in the Shadow
Blue Blood: Who Are the Patients Who Are Receiving Experimental Coronavirus Treatment?
On the one hand, patients' families are being sent to find people who recovered from the virus and can donate blood and a blood bank that refuses to accept donations on Shabbat or holidays. On the other hand, there is a patient for whom the Minister of Health located a donor, a special ambulance took him to the blood bank on a Friday, and a team of specialists oversaw the procedure.
A Shomrim investigative story: The race for plasma rich with coronavirus antibodies
April 11, 2020
During the last week of Doron Shoham's life, the wife and family members of the 37-year-old man from Petah Tikva went to immense lengths to find a blood donor who could save him. His wife, Hani, wrote on Facebook: "For my husband, a critical patient in a medically-induced coma, I am looking for a blood donation from someone who has recovered from corona (two weeks since a second negative test). Please contact me." A family friend wrote another post: "I need your urgent assistance for a close friend, a young man aged 37 with two little daughters who is critically sick with corona. We are looking for people who have recovered from corona, are two weeks after a second negative swab, and are not in quarantine to give a plasma donation to MDA's blood bank. This is extremely important for the creation of a passive vaccine. Two hours of your time, and you have the privilege of saving a life!!"
This is not the only family looking for assistance. More and more families of serious coronavirus patients are using social networks to find recovered patients and locate blood donors who might be able to save their loved ones. Daniel Shemi, known as "Patient Number 74" due to the detailed documentation of her illness on social networks, says she has received dozens of such messages over the past week. "I've been approached by many people even though it’s not yet been two weeks since my last negative test. It really bothers me that private people are contacting me. It seems really weird that people have to look high and low for recovering people when the Ministry of Health has a database of recovered people who know nothing about it."
Shemi may call it “weird,” but weird is not a strong enough word to describe the real situation. Shomrim has received testimonies that raise difficult questions about the way things are being handled—from sending the families to find donors themselves, to the blood bank dragging its feet when it comes to collecting donations, and the ego battles behind the scenes. Much worse are the testimonies of the family members of critical patients, who tell of the difficulties of obtaining the treatment for their loved ones, while MDA, according to its press release, rushed on Friday evening from Jerusalem, in a special ambulance, a suitable donor "located by the health minister and his assistant" so that her blood could be used to produce plasma for a patient hospitalized in Assuta in Ashdod. And if the involvement of the health minister and his assistant in locating this donor is not baffling enough, it should be noted that the blood bank has been refusing to accept potential donors on Friday, claiming it is closed at the weekend.
Saving lives? Not on a Friday
Using plasma to treat viruses is well-established, but the effectiveness of this method has yet to be proven for coronavirus. The evidence compiled so far is preliminary and limited and comes mainly from China. A study conducted in a hospital in Shenzhen indicated that the condition of five patients in critical condition who were treated with plasma improved quickly. Based on this, the US Food and Drug Administration has decided to approve a similar experimental treatment in the United States, currently underway in New York.The Israeli Ministry of Health is aware of this treatment, and already, two weeks ago, MDA (which oversees the blood bank) approached people who had recovered and called on them to come to the bank and donate. Their announcement read: "As part of the project, MDA will collect plasma units from corona recoveries, which will be given to critical patients via intravenous therapy. This is based on the premise that those who have recovered from the disease develop special proteins against the virus (antibodies) that are in their plasma. An infusion of those donations will provide patients with a 'passive vaccine' that can help them cope with the disease." Those who have recovered were told they could make contact 14 days after their full recovery and a special phone number was assigned for the purpose.
