JERUSALEM – When the elderly father of an ultra-Orthodox radio personality in Israel recently contracted coronavirus, his family feared the prospect of entering an isolated hospital ward and possibly never coming out.
So the TV station made a round of calls that showed an alternative.
A small charity offered a radar service that mostly treated ultra-Orthodox and elderly Covid-19 patients in their homes, even in severe cases where health experts say it could be life-threatening. Based on the services of a few doctors – and dozens of volunteers, most without medical training ̵
Hundreds had already turned to the charity for the care of a sense of staying with the family – and avoiding public hospitals – outweighing the risks. But the project was also colored with a general distrust of the government among the ultra-Orthodox community, which apparently increasingly goes it alone in dealing with 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 mixture of condemnation and curiosity. A leading epidemiologist was among those who said the approach could help ease the burden on hospitals.
The debate comes as Israel is during its second national shutdown after daily infection and deaths rose to among the highest in the world, and ultra-Orthodox areas are at the top of the viruses. Health officials say about 50 percent of those over 65 and under 18 infected in Israel are from the ultra-Orthodox community, though it does not make up more than 13 percent of the country’s nine million citizens.
And the number of actual infections can be even higher: the charity does not report coronavirus cases to the authorities, which can skew the national virus data on which decision-makers base their decisions.
Dr. Sharon Elrai-Price, a senior health ministry official, condemned the operation as a “dangerous” departure and said the ministry was investigating the legality of some aspects of it.
Dr. Ran Balicer, an Israeli health official who advises the government on the pandemic, called the charity “a game.” A coronavirus patient’s condition can worsen quickly, he said, adding that it was “difficult to predict a moment without recurrence for people who might have survived if they had reached the hospital in time.”
But Dr. Gabriel Barbash, a leading Israeli professor of epidemiology, is among those who see the charity approach as a possible way to ease the burden on hospitals and worthy of further investigation. Other lawyers insist that even in severe cases, a quiet home environment can help recovery.
Yitzhak Markovitz, a member of a small Hasidic sect, started the home ministry about six months ago through his charity, Hasdei Amram. He said his patients generally avoided taking the government’s Covid-19 tests to avoid official attention and pressure to go to hospitals, adding that these factors are also the reason why he does not report cases to the authorities.
Charity offers a limited range of treatments compared to a hospital that only provides oxygen support, medication and close supervision by a doctor. Its services are not exclusively for the ultra-Orthodox, though most patients come from this community.
The hardest part, Markovitz said, is recruiting doctors because they fear being examined if something goes wrong.
The ultra-Orthodox community has long remained separate in an attempt to protect members from outside influence. But their ways have ruined many other Israelis.
Its school system operates independently of the Ministry of Education. Many ultra-Orthodox men study the Torah full-time instead of working in paid jobs, and they receive government scholarships to remain in seminars while being largely exempt from compulsory military service. Many from the community live in almost exclusively ultra-Orthodox cities and western shores.
And now their independent approach to dealing with the pandemic is exacerbating the country’s religious-secular divide.
Gilad Malach, who heads 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 entire history of the Haredim” in Israel, referring to the ultra-orthodox.
“They can not 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 attached to each other, but more alienated from each other.”
Many Israelis blame the community for the country’s second complete shutdown, after ultra-Orthodox politicians used their political influence to thwart plans for more limited local lockdowns that would have targeted their cities. And while some ultra-Orthodox rabbis have called for compliance with government rules against large gatherings, others have wronged them and rely more on the power of prayer.
Having large families crowded into typically small apartments has contributed to the high infection rates in the community. The independent Haredi school system is at least partially open, while state schools have been closed.
And as in Brooklyn, tensions between municipalities have been driven 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 below the limits, some of which are expected to be eased on Sunday.
Although Markovitz’s ministry began with the handling of cases in Mea Shearim, it soon spread to other ultra-Orthodox neighborhoods in Jerusalem and other cities. Proponents of her case have been working to make the actual transcript of this statement available online.
Sir. Markovitz said only about 20 of his 2,000 cases had ended up in the hospital, and that only a fraction of those 20 eventually died.
“What we see from this whole experience,” he said, “is that when a person is in a good mood and spirit, it is when the situation improves.”
But critics say the project’s data is unreliable.
Sir. Markovitz said he had only started keeping a register of patients over the past month and that he currently had about 500 who received care. He and a volunteer said up to 170 of them had oxygen levels in their blood below the point where health experts advised 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 laboratory for testing. The price includes follow-up monitoring by the doctor, mostly externally.
Volunteers, who are mostly seminary students, wear protective clothing to supply drugs and donated equipment, including equipment for measuring blood oxygen levels and oxygen generators. Young family members who are prepared to risk infection help care for the patient.
Patients in need of intubation are transferred to Israeli hospitals, which currently treat approx. 800 virus cases.
A few other organizations in Israel offer some home care services to coronavirus patients, although no other surgeries the size of Mr. Markovitz has emerged since the pandemic hit.
Yad Sarah, Israel’s largest voluntary organization for health and home care services, has provided oxygen equipment. The public health system offers some degree of home care in mild cases. And a private clinic attached to a major hospital in Tel Aviv is offering advanced home care to wealthy virus patients at a hefty price, according to Israeli media reports.
For Avi Mimran, a popular presenter on the ultra-Orthodox Kol Hai radio station, saving his father meant something. Yitzhak Mimran, 85, developed a fever and tested positive for the virus a few weeks ago.
Within an hour of calling Markovitz’s charity, Mr Mimran said, there was a doctor at his father’s door. The fever and some breathing problems persisted for approx. one week. The doctor kept in touch twice a day and three grandchildren nursed him.
Because he had been tested, health officials also called to check on him. Within a few weeks, he seemed to be feeling better.
“In the coronary ward at the hospital, people are isolated, alone and without family,” Mimran said. “They’re completely cut off, and that’s what kills.”
Sir. Markovitz insisted that his efforts were not driven by ideology or anti-Zionist sentiment.
“We’re just about saving lives,” he said.