The first cases of COVID-19 arrived in Israel in March 2020. In Israel, the first known cases were Israeli patients diagnosed with COVID-19 aboard the Diamond Princess which were repatriated.

Shortly later, additional cases were found in increasing numbers constituting the "first wave". The high number of patients put significant strain on Israeli hospitals. The initial wave was later followed by additional surges in the number of patients further straining the system. At the peak, hospitals with a total bed capacity of 800 had 135 covid-19 patients with 21 of them requiring ventilatory support.

Daily and weekly multidisciplinary meetings were held and daily reports were composed. Following each wave, lessons learned and recommendations for improved preparedness were formulated. The following results and conclusion sections summarize some of the main insights and recommendations.

The main challenges in Beilinson hospital during the "first wave" were a shortage of personal protective equipment (PPE) and how to best utilize the existing supplies, uncertainty regarding infectiveness, best management practices and uncertainty regarding the expected magnitude and duration of the pandemic. In retrospect, the major insights were the need for a flexible and divisible ED to safely care for changing loads of suspected and verified COVID-19 patients as well as COVID-19 negative patients. Increasing the in-hospital stockpile of PPE as well as the regional and national stockpile and creating local production capacities. The importance of the daily multidisciplinary managerial meeting was to improve situational awareness and allow improved decision making. Staff briefing occurred on a daily basis and during times of high uncertainty at the beginning of every shift.

Performing structured and frequent debriefing and analysis to achieve clinical and operational insights is crucial for improved short-term performance as well as improving preparedness for future challenges.