Hoogleraar ouderengeneeskunde: ‘Tachtigers blinde vlek bij aanpak coronavirus’
Marcel Olde Rikkert Hoogbejaarden die Covid-19 hebben, vertonen vaak andere symptomen dan jongere patiënten. Artsen werden daardoor op het verkeerde been gezet.
Ze hebben de ouderen over het hoofd gezien, zegt Marcel Olde Rikkert. Hij noemt het de „blinde vlek” in de geneeskunde. In de coronacrisis – en vooral in de beginfase tijdens de grote verspreiding – zijn ze vergeten hoe oude lichamen functioneren. „Alsof we twintig jaar terug gingen in de tijd en niets van geriatrie wisten.” Olde Rikkert is hoogleraar ouderengeneeskunde aan de Radboud Universiteit Nijmegen en werkt er in het ziekenhuis.
Het pandemiebeleid werd, in de hele wereld, vanaf december bepaald door virologen, epidemiologen, infectie-artsen. Olde Rikkert: „Iedereen keek hoopvol naar hen, de eigenaren van het probleem. En zij keken naar het virus, het spannende, nieuwe virus uit China; Hoe zich dat verspreidt en wat het doet met organen. Ze keken níet naar de gastheer, die er het meeste last van heeft: de hoogbejaarde. Terwijl in China meteen al bleek dat 85 procent van de overledenen heel oud waren.”
Het was geen bewust beleid, zegt hij, eerder een „mechanisme dat in werking trad als reactie op een aanval uit onbekende hoek”.
Maar inmiddels zijn er 9.053 hoogbejaarden in Nederlandse verpleeghuizen besmet met het virus. 1.696 van hen zijn overleden, meldde beroepsvereniging Verenso woensdag, 1.861 zijn hersteld.
Oud lichaam
Het oude lichaam functioneert anders dan het jongere, legt Olde Rikkert uit. Dat verandert niet bij iedereen op hetzelfde moment. De één is 85 jaar maar heeft een ‘biologische leeftijd’ van 65 en is dus relatief fit – „er zijn 100-jarigen die herstellen van Covid-19” – een ander is jong, maar heeft versleten organen: de longen door het roken, de lever door het drinken, diabetes door overgewicht. Of gewoon door pech.
Maar de grote lijn is: naarmate de leeftijd oploopt, worden de vaten nauwer, pompt het hart minder goed, stroomt het bloed minder snel en slijten organen en onderdelen zoals hersens en gewrichten. Gemiddeld hebben tachtigers een lichaamstemperatuur van 35 à 36 graden. Het bloed stroomt moeizamer en dus zijn ze kouwelijk. Als een tachtigjarige 37 graden meet, dan heeft ze koorts als ze normaalgesproken op 35 graden zit. „Maar de coronarichtlijnen van RIVM en WHO spreken tot op de dag van vandaag van een coronaverdenking vanaf 38 graden koorts. Dat is bij ouderen niet relevant”, zegt Olde Rikkert. „Ze hebben vaak Covid-19 zónder 38 graden koorts.”
Negentien ouderen
Omdat dit de geriaters in het Elizabeth/Tweesteden Ziekenhuis in Tilburg in maart al opviel, besloten ze met Olde Rikkert en collega’s snel voorbeelden te verzamelen. De eerste negentien ouderen die in Tilburg en Nijmegen met Covid-19 waren opgenomen in het ziekenhuis, beschreven ze op 8 april in het Nederlands Tijdschrift voor Geneeskunde (NTVG). Wat bleek? „Van de negentien heel oude patiënten had bijna niemand twee typsiche Covid-19-verschijnselen. Hooguit één. Dus níet de combinatie van symptomen die officieel op Corona wijst: 38 graden koorts, droge hoest, kortademigheid. Nee, zij hadden soms iets compleet anders: ze hadden een delier (acute verwardheid) of waren gevallen.”
Het artikel, een ‘klinische les’, is online het best gelezen stuk over Corona in het NTVG, omdat steeds meer huisartsen zieke oude patiënten zagen van wie ze niet begrepen wat hun mankeerde. En voor een coronatest kwam je bij de GGD’s zonder hoge koorts en hoest, of twee andere ‘typische coronasymptomen’, niet in aanmerking.