This would suggest that the health authorities, in contrast perhaps to their behavior since the beginning of the crisis, were acting quickly and efficiently; but one look at the accumulating evidence and it turns out that things are not as they seem. Erez Turgeman, a 43-year-old tech employee from Ramat Gan, was Israel's 113rd coronavirus patient, and after a stay in hospital and then further hospitalization in the Dan Panorama hotel, he recovered and was released. He has also received requests to donate plasma. "Immediately after being approached, I called the blood bank and they told me I needed to wait 14 days because I still had traces of the virus in my body. They also told me that because of Passover, it could not be done exactly 14 days after, because that would be a Friday," he says. Turgeman did not immediately accept this answer. For a person to be considered as having recovered from coronavirus, they need negative results in three consecutive tests checking for the presence of the virus in the blood. According to MDA's announcement, blood can be donated two weeks after the second negative test, which in Turgeman's case was April 6. The blood bank insisted he donate only a week later. "I told the clerk that it was to save people's lives and she answered that these are the Ministry of Health regulations. I don't understand it. I am one of the first to recover, I have a blood type that can be donated to everyone, and yet, they scheduled me an appointment for as late as April 12 and told me it was because of Passover."And it is not just Passover that pushed back Turgeman's donation by almost a week. In a conversation with the special call center for recovering patients who want to donate, we heard several explanations that are hard to believe in a situation where efforts are being made to save lives. For example, when we asked why the families must search for donors by themselves, we were told that there are around 600 recovered people, "but we only get the data after the Ministry of Health has called people and asked for permission to hand over the data and that takes a long time. Also, some people are not in the health ministry's file, and so to speed things up, we made a general call to the public." When we asked whether donations could be made during Passover, we were told, "not on the holiday itself. But it is possible on Friday and during Chol HaMoed."Back to Turgeman. He continued receiving appeals from the family of 37-year-old Doron Shoham who lay ventilated and in a medically-induced coma. The knowledge that Shoham’s family was making every effort to find a donation and save his life and that he himself could make this donation wasn't letting him rest. Last Tuesday, more than two weeks after he was considered recovered according to MDA's criteria, he called the blood bank again and explained the situation. He was told: "You are donating on April 12. Anyway, we don't work at the weekend and during the holiday." He told us: "I explained that I’d been free from the virus since doing my second test on March 23. I told her that I had received requests from everywhere possible and that I really wanted to donate blood before that date." The blood bank refused to schedule an earlier date. Doron Shoham died in hospital that same night.
Daniel Shemi: "I've been approached by many people even though it’s not yet been two weeks since my last negative test. It really bothers me that private people are contacting me. It seems really weird that people have to look high and low for recovering people when the Ministry of Health has a database of recovered people."
Erez Turgeman: "I told the clerk that it was to save people's lives, and she answered that these are Ministry of Health regulations. I don't understand it. I am one of the first to recover, I have a blood type that can be donated to everyone, and yet, they scheduled me an appointment for as late as April 12 and told me it was because of Passover."
More evidence of the blood bank's conduct was provided by S, a man from central Israel who caught the virus while abroad, recovered, and was looking to donate blood. "I heard on the news that people who had recovered could donate blood to help critical patients," he says. "I called Maccabi [one of Israel's health maintenance organizations], and they said I should call MDA. I called MDA, they bounced me between call centers, and finally they gave me a phone number for the blood bank. There was no answer at the bank. I waited on the line for 20 minutes and then left a message. They didn’t call back. I called MDA and Maccabi again, and again they sent me to the blood bank. Again, I waited 15 minutes only to reach an automated response. I left another message."
Fearing the plague of starvation
The massive fear over the outbreak of the virus is intermingled with an even greater concern. Many families in East Jerusalem struggle to buy basic food products even in regular times, and there is real concern about the economic consequences of the crisis.
"Those who manage today will not necessarily manage tomorrow, not to mention a month from now," says Hondaide (real name withheld), a mother of three daughters from At־Tur, describing her distress. "Only God knows my situation. Some days we eat, but I have no idea what will happen tomorrow."
Hondaide is far from a unique case. Khaled Salman, the head of the social services department responsible for East Jerusalem, says that prior to the corona crisis the poverty rate stood at 75%. In the past few weeks, it has, according to estimates, risen to 90%. If there is no significant change by the end of April, he says, "almost all of East Jerusalem will be under the poverty line."
According to current statistics, 84% of the male population of East Jerusalem work, though most perform daily jobs for meager pay. The percentage of working women stands at only 22%. There are also many salaried employees, but here too most make just a minimum wage. Among East Jerusalemites, there are also some who are more affluent, as can be seen in neighborhoods like Beit Hanina and Beit Safafa. However, most live in neighborhoods like the refugee camps of Shu’afat and Silwan which suffer from systematic neglect.
Khaled Salman says that as of April 2, over 40,000 people in East Jerusalem required regular support to make ends meet. "And those are just the people who are registered with social services. Estimates are that there are tens of thousands more who are unregistered. This week, I handed out food coupons worth NIS 735,000, and next week, we are providing additional support packages to the elderly." This support is worth NIS 250־NIS 400 a month and goes mostly to the elderly and single־parent households, but this is not a sum that can significantly change the recipient’s destitute situation.
