“There are immense gaps between approaches for dealing with the coronavirus, and the truth is not in the middle.”

Where is the truth, on a scale of 1 to 10?

“My impression is that if 1 is, it’s only flu and 10 is a colossal disaster, we’re between 2 and 3, at most. Ultimately, this is a viral disease, so there is a movement today that objects to its categorization as a pandemic. Our hospital deployed excellently to receive coronavirus patients, and even if their number doubles they will get optimal treatment. I don’t understand what my colleagues mean by ‘another X number of patients and we’ll be beyond our capacity.’ It’s hard for me to imagine a situation in which a coronavirus patient is hospitalized and doesn’t get the proper care, even if there’s an overload, or delays.”

Could this change rapidly?

“As of now, about one-third of the patients in my ward don’t need to be in the hospital. They’re stuck here because they’re afraid to move to a designated coronavirus hotel, because they’re too old, or for various [other] social reasons – for example, a patient with a broken arm who requires quarantine but has no one to look after her at home. I could immediately release a third of the patients and take in seriously ill people instead.

“The coronavirus will not disappear. The present strategy is not ‘flattening the curve.’ All it’s doing is changing, at the extremes, the timing of the number of infected. It is not changing the percentage of the seriously ill or the mortality rate. My colleagues and I find it difficult to listen to the fear-mongering campaign being waged vis-a-vis this disease. There are far more correct and far cheaper ways to handle the disease than a lockdown.”

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So we can say that the tone is changing among health-care professionals?

“I don’t know anyone at my level who supports a total lockdown. I sense that we’re hearing a saner voice lately, saying: ‘Let’s stop for a minute, look at the numbers and make an educated decision.’”

Prof. Asher Elhayani, former CEO Meuhedet HMO, former director of Meir Hospital, Kfar Sava

“It’s crucial to talk about the consequences of the lockdowns, to recall that they caused a million jobless, to say that poverty kills. Not to mention tensions in the home, domestic violence. I work in Sderot, where people are used to posttraumatic stress from the rockets [from Gaza]. Now traumas from the lockdown have been added. People come to me with serious anxiety, breathing difficulties, loss of appetite – and the loneliness itself is very hard. We are bleeding GNP and creating a sick society.”

But flattening the curve?

“And then we’ll reopen and the numbers will surge again. The virus will not disappear, and if we don’t treat it in a proportionate way, we will not control it. It’s not reasonable to tell people: ‘Run in the park, but don’t go to the beach’; ‘You can swim in a hotel pool, but not at the country club.’ When people don’t see logic, they lose trust. The elderly are also at the limit of their ability. They have to be allowed to go to parks, to breathe fresh air. Alone, at certain hours. That’s how you deal with an epidemic, not by locking everyone in a prison.”

As a former hospital director, what do you say about the threshold of 800 seriously ill coronavirus patients as defining the system’s level of incapacity?

“It infuriates me. After all, we aquired 5,000 ventilating machines, no? Anyway, the hospitals are deployed for wartime situations with extreme scenarios of tens of thousands of wounded. Does anyone seriously believe that we will treat the first 800 and tell the others to go home?”

As a former director of Meuhedet, how would you share the burden with the HMOs?

“The HMOs are already carrying the brunt of the [coronavirus] burden, but during the first wave people were told not to visit their clinics. Vaccinations, mammograms, colonoscopies were postponed. We will all pay the price for that.”

Why aren’t the authorities listening to you and others?

“They are captive to a conception. The scenario that was set forth in February didn’t happen; the scenario presented in April was also dispelled. So maybe a little humility is called for? At least let’s discuss, let’s debate,”

Dr. Anat Engel, director, Wolfson Medical Center, Holon

“I don’t think this disease will disappear anytime soon. We need to learn and understand the basic principles of how to live with it and to preserve other things that are vital in our life. I also look at the economic, social and mental aspects of coping with the pandemic. Do we need to aspire to the disease’s disappearance, if the price is adopting very rigid restrictions? I don’t think so. The goal should be to live with the virus while protecting the at-risk population.”

Engel reports stability in the number of coronavirus patients at Wolfson, about 65 in fair or serious condition. She is proud that Wolfson is leading in treatment with plasma antibodies from recovered patients, which keeps patients in fair condition from becoming seriously ill. The seriously ill are also being taken off ventilators faster and with better results as knowledge about the virus increases, she says.