Een ander verschil met jongeren is dat bij ouderen het afweersysteem minder goed werkt. Olde Rikkert: „Door een aanval van een griepvirus of een virus als corona raakt het immuunsysteem van de oudere in opperste staat van activiteit maar het strijdt niet gericht. Er ontstaat een soort afweerstorm, een overkill, en díe kunnen het hart, de longen en het brein (delier) niet meer aan.”
In de coronacrisis keken beleidsmakers volgens Olde Rikkert op dezelfde manier naar iedereen. „Je moet écht anders naar ouderen kijken, ze zitten anders in elkaar.”
Doden tellen
Intussen zijn alle verpleeghuizen per noodverordening gesloten sinds 20 maart. Bezoek is niet meer welkom, omdat verpleeghuizen heuse besmettingshaarden bleken. Familie bracht het virus zonder dat te weten naar binnen en weer naar buiten. Ouderen besmetten elkaar onderling, verzorgenden raakten besmet. De sterkste verspreiding gebeurde op afdelingen voor bewoners met dementie. Olde Rikkert: „Als iemand dement is, begrijpt hij isolatiemaatregelen niet. Een hechte leefgroep uit elkaar halen op een psychogeriatrische afdeling is lastig.”
Tegelijk werden de coronadoden in verpleeghuizen niet bijgehouden. Omdat een groot deel van de zieke ouderen niet was getest op het virus telden ze niet mee in de RIVM-statistiek. Ze kwamen niet in aanmerking voor een test. Of er werden twee zieke ouderen getest op een afdeling en van de andere zieken op die afdeling werd aangenomen dat ze ook Covid-19 hadden. Verenso, de vereniging van specialisten ouderengeneeskunde, is dat zelf maar gaan turven vanaf eind maart. „Het is het beste om te testen want dan weet je ook hoe je een patiënt moet behandelen en kun je beschermingsmiddelen inzetten”, vertelt Olde Rikkert.
Achterin de rij
En misschien wel het belangrijkst, zegt Olde Rikkert: de verpleeghuizen stonden in maart en april achterin de rij bij de verdeling van de mondkapjes, schorten en brillen. De bulk ging naar de ziekenhuizen. Er was van alles te weinig. Zo weinig dat de richtlijnen van het RIVM erop waren aangepast: ‘verpleeghuispersoneel gaat alleen beschermd te werk wanneer de cliënt besmet is (of daarvan wordt verdacht).’
Pas op 20 april kreeg verpleeghuispersoneel bij twijfel het recht om meteen op corona te worden getest. Op 23 april werd een specialist ouderengeneeskunde toegevoegd aan de deskundigen van het Outbreak Management Team die de Tweede Kamer informeerden.
Vaccin
En zelfs nu wetenschappers wereldwijd zoeken naar een coronavaccin, wordt het oudere lichaam vergeten, zegt Olde Rikkert. „Alle vaccintests worden gedaan op vijftigers! Dát zijn de mensen die zich melden voor onderzoek. Als je iets langer de tijd neemt en ook test op tachtigers krijg je misschien een vaccin waar ouderen baat bij hebben. Maar het moet snel, snel.”
Het doel moet niet zijn dat kwetsbare ouderen zoveel mogelijk overleven, zegt hij. „De ouderengeneeskunde moet leven toevoegen aan de dagen van mensen op hoge leeftijd en niet dagen aan het leven. Bij COVID-19 moet je dus de veerkrachtige, biologisch jonge ouderen steunen bij overleven en de zwakkere ouderen goed begeleiden. De symptomen verlichten. Als dat laatste lukt kan COVID-19 ook ‘The old man’s friend’ zijn, zoals William Osler 100 jaar geleden de longontsteking noemde.
