on regular wards and intensive care units, as well as the lack of trained staff – especially doctors and nurses in internal medical and ICU units – has led us into a total lockdown for the second time in six months, at an enormous cost to Israelis' mental health and the economy.

It takes many years to train internists who care capable of providing high-quality treatment to intensive care patients, and these patients cannot be handed off to doctors from other specialties. Even though we don't expect to see scenarios of patients who cannot be put on ventilators or thousands of dead, and we are not expected the hospitals to collapse entirely, it is almost certain that thousands more will fall ill and die because vital treatments are being postponed, and diagnoses are being delayed.

To limit the harm to the health of Israel's citizens, we must bolster hospital capacity on internal wards as well as ICUs. The solution to the shortage of staff and hospital beds must be dual: first, we need to reduce the burden on internal medicine departments and ICUs. We can staff internal medicine departments with administrators, physician assistants, phlebotomists, and paramedics, who will help cut down the burden on medical teams and allow the rest of the patients to be treated. We can enlist high-quality manpower from the IDF reserves and among students, and train them to carry out these procedures now ahead of the difficult winter we are expecting.

After that, it is vital to realize that internal medicine and ICU comprise the foundations on which we build treatment for patients in intensive care. These specialties are neglected and poorly paid in comparison to other fields of medicine, so are less attractive to young doctors. As the population ages, we can expect a greater burden on the internal medicine departments. To strengthen them, we must pay the doctors and nurses who choose that difficult field appropriately. Without bringing in good staff and adding more beds, we will not be able to avoid the disgraceful sights of elderly patients hospitalized in hallways and certainly not be able to improve the quality of their treatment.

But there are bright points in our battle against COVID. The health care system is managing to use limited resources appropriately to prevent a lack of beds in areas where the epidemic is raging. The Sheba Medical Center at Tel Hashomer, the largest hospital in Israel, has taken a lead role the battle as is preparing to open units for children with COVID, for COVID patients who require dialysis, and psychiatric patients who contract COVID. The complex cases demand a combination of infectious disease knowledge as well as the ability to balance their underlying conditions with additional areas of expertise, which is not always available everywhere in Israel.

Wise use of global centers of excellence like Sheba can help our national fight against COVID. Support in the departments that are already on the front lines will give the public health care system the time it needs to contain community spread. That is the only way we can beat COVID and get back to our normal lives.

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On Monday, the isolated coronavirus treatment unit at Sheba Medical Center was 90% full, and other hospitals are reporting that the number of hospitalized corona patients is still going up. We know that there is a lag of a week to two weeks from the time the spread of the virus slows to the time we see a drop in the number of serious cases. What is the most important thing to do right now?

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First, and most crucial, is to collect reliable, updated information about the number of confirmed cases, the places where they contracted the virus, and in what circumstances. Information about the circumstances of infection will help locate the hotspots such as parties and public events that led to a lot of infections in the current wave. In addition, collecting reliable information will make it possible to identify activities that carry a low risk of spreading the virus, and permit them.

It is likely that activity in open air, such as hiking and possibly even the use of public pools, if instructions about masks and social distancing are followed, are low-risk. There is still not enough reliable information about the risks of dining in enclosed restaurants or using gyms, and we must remember that a lack of information does not mean that these are low-risk activities -- it means that epidemiological research must be improved.

Secondly, we must keep close tabs on the number of hospitalized corona patients, their condition, and how their illness progresses. That will allow the healthcare system to direct patients in serious condition or patients whose condition is at risk of worsening to hospitals with fewer cases, and compare the number of seriously ill patients and patients on ventilators to the number we saw in the first wave.

We need to remember that the biggest concern is about a rapid rise in the number of serious cases. As long as the number of patients and their condition is carefully monitored at the national level, we will be able to take preventative steps in time.

At this stage, we are seeing the spread of the virus slow down, with fewer new cases, and know that the number of hospitalized corona patients is expected to rise, but the situation does not mandate more stringent restrictions or a full shutdown.

The country's leadership has to weigh every case of upping localized restrictions: the information needed to identify high-risk activities is epidemiological and measures the number of cases contracted during the activity in question, as well as information about the economic harm entailed by banning certain activities. Options to stopping activities should be considered: issuing special public health guidelines for it, a "capsule" approach to reduce the number of people participating in said activity, work from home, or holding activities in the open rather than in enclosed spaces. The government should decide on additional restriction only when it is clear that stopping a certain high-risk activity, and the economic harm doing so would cause, justify that step.

The public has a responsibility to follow the Health Ministry's instructions and understand that sometimes, they need to take greater caution when people's lives are weighing in the balance.

Coronavirus is expected to affect our lives for the next few months and years. It does major harm to those who contract it and causes broader social and financial harm to hundreds of thousands more. We are all responsible for protecting at-risk populations. 

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