Similar concerns about hunger were voiced by all those interviewed for this article. "At the start of April, I might have spoken differently," said Hussein, an activist in the Center for Palestinian Rights Awareness who lives in Beit Safafa, "but this morning, requests for assistance started coming in. Even here in Beit Safafa, which is an affluent neighborhood, 12 families have no way of putting food on the table."
Back to Hondaide, whose story is similar to many other residents of East Jerusalem. Born and raised in Gaza, she married an East Jerusalem resident 25 years ago and relocated. Seven years and three children later, they got divorced and her ex־husband left and doesn’t provide support for her or their children. His father offered Hondaide a place to stay, and she has lived there with her daughters ever since. "If you saw the house I live in, you’d say ‘God help her, how does she stay there.’ In the winter, we suffer from rainwater leaks. I filed requests with house renovation associations; they said ‘yes, yes,’ but have done nothing."
Hondaide is dealing with her fear of starvation all on her own. "I heard that the Ministry of Social Services helps both people who have a file and people who don’t. I have had a file for 20 years now, and I have only received help two or three times during that time with sums of NIS 700 or NIS 800. Even then, I had to bring receipts for the expenses. I contacted them before the coronavirus, and they told me they can’t help because my ID is Gazan. Okay, I get it, but what can I do? Die? Should I be thrown onto the streets because I’m Gazan?"
As said before, Hondaide is not an isolated case. Though she married an East Jerusalem resident and her children have Israeli IDs, she is not eligible for support from the Israeli social services. Her adult daughters do not receive any support either despite suffering from mental illness. "I’ve spoken with social services several times about help with one of the girls. She is almost 23 and she sometimes goes through several days when she refuses to eat anything. She sits on the couch and doesn’t let anyone come close. I have asked for care for her, and if she can be taken for treatment, but they said no, she is already an adult."
Until the coronavirus crisis, Hondaide worked managed to eke out a living as a living, but she has been out of work since the crisis broke out. The Palestinian social services give her NIS 750 every three months, but even that is no always regular. Hondaide doesn't know what else she can do. "The muqaddas, with all due respect, don’t feel the suffering of the others, those who come from the West Bank or Gaza. A woman like me has no one to lean on. On Facebook, all kinds of people write ‘we help,’ but no one has come to my home to bring me a bag of bread or meat or chicken or even rice. Nothing. Where is this help?"
Another indication of the dire situation comes from Palestinian refugee camp Shu’afat, where the welfare system is far from adequate even during normal times. As of the beginning of April, over 700 resident families reported being in distress and on the brink of starvation with an immediate need for baby formula,
The minister locates, the ambulance is private
The conduct described by both Turgeman and S is especially jarring in light of the desperate attempts made by the families to find suitable donors. It seems, however, that there are those who do manage to receive the necessary treatment in one way or another.Here too, the first testimony comes from social networks, where the sons of a critical patient posted desperate posts: "Please share!!! If you know someone who has recovered from coronavirus who is willing to come and donate blood (plasma) to a patient in critical condition who has been in a medical coma and ventilated for the past two weeks, please contact the following phone numbers."Turgeman received the message from an acquaintance on the eve of the holiday. "She asked me my blood type, and when she understood I have the right one, she passed on my number to the family," he recalls. "The son called me and told me that his mother had been hospitalized in serious condition for a week and a half already. He said the hospital was looking to do whatever it could to help her recover and that they were willing to get someone to come and collect a donation from me, at my home, the very same day."Turgeman wanted to know whether the process was coordinated with the blood bank, whether there was permission from the health ministry, and who he would be donating to. "I want the patient who needs the donation most to receive it. Not the person with the most connections. I wanted to know whether, if I donated to them, I'd also be able to donate at the blood bank come Sunday," he says. The family did not call him back. The next chapter in the story also comes from social networks. The evening after the holiday, the patient's family posted this update: "First of all, we want to personally thank all those who shared and all those who showed what friendship and community are and did whatever they could to donate! There are no words to describe the amount of love we have received; you are simply wonderful and touching people! The people of Israel showed once again that they are all one pure and united heart!!! ❤ As of yesterday, a donor was found and we are all hopeful that we will win this war together."
On Sunday, Yedioth Ahronoth reported that the patient, a woman in her 60 who had worked at the Sheba Medical Center for decades, did indeed receive the infusion and the name of the donor was disclosed.