“We are not at incapacity and we will not be at incapacity anytime soon. We are a system that is built to provide a response in crises, be it a prolonged pandemic or an earthquake. In periods of winter overload, too, there have been ambulances that waited outside, patients in the corridor, sparse medical teams. Those are not inventions of the coronavirus. Still, I don’t completely reject the idea that optimal treatment might be compromised. I can see a situation where we postpone a knee operation because of a high incidence of illness that requires maximum attention to coronavirus patients.”

Maybe your situation is better because you’re in the center of the country?

“It’s true that the burden has mostly been in the north lately, but there’s also overload in the center sometimes. It comes in waves. We specifically are relatively high on the overload index: Bat Yam is a very elderly city.”

Prof. Jonathan Halevy, president Shaare Zedek Medical Center, Jerusalem

“On a spectrum that ranges from coronavirus deniers, such as Prof. Yoram Lass, to the professors who are calling for a full and prolonged lockdown, I am somewhere in the middle.”

Despite the sharp rise in mortality?

“Based on a sample check that I conducted, in a quarter to a third of the cases of people who appear in the statistics of coronavirus deaths, the virus was not the principal cause of death. Meaning that they died with corona, not from corona. You have to understand, if by ‘collapse,’ you mean Italy in the first wave – that is, a shortage of ventilators that demand a decision of who gets one and who doesn’t – we are as far from that situation as East is from West. Incapacity refers to an overload in which patients receive less than optimal treatment. I have news for you: Every winter, internal medicine wards are in a situation of incapacity.”

But it’s claimed that we are already at incapacity, because there are more than 800 seriously ill coronavirus patients.

“The number 800 was cited as a threshold three months ago. Since then things have been done: Teams have been trained, medications have appeared that help reduce the need for ventilation and shorten the duration of hospitalization, the hospitals have adapted. If you ask me, the magic number today is 1,500.”

How do we ensure we don’t reach that?

“One asks why the state has not succeeded in gaining the public’s trust. Because it appoints a project coordinator and immediately nullifies him. The route to renewing public trust does not pass through the education minister, who is pushing for the full opening of the school system; the transportation minister, who is pushing for the opening of the airport; or Haredi politicians who are pushing to exclude synagogues and mikvehs [ritual baths] from the restrictions. The route passes through adhering to the coordinator’s directives. But he wasn’t given the opportunity. This is what it looks like when political intervention distorts purely professional decisions.”

Dr. Ariella Levkovich, infectious-disease specialist

“The coronavirus is new, so its spread is more significant than that of flu, but it’s also a virus that we are testing for much more. The number of people being tested is unprecedented.”

On a scale of 1 it’s only flu and 10 it’s a raging epidemic, how do you see the coronavirus?

“Four.”

What strategy should have been adopted?

“The lack of professionalism in managing the crisis was apparent from the beginning, from the very attempt to stop the spread of the virus. It was clear to me that its spread could not be stopped and that we would have to learn to live with it. That means allowing low-risk activities, making adjustments for high-risk activities and preventing those that cannot be held safely, like large weddings.

“But the decision makers’ behavior is characterized by cowardice and a lack of creativity. You can’t force nine million people to be locked in their homes like dogs in a kennel. The dogmatism can be seen in the terminology that was coined in the first wave. ‘Capsules,’ for example. Capsules in the open air are meaningless, sheer nonsense. All that’s needed is enough space between people. Some of the regulations are also unreasonable. Why do people have to wear face masks in the street?”

What can be done now?

“Epidemiological investigations should be revised. To draw a distinction, when it comes to contacts, between people who are significantly at risk to fall ill and those who are less so. Because, given that we will need to live with this virus, it’s inconceivable for a class to enter and leave quarantine seven times in a year just because one of the pupils smelled someone with the coronavirus.

“We need to aspire to a safe life with calculated risks. However, if the Haredi population has decided to let go completely and allow unrestrained infection – and the impression is that an experiment like that is underway, at least in the yeshivas – a hermetic separation is required between the population that is trying to achieve herd immunity and the general population, whose strategy is to reduce infections. Both physically and in the data collection, too, because if we mix the numbers [of infected among Haredim and the general public], my children won’t see their school even in another year.”