Op de ‘oversterfte’ van deze maanden door het coronavirus zal ‘ondersterfte’ volgen, verwacht hij. „De mensen die anders het komende jaar zouden zijn overleden, zijn alvast gegaan.” En de ouderen die Covid-19 hebben overleefd, zullen allemaal zijn verzwakt. „Mensen die besmet zijn geweest, houden er schade aan over. Mensen die niet zijn besmet maar sociaal zijn geïsoleerd, leveren ook in. Het is bewezen dat je immuunsysteem daardoor verslechtert.”
En dan heeft hij het nog niet over eenzaamheid in de kostbare tijd die ouderen rest. Door de intelligente lockdown zijn ouderen lange tijd alleen geweest. Dat is een paradox. Olde Rikkert „Want het is tevens de liefde voor opa’s en oma’s, vaders en moeders, die de kurk is waar de bereidheid van jongeren om te doen aan social distancing op drijft.”
Reviving the US CDC (US Centers for Disease Control and Prevention)
Editorial 16 May 2020
The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.
The US Centers for Disease Control and Prevention (CDC), the flagship agency for the nation's public health, has seenits role minimised and become an ineffective and nominal adviser in the response to contain the spread of the virus.
The strained relationship between the CDC and the federal government was further laid bare when, according to The Washington Post, Deborah Birx, the head of the US COVID-19 Task Force and a former director of the CDC's Global HIV/AIDS Division, cast doubt on the CDC's COVID-19 mortality and case data by reportedly saying: “There is nothing from the CDC that I can trust”.
This is an unhelpful statement, but also a shocking indictment of an agency that was once regarded as the gold standard for global disease detection and control. How did an agency that was the first point of contact for many national health authorities facing a public health threat become so ill-prepared to protect the public's health?
In the decades following its founding in 1946, the CDC became a national pillar of public health and globally respected. It trained cadres of applied epidemiologists to be deployed in the USA and abroad. CDC scientists have helped to discover new viruses and develop accurate tests for them. CDC support was instrumental in helping WHO to eradicate smallpox.
However, funding to the CDC for a long time has been subject to conservative politics that have increasingly eroded the agency's ability to mount effective, evidence-based public health responses. In the 1980s, the Reagan administration resisted providing the sufficient budget that the CDC needed to fight the HIV/AIDS crisis. The George W Bush administration put restrictions on global and domestic HIV prevention and reproductive health programming.
The Trump administration further chipped away at the CDC's capacity to combat infectious diseases. CDC staff in China were cut back with the last remaining CDC officer recalled home from the China CDC in July, 2019, leaving an intelligence vacuum when COVID-19 began to emerge. In a press conference on Feb 25, Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, warned US citizens to prepare for major disruptions to movement and everyday life. Messonnier subsequently no longer appeared at White House briefings on COVID-19.
More recently, the Trump administration has questioned guidelines that the CDC has provided. These actions have undermined the CDC's leadership and its work during the COVID-19 pandemic.
There is no doubt that the CDC has made mistakes, especially on testing in the early stages of the pandemic. The agency was so convinced that it had contained the virus that it retained control of all diagnostic testing for severe acute respiratory syndrome coronavirus 2, but this was followed by the admission on Feb 12 that the CDC had developed faulty test kits.
The USA is still nowhere near able to provide the basic surveillance or laboratory testing infrastructure needed to combat the COVID-19 pandemic.
But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets—vaccines, new medicines, or a hope that the virus will simply disappear.
But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today's complicated effort.
The Trump administration's further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic.
Americans must put a president in the White House come January, 2021, who will understand that public health should not be guided by partisan politics.
US could face 'darkest winter in modern history', warns former vaccine official – video highlights
Americans should brace themselves for the risk that they will suffer their “darkest winter in modern history” due to the ongoing federal government failures in addressing the coronavirus pandemic, a recently ousted public health official turned whistleblower warned the US Congress.
Rick Bright, who was removed from his role heading a federal agency in charge of vaccines last month, told a congressional committee on Thursday that as the virus continues to spread in the US the “window is closing to address this pandemic” because the Trump administration still lacks a comprehensive plan to tackle Covid-19.
“Time is running out because the virus is still spreading everywhere, people are getting restless to leave their homes,” Bright told the lawmakers, many wearing masks or bandannas over their faces. In written testimony, he added that without a proper response “I fear the pandemic will get far worse and be prolonged, causing unprecedented illness and fatalities”.