The holiday, as well as the fact that the blood bank was closed, did not get in the way of the case of another young man in critical condition. "Looking urgently for someone who was sick and has recovered for my cousin, a 29-year- old father of three, who is fighting for his life, " wrote a relative on the eve of the holiday. Friday evening, an update was posted: "With the help of good people, we have, happily, managed to obtain plasma donors, but we still need more units in order to save his life." Proof that the blood bank can operate on Friday and that the health authorities can help when they want comes in this case directly from MDA. A MDA press release announced that a blood donor had been found with the help of Health Minister Yaakov Litzman and his assistant. Unlike other potential donors whose messages had been left unanswered, this donor was rushed in a special ambulance from Jerusalem to the blood bank center in Tel Hashomer, her blood donation was collected with the approval of the Ministry of Health specialist committee, processed, and then sent to the hospital where the young patient was hospitalized. MDA's response to a request for comment indicates that the infusion was given to the patient without performing the necessary tests which could not be performed quickly enough. More on that later.The gap between this urgent and admirable conduct and the treatment experienced by other families is unfathomable. "We understood from the blood bank that there are not a lot of recovered people, not everyone has been in recovery for two weeks, and, most importantly, the blood type has to match Mom's," explains the son of a coronavirus patient in critical condition. He and his family also turned to the public for assistance in finding a suitable donor. "At the blood bank they said they are doing all they can but it would help if we also tried." When asked what the family was doing to find potential donors as the blood bank was not open due to the holiday, he asked not to expand on the topic for now but said: "I have many complaints. First, Mom needs to recover; then we'll talk."
How much blood is needed for plasma?
As with the initial policy regarding coronavirus testing (which was eventually changed), in the case of plasma treatments, the Ministry of Health is trying to maintain full centralization. According to media reports, Dr. Vered Ezra, the head of the Ministry of Health’s medical administration, notified all hospital and HMO administrators that the collection of blood from recovered patients in order to produce plasma would be performed via MDA's blood services. Ezra emphasized that the decision regarding "who is eligible to receive the novel treatment" will be made by a doctor from the ministry's medical administration who will compile all requests. The Ministry of Health did not stop there, however; it has taken action to prevent other healthcare entities from providing this treatment. Over the weekend, Israel Hayom reported that the ministry ordered Jerusalem-based Hadassah Hospital to stop collecting blood donations from people who had recovered from coronavirus, claiming this was a "national resource" that should be provided by the Ministry of Health. A senior healthcare system official was cited as saying: "The plasma from those who have recovered is being managed centrally on the national level by MDA's national blood bank and not via private initiatives. It is a limited national resource, and therefore it must be done in a centralized way and according to a central protocol." This Ministry of Health directive was issued after Prof. Zeev Rotstein, director-general of Hadassah and an outspoken critic of the health ministry's conduct, announced last week that, after much hard work, a serological testing lab (for the identification of antibodies) had been opened at Hadassah. These tests are more accurate than the other tests to identify the virus (PCR) being conducted in Israel, and in contrast to those, are able to determine the stage of the infection, illness, or recovery process. As yet, only Hadassah has such a testing capability.A senior healthcare system official told Shomrim that without serological tests, plasma infusions cannot be given to patients. This was confirmed by the deputy director of MDA's blood services, Prof. Ayelet Shenar, in an interview with Haaretz. It remains unclear what will be done with the donations being collected by the blood bank as long as the serological tests of the amount and the effectiveness of the antibodies cannot be performed there. As mentioned before, the 29-year-old patient received the plasma without it undergoing the necessary tests.The same official said that the families are, to his understanding, being misled by the blood bank when they are told to find donations. He added that in order to save a patient in critical condition, 13 liters of fresh blood are needed from recovering patients with a high level of antibodies. When asked to explain the donation given to the 29-year-old patient, he said that the donation had not followed protocol but was still better than nothing.
Shomrim gave MDA a list of questions. The organization returned the following comment: "We ask that those who wish to donate blood contact MDA's call center (03-9101101) or contact the email address: email@example.com. We will contact all those who message us to schedule an interview and a donation.""A donation appointment is not scheduled on the spot as we must have machines available for hooking up the donors. MDA does not have a hotline for serological (antibody) tests and therefore the tests are conducted at Tel Aviv University within 24–36 hours of the donation. That is why the 29-year-old critical patient received untested plasma. The test will be performed tomorrow. This is the only case in which MDA was involved during the holiday and the weekend due to the need to find donors with a blood type matching the patient’s."
The Ministry of Health had yet to respond by the time of publishing this story.