Dr. Amir Shachar, emergency room director, Laniado Hospital, Netanya

“In our coronavirus ward, nine of the 35 patients are mildly ill and don’t require hospitalization. They are waiting for a designated hotel or for another housing solution in the community. So there’s no ‘collapse,’ it’s all a matter of management. Here’s another statistic: Every winter we have an average of 30 patients on ventilators. Today we have seven-eight coronavirus patients on ventilators and and another 14 on them in other departments.

“As of mid-October, the death rate is continuing to rise. One reason is that when you crowd people into their homes, you create more contact with those who were infected, so the incidence of becoming ill rises. It’s the same elsewhere: Countries that imposed a strict, early lockdown, like Peru and Belgium, suffered the most serious mortality rates.”

New Zealand also imposed strict lockdowns and last week announced it had defeated the virus for the second time.

“The emphasis should be on ‘the second time.’ It’s like cheering at the end of a soccer game that you lost, because you were ahead at halftime. We can at least say that the same rates of infection existed in countries that imposed a lockdown and in those that didn’t.

“Look at these two pieces of data: Pneumonia diagnoses declined by 30 to 40 percent [during the epidemic]; we replaced one disease with another – pneumonia caused by coronavirus instead of ‘regular’ pneumonia. The second statistic is that there had been a 30-percent decrease in the number of people arriving at ER for any reason. So there’s no place to talk about collapse, overload or incapacity.”

Dr. Shmuel Rochberger, specialist in internal medicine

“I’ve been walking around since day one with the feeling that we’re in the wrong movie, that we’re fixated on a mistaken narrative that is unrelated to reality and is driving us to ruin.

With this virus, 96 percent of those who contract it will be asymptomatic or develop symptoms of a mild disease. If only all viruses were like that – I say as a physician. Without paralyzed children, without children dying.”

But for the elderly population, the mortality rate isn’t marginal.

“I ask myself what would happen if in a given year, the flu vaccine turned out to be unusable, because of a manufacturing snafu. No physician in the world would conceive of suggesting that we bring the global economy to a halt, shut down the airports and force everyone to stay home because there’s no flu vaccine. But here we’ve found ourselves in a horror movie, with a total loss of proportion.

“What most worried me has been the unanimous agreement. The senior Health Ministry staff all spoke in the same voice. Today, I understand that the person setting policy and silencing every other voice is the prime minister. He’s not allowing any dialogue, and I say that with pain. I supported Netanyahu, I persuaded others to vote for him. Today I am deeply ashamed of that.

“For the past half-year, I’ve seen that a lot fewer people are coming for examinations to check and prevent colorectal cancer. Who will be accountable when they die because they didn’t get checked in time?

I see the Shin Bet [security service] tracking, the tens of thousands of unnecessary tests, the hysterical quarantines. All resources are aimed at persecuting young, healthy people instead of protecting the elderly. Leave the young people – on the contrary, let them acquire resistance. We could have had immunity in the general population by now.

“Imagine if in March every family doctor had sent the Health Ministry a list of his at-risk patients. The ministry would have divided these people according to the local governments and would have trained personnel to be in daily contact with them. Each representative would be responsible for 15 people, whom he would call in the morning to ask how they feel and to go through their day’s plans with them. You need to go to the supermarket? I’ll help you arrange a delivery. You have an appointment at the clinic? I’ll organize a Zoom session for you with the doctor. You have to see your granddaughter? Let’s do it outside, in a protected mode. In other words, voluntary protection, not the despicable paternalistic approach that has gripped the world.”

Prof. Orly Manor, statistician, chairwoman of Israel’s National Institute for Health Policy Research

“In the past half a year we have learned how to treat the disease better. We have medications against the virus itself, steroids that counteract hyperactivity of the immune system, we administer medication against clotting, we use plasma of recovered patients containing antibodies, we don’t rush to ventilate, because there are advantages to delaying ventilation. We have enlarged our arsenal.”

Manor also enumerates advantages unique to Israel that are beneficial in combating the coronavirus: its young population (“the median age in Israel is 35”), longevity (“Israeli men are between second and third place worldwide; the women a bit lower but also at the top”) and high-quality health services (“the cuts have left it efficient on the border of the miraculous”).

But there are also the disadvantages: Israelis’ limited patience (“we’re built for sprints, not marathons”) and their contrarian mentality (“we’re manipulators, always looking at what’s happening with the neighbors”). According to Manor: “We need to take the totality of these traits and translate them into an effective recipe.”