Bright was director of the Biomedical Advanced Research and Development Authority for nearly four years but was shifted from the role in April. In a whistleblower complaint, Bright has claimed he was removed after resisting pressure by the administration to make “potentially harmful drugs widely available”, including chloroquine and hydroxychloroquine.
These two anti-malarial drugs have been repeatedly touted as a treatment for Covid-19 by Donald Trump, despite them not going through clinical trials for this use and mixed results in initial studies on their efficacy.
The US president has also publicly pondered the benefits of injecting disinfectants into patients, a statement widely condemned as dangerous by public health officials and bleach manufacturers.
In his testimony to Congress, Bright wrote that “science, not politics or cronyism, must lead the way to combat this deadly virus”. He added: “Without clear planning and implementation of the steps that I and other experts have outlined, 2020 will be darkest winter in modern history.”
The warning came as Covid-19 deaths continued to mount in the US, with more than 83,000 people perishing from the virus, which has infected more than 1.3 million to make the US the world’s most serious coronavirus hotspot.
Mass joblessness has swept the US as businesses shut down to slow the pandemic, with 36 million people filing for unemployment benefits in the past two months.
This death toll would probably be much lower had the Trump administration acted far more quickly to address the crisis, Bright told the hearing. He said his efforts to obtain early viral samples from China was met with “frustration and dismissal” from leaders in the Department of Health and Human Services (HHS).
Bright claimed he also agitated for a greater stockpile of masks, swabs and other urgently needed medical equipment but was met with “indifference” and was then sidelined. “I was told that my urgings were causing a commotion and I was removed from those meetings,” he said.
Bright said the gravity of the unfolding crisis was made clear to him by an email from the co-owner of Prestige Ameritech, a manufacturer of N95 respiratory masks. “He said: ‘We are in deep shit, the world is, and we need to act,’” Bright told lawmakers.
“I pushed that forward to the highest levels I could at HHS and got no response. From that moment I knew we’d have a crisis with our healthcare workers because we were not taking action. That was our last window of opportunity to turn on that production to save the lives of those healthcare workers and we didn’t act.”
In a statement, HHS said it “strongly disagrees” with the “one-sided arguments and misinformation” contained in Bright’s whistleblower complaint.
Trump used his favoured medium of Twitter on Thursday morning to repeat his claim that he had never heard of the “so-called Whistleblower Rick Bright”. The president then added that “to me he is a disgruntled employee, not liked or respected by people I spoke to and who, with his attitude, should no longer be working for our government!”
The attack was Trump’s second in two days on a senior infectious disease expert. On Wednesday, he criticized Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, for warning against restarting economic activity too quickly.
Fauci testified at a hearing on Tuesday that the coronavirus was still out of control in the US and rushing to reopen before numbers of new cases and deaths were on a steady decline risked “serious consequences”. He remarked the night before that premature reopening risked “needless suffering and death”.
Fauci also stressed to US senators the unknown effects the coronavirus could have on children returning to reopened schools.
“I was surprised by his answer,” Trump told reporters. “To me it’s not an acceptable answer, especially when it comes to schools.”
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Trump says Fauci lockdown easing warning 'surprising' – video
On Thursday, a small but heavily armed group of protesters gathered outside the state capitol building in Lansing, Michigan, demanding the end of stay-at-home orders and calling for the resignation of the governor.
Michigan closed down its capitol and canceled its legislative session rather than face the possibility of the armed militia members disrupting business, amid a flurry of online death threats against the Democratic governor, Gretchen Whitmer.
Such protests broke out in Michigan first and then spread to other states in recent weeks, despite opinion polls showing a majority of Americans do not support widespread reopening for business while the pandemic is still raging. The protests were coordinated and also backed by various rightwing groups.
He Laid the Foundation for Israel's Army. His Story Was Kept Secret – Until His Diary Turned Up
NIR MANNMAY 07, 2020
Miriam Buchval was choked up. She’s 98 years old, and during the coronavirus emergency, finds herself isolated in an assisted-living facility. She probably never expected this moment to come.
