Health Systems and Policy Research

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Rapid Sequence Adaptation: Establishing the First Military COVID-19 Ward in a Large Civilian Medical Center

Galina Shapiro , Omer Tehori , Gil Zehavi , Noa Goldscher , Gilad Twig , Avi Benov , Noam Fink , Elon Glassberg , Yael Shachor-Meyouhas , Khetam Hussein , Michael Halbertal , Erez Karp  and Ariel Furer 

Background: Coronavirus disease (COVID-19) challenged health systems worldwide. Even though an early aggressive containment strategy successfully delayed the initial outbreak in Israel, eventually COVID-19 care came at the expense of other patients. To increase the national surge capacity, a COVID-19 facility was established in an underground emergency hospital. Operation of Military COVID-19 Wards (MCWs) in the facility was assigned to the Israeli Defense Force Medical Corps, which does not operate hospitalization facilities regularly. We hypothesized that military health care providers could be quickly mobilized, trained, and deployed to a civilian facility to operate a MCW.

Methods and findings: To test this hypothesis, we examined the timeline of MCW deployments and conducted a retrospective cohort study comparing patients admitted to the MCW during the first and second deployments. The cohorts were compared in terms of patient characteristics at presentation, in-hospital COVID-19 care and quality of care measures. The MCW admitted its first patient 10 days after the operation was announced and 5 days after it was reopened. 52 and 182 patients were treated during the first and second deployments, respectively. No significant differences in age, sex, time after symptom onset or diagnosis, and COVID-19 severity at presentation were found between deployments. A significantly higher proportion of patients treated during the second deployment were vaccinated (p=0.03). No significant differences were found in maximal respiratory support, the use of Dexamethasone or anticoagulation. The use of remdesivir on the other hand, was significantly less prevalent in the second deployment (p<0.0001). No significant differences in length of stay, discharge destination or mortality were found between deployments.

Conclusion: Opening the MCW increased the national surge capacity within days, thereby relieving the overextended national healthcare system. The only differences found between deployments reflected external changes in vaccine availability and standard of care. The MCW proved to be an agile strategy in mitigating unpredictable surges in health care demand.