What do you suggest?

“The strategy needs to be far more differential. Guidelines need to be laid down and on their basis specific, adjusted policy must be decided.”

Like the “traffic light” plan, the differential strategy promoted by coronavirus coordinator Ronni Gamzu?

“Yes, to delegate powers to the local governments but with an even higher ‘resolution’ than in the traffic light plan: to reach the level of neighborhoods and community councils. To learn from the good examples – Kafr Qasem, Sderot – and reproduce them. Those two success stories show that it’s not logical for everything to be managed by the state.”

Manor is part of a Hebrew University-Hadassah Medical Center team in Jerusalem that examined the incidence of illness and infection from the virus in children up to age 10. The conclusion: The infection rate at those ages will remain low, even after the schools reopen.

“There’s a principle involved here,” she asserts. “We are constantly wondering whether children infect others, if they’re to blame, how to get them back in preschool so the parents can work. In [looking at it that way], we are doing the children a tremendous injustice.”

Prof. Ariel Munitz, head of the coronavirus laboratory, Tel Aviv University

“It’s quite amusing: I am totally dedicated to implementing the guidelines of the Health Ministry, and at the same time I’m doing all I can within the system to bring about change. I think there is over-testing. It’s not necessary to do so many coronavirus tests.”

Why not?

“Because we are monitoring the wrong thing: confirmed cases instead of sick people. And then we enter a kind of loop of masses of carriers that creates a false picture of the incidence of infection, and that data is irrelevant. The virus can be coped with in other ways without throwing the entire economy and society into a tailspin.”

So you are doing something you don’t believe in?

“I am doing the required task at the moment, but yes, I am working contrary to my scientific truth, which says the testing should be stopped. I think that breaking the chains of infection needs to be focused on the seam line between the at-risk population and those who are not at risk. In assisted-living facilities and homes for the elderly – not only the occupants, but anyone who enters and leaves those institutions should be tested.

“Lockdowns, general or local, and even quarantines, are not effective over time, especially in the absence of certain knowledge that a vaccine is on the way. For the sake of the discussion, if the vaccine becomes available [only] in five years, are we going to continue the policy of entering and exiting lockdowns for five years? We need to find an alternative that allows us to live alongside the virus.

“By the way, if we examine the present lockdown, we will see that the decrease in the number of verified cases of illness in the general population and in the Arab population started a day or two after the lockdown. Amazing. But a pandemic never retreats abruptly. There’s always a slowdown before the decline.”

How do you suggest protecting the elderly population who don’t live in old-age homes?

“We should map them and then define specific hours of activity for them in public places: when they can come to the supermarket, when they go out for leisure-time activity. Ditto for the school system. We open it up completely and support those who are at risk. It’s easier to put 5 percent of the system on remote learning than everyone.”

Prof. Yehuda Adler, former deputy director, Sheba Medical Center, Tel Hashomer, Ramat Gan

“The health system is not at a level of incapacity; that’s a bluff. It’s [just] exhausted. And naturally so, after years of being abandoned and starved. Incapacity refers to a situation where you are short of beds, where you have to decide whom to ventilate and whom not. We’re not even close to that. There’s certainly a shortage of personnel, but there are available solutions for that, which are relatively easy to implement. Don’t let doctors and nurses retire, bring back retirees who want to work. I met with Yuli [Health Minister Edelstein] twice and told him that. He said, ‘You’re right, you’re right,’ but they [the authorities] can’t get anything moving.

“If there’s such a fear of incapacity, why are mildly ill coronavirus patients being hospitalized? I raised that question in the coronavirus committee [of the Knesset]. Sharon [Dr. Sharon Alroy-Preis, director of public health services in the Health Ministry] replied that only mild cases of individuals with risk factors are hospitalized, for fear their condition will deteriorate. That’s logical, but if there’s an overload, accommodate them in designated hotels and hospitalize them only if they actually do deteriorate.

“This lockdown is only a bandage, not a solution. People mistakenly think that a gradual exit from it is a strategy. The truth is that there is no long-term thinking. The virus will be with us for at least another year; a plan for living with it has to be drawn up.