“A letter has come from the Haganah,” her niece, Edith Margalit-Hecht, told her, referring to the underground, pre-independence army of Palestine’s Jews. Buchval tried not to listen, bracing herself as if to ward off the letter’s contents. “For 90 years we’ve waited for this letter,” Idit implored her aunt – until finally she agreed to hear her out, still bristling with suspicion.
Idit began to read: “Yosef Hecht, of blessed memory, the first commander of the Haganah organization, passed away half a century ago.”
On the other end of the line, the fraught silence from Buchval, the eldest of Hecht’s four children, was almost palpable, as Idit continued: “On the centennial of the founding of the Haganah, its members and those who follow in their path bow their heads in remembrance of him, and cherish the memory of his security activity in creating the Jewish defense force and of his contribution to the rebirth of the independent State of Israel. With a final salute, Baruch Levy, national chairman, Haganah Membership Organization.”
Next month, the Haganah will mark its centenary, and the last week of April marked the 50th anniversary of the death of the organization’s first commander, Yosef Hecht. Hecht led the Haganah for 10 years, from 1922 to 1931, until he was dismissed in the wake of a bitter clash with David Ben-Gurion and other leaders of the Yishuv, the pre-1948 Jewish community in Palestine.
The confrontation exacted a steep price – not only Hecht’s dismissal but the erasure of his memory from the public record. Indeed, his name is almost completely absent from Israeli historiography and from institutional commemorative projects.
Interviews he gave were rendered classified and made inaccessible to scholars; he is effectively a nonperson as far as the education system is concerned; and not a single street in the country was named for him.
The result is that today hardly anyone knows who the first commander of the Haganah was, even though he laid the foundations for the armed forces of the state-in-the-making.
To his dying day Hecht cloaked himself in silence and never uttered a word about his past. Not even his grandchildren knew of his contribution to the national defense force.
“Grandpa never told us about his activity in the Haganah,” says Margalit-Hecht, who spoke with Haaretz at her home in Rosh Ha’ayin. “We were a very involved family. In my parents’ home, we talked about developments in the country, but never about Grandpa’s part in creating the state. The first time I heard about it was in a talk in the army. He didn’t tell us anything. He was an introverted person who devoted himself to the firing range he built in the sands of Mikhmoret [a seaside village north of Netanya] and to his hobby of fishing in the Alexander River.”
In 2011, in a rare interview, Miriam Buchval said, “You never heard anything from him. People in his milieu also knew that Yosef Hecht doesn’t talk. When he came home in a black car, all the children in the neighborhood went out to see the old Ford. I knew he was an important person, but I didn’t know what his job was. When I was 12-13, I knew that all the Haganah officers in the cities called him ‘Yosef the Great.’”
Like the Bible
It has now become clear, however, that although Hecht held his tongue, he let his innermost thoughts flow freely in a private notebook. In it, he fired slings and arrows every which way. No one knew about it or its contents – until now.
It was Margalit-Hecht who found the notebook, recently, among her grandfather’s belongings. It was written in the early months of 1960, in one great outburst. It has almost no punctuation or diacritics – like the Hebrew Bible. It’s clear to see that he was overwrought. The trigger for the volcanic eruption of writing was the publication of the third volume – the one covering the 1920s – of the “History of the Haganah” (in Hebrew).
“The writing of the history of the Haganah is actually the work of one person,” Hecht wrote, referring to the author, Prof. Yehuda Slutsky, with whom he himself had spoken. “He devoted most of his time to the project, meticulously and consistently, and collected a great deal of material. I know him to be a person of integrity for whom the truth is a beacon – but he is under the influence of his superiors in selecting the material. Under those circumstances, it is no wonder that one feels that someone wanted to diminish the value of the other with fabricated tales.”
What was “the value of the other”? To understand the part Hecht played in the history of Israel’s defense, we must go back to 1920 – before the fall of Tel Hai, the Jewish agricultural settlement in northern Galilee, which was attacked by an Arab militia on March 1, 1920 – when the Yishuv’s leadership was trying in vain to establish an autonomous defense organization.
On the eve of the Jerusalem riots in early April 1920, Revisionist Zionist leader Ze’ev Jabotinsky organized the city’s defenses, and found himself arrested by the British Mandate authorities. After his release a few months later, he set out to establish an open “Jewish Legion,” under the aegis of the Mandatory regime. For their part, however, the British declined to cooperate, even though the Jewish frontier settlements were in immediate need of a force that would protect them.
With the fall of Tel Hai, the path was paved for establishment of the Haganah as a federation of a number of local defense groups, headed by one person: Yosef Hecht.
Hecht was born in 1894 in the town of Bychow, part of the Russian Empire (today Belarus). A pogrom perpetrated by Russian hooligans when he was 9 was engraved on his memory as a formative event. His family subsequently moved to Odessa; at age 19 Hecht immigrated, on his own, to Palestine.
During the World War I years, he worked in almond groves in Kfar Sava and participated in arms-smuggling activities, along with Eliahu Golomb and Dov Hoz, two key figures in the emerging Jewish defense effort.
In 1918, Hecht joined the Jewish Legion – the Jewish volunteers who fought alongside the British against the Ottoman Empire – and when Arab anti-Jewish rioting broke out in 1920, he was put in command of Hulda, a farm near Rehovot.
He subsequently worked at the Mikveh Israel agricultural school, near Tel Aviv. When the facility was attacked during the Jaffa disturbances of May 1921, Hecht stood out as the commander of the local force. But his prowess on the battlefield was even surpassed by his grit as a leader: He refused to obey an order to abandon the site.
“At the end of that month, Eliahu [Golomb] offered me the position of coordinator [of the Haganah],” Hecht recalled, in testimony found in the militia’s archives.
Hecht's notebook.
During his decade commanding the Haganah, Hecht was primarily engaged in raising funds to procure weapons, digging underground arms caches (with his bare hands), organizing officers training courses and managing ties with other top brass throughout the country.
His tough appearance, stocky build and tight-lipped and introverted demeanor created an image of threatening authority, but his subordinates revered him and went along with his suspicious, conspiratorial approach.
“From the earliest days of the Haganah I did not cease to ensure the secrecy of all its operations,” he wrote in his notebook, some four decades after the fact. “We were against holding parties, we banned photographs, and we often destroyed pictures of personnel who were weak enough to be photographed holding a weapon. We were wary of public figures, knowing their pathological pursuit of publicity.”
The budget provided by the Histadrut Federation of Labor for the Haganah at that time was negligible; in practice, the organization’s branches were autonomous entities. In his notebook, Hecht is sharply critical of those, such as the Histadrut officials, who were dismissive of the idea of Jewish self-defense.
“We need to remember,” he wrote, “that the few who worked persistently and unceasingly to create a Jewish force [did so] with extremely meager means in the underground not only vis-à-vis the hostile foreign ruler, but [also] amid the indifference of the closest public – the workers’ functionaries [in the Histadrut] – and the opposition and refusal of the majority of the Yishuv. Even, with all due respect, very important officials – Moshe Smilansky and the residents of the moshavot, the people of Degania and Nahalal – thought the [defense force] was dangerous and unnecessary.
“Rutenberg [Pinhas Rutenberg, founder of the Palestine Electric Corporation] mocked the childish efforts and advised dropping the whole matter. All of these individuals claimed that the [British] government would protect us. There were also those, no few in number, who were bystanders. Quite a few have come to occupy important positions lately, and [now] shamelessly emphasize their devotion in the past to the Haganah. They are the self-serving, and there has never been a shortage of such people.”
Hecht, for one, had no doubts about the necessity of creating a proper defense force.
“We are always persecuted [and] murdered by the majority of ‘civilized’ peoples, or savage and cruel [peoples] like the Arabs,” he wrote. “Their intention toward us is not only to humiliate but also to destroy [us] physically. We must respond in kind [offensively], because philosophy and cleverness have been of no benefit to us for many generations, and that is unlikely to ever change.