“Through my encounters with patients, I understand how much this lockdown is a disaster born in sin, and how much we will all pay for it. A new generation of poor people has sprung up here. A 60-year-old woman from Petah Tikva, not exactly a distressed area, is standing before me and crying from shame because she doesn’t have 150 shekels [$45] to pay the deductible of the HMO. There have always been poor people, but they knew how to cope with it. This new generation has been hurled into a reality it doesn’t know.”

Dr. Michael Goldberg, director, emergency room internal medicine services, Carmel Medical Center, Haifa

“At the moment, the hospital is functioning excellently. We studied the disease, we updated our treatment and the number of coronavirus patients is relatively stable at 45 to 50. But it’s a delicate situation, and every increase can lead us to a state of pre-collapse.

“Lockdown is not a solution, it can only help for a short period. We already tried it once and we saw that it didn’t work: In the end there was an increase in the rate of illness. My hypothesis is that because it’s such a drastic measure, the moment it’s lifted, things fall apart. When people are told that the lockdown has ended, they take it to mean that there’s no need to be careful any longer, no need to wear face masks.

“A more proportional and general strategy is needed. I estimate that we have at least another year of the coronavirus [ahead of us]. We need to learn how to survive it.”

Prof. Nadav Davidovitch, director, Ben-Gurion University School of Public Health, Be’er Sheva

“We are not in a second wave, as opposed to a first wave. We are in an ongoing coronavirus routine. So it’s time to formulate a strategy that isn’t aimed only at the number of tested, infected and dying. Those are important indices, of course, but we need to talk about public health in a broader perspective, factoring in economic, mental and social components.

“The lockdown itself is an admission of failure – Prof. Gamzu has said so explicitly. It was a political decision. But regrettably, the debate is constantly swinging between lockdown or no lockdown, when there are many things to be considered in the middle, including from the coronavirus aspect. For example, people who suffer from side effects for months. And also things that are not coronavirus proper, like how to cope with loneliness so many people are suffering. For example, I think we should consider the possibility of letting older people go outside at certain hours.

“Overall, it’s time we found a way to live with the virus. If we follow the rules, avoid gatherings and adjust our activities wisely and effectively, by moving some of them into the open air, for example – we will be able to reduce infection dramatically.”

Dr. Aziz Darawsha, director, Emergency and Urgent Care Medicine, Rambam Medical Center, Haifa

“It’s clear that if you shut down the country, the result will be a certain improvement, but it will be only momentary. I see no rationale in the lockdown. We need to strive for [a maximum of] 1,000 to 2,000 verified cases of illness a day, keep the virus on a low burner and liberate the economy, set it in motion and let people breathe.

“In March, we feared the unknown and in April we saw the harrowing pictures from Italy, and obedience was absolute. The mosques were deserted. But in the long term, policy cannot be based on fear. We would not have reached this situation if enforcement hadn’t strived for zero cases, and public information policy wasn’t so poor. When a deputy director general of the Health Ministry says one thing and the director of public health services says another, it’s no wonder the public is confused. Not to mention the friction within the government.

“The general rate of illness hasn’t risen, but treatment of coronavirus patients demands three times as many resources as treatment of another, conventional patient. These patients take up perhaps 20 percent of the hospital’s beds, but that’s a volume that weighs on you far more in terms of facilities and personnel. That’s why we get stressed out – not because the system has almost collapsed. The tragedy is that if you took the billions that are being lost because of the lockdown and allocated them to infrastructure, we could cope much better.”

Dr. Guy Dori, outgoing director, coronavirus ward, Haemek Hospital, Afula

“We opened a second coronavirus ward in early September, and at the peak we had 50 patients. Now it’s dropped a bit to around 40, apparently under the impact of the lockdown. The general hospitalization load is also not awful. The internal medicine departments are getting along, with a daily occupancy of 85 to 90 percent, and the ER is also not exploding. But hospitalization overload doesn’t accumulate in a linear fashion; it comes in waves. It can change at any moment. At Haemek we have three ER experts for six beds. During the crisis they’ve dealt with 12 patients – double the number. At times we definitely felt we were nearing incapacity levels.

“The coronavirus is unequivocally not the flu. I myself treated young people who were in a state of respiratory failure and needed ventilation, whose results, in some cases, were bad. The ventilation didn’t help, and they died. Those are grim images that are engraved in my mind. Completely lucid people, to whom you explained that there was no alternative to ventilating, and in retrospect it turns out you escorted them to the gallows. As an internal medicine specialist, I am used to cases of death. But they are usually older people, or very sick, who in the end are done in by something. That’s legitimate, it’s the way of the world.