“No quotations from Plato and Aristotle, from Buddha or the Prophets will make any impression on them – only the circumstances. And if the circumstances will be in our favor, we will be smart and desirable to everyone, and if the circumstances will not be in our favor, we must be ready for that with all the possible means that will take the enemy by surprise, and not even the ‘Name’ [the Tetragrammaton, or God] will help.”
De Haan, born in The Netherlands, was a jurist, an intellectual and a writer – as well as being a Zionist, before becoming a political spokesman of the anti-Zionist Eda Haredit, an ultra-Orthodox sect in Jerusalem. He made no secret of his homosexuality or his sexual relations with young Arabs, but the rabbis turned a blind eye and accepted him as he was.
Dr. Jacob de Haan.
De Haan was a sensual, brilliant and eccentric person, who left his mark in a variety of areas in which he sought to foment a revolution. (In Amsterdam a street was named for him in 1993 under the pressure of the local LGBT community, while in Jerusalem’s ultra-Orthodox Mea She’arim neighborhood, wall posters memorializing him can still be found.)
Specifically, de Haan gained notoriety by managing the anti-Zionist foreign policy of, and providing legal representation for, the ultra-Orthodox Agudath Israel movement, which advocated peace among all the country’s inhabitants under the Hashemite flag. He opposed the allocation of benefits granted by Mandatory authorities to the Yishuv, attacked Zionism in the European press and met in Amman with Emir (later king) Abdullah and his father, the Sharif of Mecca, rulers of Transjordan.
On the eve of a trip to London to pursue his anti-Zionist activity, de Haan was shot three times on Jaffa Road in downtown Jerusalem, as he emerged from the synagogue at Shaare Zedek Hospital.
The assassination did not generate serious shock waves in the Yishuv: The general public accepted the Zionist leadership’s denial of involvement in the deed, as well as the allegation that the assassination was perpetrated by Arabs.
Over the years, doubts grew over the question of who actually perpetrated the assassination, until, in testimony that Hecht gave to Haganah historian Slutsky in October 1952, he stated explicitly that when he learned that de Haan was about to visit London, he consulted with the Haganah commander in Jerusalem, Zechariah Urieli, and the decision was made to assassinate him. Avraham Tehomi and Avraham Krichevsky, two members of the underground, were assigned to commit the deed.
Only after the assassination did Hecht inform Yitzhak Ben-Zvi, a senior member of the National Council (the Yishuv’s pre-state civilian leadership), and added that “he did not regret it and would do it again.”
In advance of Ben-Zvi’s election as second president of Israel, in 1952, the weekly newsmagazine Haolam Hazeh reported that his wife, Rachel Yana’it Ben-Zvi, had been involved in the de Haan assassination. According to Slutsky’s 1959 “History of the Haganah,” the order was issued by the “Haganah coordinator” – a reference to Yosef Hecht. The author vilified de Haan, describing him as “he of the dangerous pathological background, tainted with homosexuality and with the lust of his perverse acts of love with the Arab shabab [youth].”
The civilian leaders overseeing the Haganah maintained that Hecht had exceeded his authority, but that view was not made known in real time: It became a fierce accusation against him only in the atmosphere of growing resentment among the Yishuv and Histadrut leadership toward Hecht sparked by the 1929 riots in Palestine, in whose wake the Haganah and Hecht had been glorified for saving Jerusalem.
Hecht’s tenure as Haganah commander was also marred by another strange episode: a special court appointed by him condemned a Jew to death by suicide.
The trial was held in 1930 before a panel of three commanders, none of whom had a legal background, and in the absence of the accused himself, a young man from Givatayim, near Tel Aviv. He was charged with providing information about the Haganah to a senior officer in the Mandatory police, Eugene Quigley – and was ordered to kill himself.
Hecht (at center, with pith helmet), with soldiers near the northern border. Reproduction by Moti Milrod
After the trial, two of the judges broke into the condemned man’s home in the middle of the night, bombarded him with accusations, forced him to sign a confession of treason and, on their way out, left him with a loaded pistol with which he carried out the sentence.