“With the coronavirus I encountered the death of young people, or people who were in a state of equilibrium despite the risk factors. Your feeling is that it’s so unnecessary, if they had only been careful.”

But even though he does not make light of the disease and thinks that the risk of hospital incapacity is genuine – Dori recently signed a petition of physicians who are against lockdown.

“I signed the petition out of much consternation vis-a-vis the situation. The estimates are that the damage [to the national economy] already stands at 150 billion shekels [$44.4 billion] – and for what? To prevent the collapse of the hospitals. But the absurdity here cries out to the heavens, because with a tenth of the amount of money wasted in the lockdowns you could have provided more hospital beds.”

Both lockdowns were a mistake?

“The first one might have been correct. It was a new disease, we didn’t know anything about it, and we needed to mobilize for battle and be disciplined. The second lockdown is totally political. Everyone was suffocated because of the inability to impose restrictions on concentrations of high infection rates. If you’re already introducing that measure, it has to be selective.”

Dr. Gili Ofer-Bialer, outgoing director, coronavirus center, Maccabi HMO

“Reality shows that this is a disease we’re going to have to live with. There will be more significant and less significant waves, and within the maneuver space we have, we can already know what we’re doing right and what we’re not. The information given to the public has been the worst imaginable. The transmission of the messages was totally confusing from the outset. The media also stuck to the approach that gladiators from both sides should be brought to the studio: those who say there’s nothing, versus those who say we’re on the brink of a tremendous disaster. The result is panic. The information needs to be conveyed judiciously and evenhandedly.

“The second thing is the reinforcement of the medical teams. In the first wave, there was a sort of paralysis, a reaction of shock [among the public]. I had a patient who stayed home 10 days with a broken leg because she was afraid to come to the emergency room. Or patients who arrived with appendicitis at the last moment. Today the clinics are operating, and in addition to the physical disease, there are a great many patients suffering from anxiety over the coronavirus.

“My usefulness as a physician is not very consequential when I’m spending my time calling every patient to ask how they feel and how long they haven’t had symptoms. Excellent people are wasting their abilities on nonsense, and it wears down the forces and resources of medicine in the community. Half a year ago, it was important for us to be in contact with every sick person,” says Ofer-Bialer, who until recently managed a center that consists of physicians, nurses and other personnel all working with coronavirus patients.

“We’ve learned from that; we compiled data. But today, when we know that people under 60 with no preexisting conditions are very unlikely to develop a serious illness, there’s no need to maintain that sort of apparatus. There’s no need to track every youngster of 16 [who tests positive]. The HMOs are telling the Health Ministry that we should let up a bit. But the Health Ministry is finding it hard to part from the paradigm of accepting and releasing every patient.”

Dr. Raya Leibowitz, director oncology department, Shamir Medical Center

“Health, according to the World Health Organization, is a condition of physical, mental and social wellbeing, not only an absence of illness. Over the past few months, we have been talking only about the coronavirus, yes or no, forgetting all the aspects of health in the broad sense. I am amazed at this approach in the face of a virus that will certainly not annihilate humanity. It is more violent than other respiratory viruses, but not to an extreme. The accepted view today is that this virus won’t go away. That is the naked and unfortunate truth. So we need to learn how to control it and accommodate it.

“The only thing a lockdown can do is delay the inevitable. It’s like giving acetaminophen when body temperature rises without finding out the underlying reason for the fever. Not to mention the fact that a lockdown leaves the virus in our homes.”

Maybe a tight, time-limited lockdown is necessary because the Israeli public can’t deal with interim prescriptions?

“To throw the ball back into the public’s court is to abandon responsibility. The absence of internal logic in the guidelines, the zigzagging, the tight police enforcement, the disregard of experts, the grim feeling that the subject is being politicized, and the lack of personal example – all these have a greater impact than the traits of a community. The majority of the public want to live and are law abiding. We need to refine a set of precise rules that are reasonable and operable, and to explain them everywhere and to everyone, combined with enforcement that is not draconian.”

The statements above reflect the personal opinions of the interviewees, and not those of the institutions where they are employed.