Mistaken identity
What was Hecht’s policy regarding the Arab community? According to his declared approach, as revealed in his notebook, there must be a “correct and useful response” to every Arab attack. However, he was not adamant about this subject: During the 1929 disturbances in Jerusalem he refused to authorize the killing of the grand mufti, Hajj Amin al-Husseini, and prohibited retaliatory attacks on British soldiers that arrested Jews who had behaved provocatively (“One enemy is enough for us – the Arabs”).
Still, in 1923, he gave his approval to a liquidation operation initiated by Hashomer (The Watchman, an early Jewish defense organization in Palestine). The target was Tawfiq Bey al-Ghussein, patron of an Arab militia from Wadi Chanin (Nes Tziona). However, the assassins mistakenly shot and killed an Arab in the Mandatory police force with a similar name. When the error was discovered, the victim himself was falsely accused of having been responsible for the massacre of Jewish immigrants during the Jaffa disturbances of 1921, in order to justify the murder retroactively.
For his part, Hecht told Slutsky, the historian, that the assassins had informed him about their mission and he “did not interrogate them at length.”
In the summer of 1927, another event occurred that did prompt a sharp response from Hecht. At the time, residents of the Mughrabi (Moroccan) Quarter, adjacent to the Western Wall of Jerusalem’s Old City, were harassing worshippers at the holy site. Hecht assembled a primitive bomb, which at his order was planted in the home of the local sheikh. The dwelling collapsed under the force of the blast, and the quarter’s inhabitants fled in panic. The Arab press accused the Jews of being behind the explosion, but the Yishuv’s leadership dissociated itself from the event – and Hecht stayed mum.
A traumatized B-G
Hecht’s decade at the helm of the Haganah ended with a tremendous explosion. How should it be interpreted? Its origins lie in the trauma that accompanied the exposure of a group within a group, an underground within the underground, during the 1920s. This trauma scarred Ben-Gurion and planted the seeds of his decisive policies regarding the Saison (the “hunting season,” when the Haganah suppressed activities by the Irgun and Lehi breakaway underground organizations); the Altalena incident (the decision to fire at an arms ship that was brought to the Tel Aviv coast by the Irgun); and the dismantlement of the national headquarters of the Palmach, the Haganah’s strike force.
The episode of the secret underground generated a huge tumult in the Histadrut in the mid-1920s, and became a perfect storm toward the end of the decade. The saga began when members of Hashomer actually joined the Haganah, but, unbeknownst to it, together with members of the Labor Battalion (a collective of Jewish workers), set up a closed group called the “Secret Kibbutz.” The existence of this private army was known to the Histadrut leadership, but Ben-Gurion was unaware of its existence until the autumn of 1925. He viewed the organizing activity as a gross breach of Histadrut authority. The Secret Kibbutz was disbanded in January 1927, but the group’s weapons depots were not turned over to the Haganah.
In a compromise with Hashomer personnel, only Hecht was allowed into a bunker owned by the secret group in Kibbutz Kfar Giladi, in the Upper Galilee, to see the contents for himself. This led Ben-Gurion to suspect him of being close to the subversive isolationism of Hashomer.
Hecht wrote in his notebook that weapons from another cache, at Kibbutz Tel Yosef, also in the north, were confiscated when rumors arose that there was an intention to sell them to Arabs in order to finance the return to the Soviet Union of a group of Jewish immigrants.
Hecht (in foreground, left) at a soldier’s funeral. Reproduction by Moti Milrod
“They [the Secret Kibbutz members at Tel Yosef] ridiculed our demand to hand over the weapons and were certain that we would not get to the depot, which could be accessed through an opening under the floor of a cabin,” Hecht wrote, going on to document the operation he undertook with Ben-Zvi, the future president, to put an end to the affair:
“[Zalman] Zeiger, a local person, showed me a secret entry from the outside through a long tunnel. I got hold of ropes and a flashlight and we started to crawl through a narrow tunnel covered with tins. In the middle of the tunnel the tins were rusty and disintegrated at touch, and the soil spilled out. Ben-Zvi crawled back and I went on crawling forward with great difficulty, because the passage was very narrow.
“Finally I reached a large, deep pit, which I could enter head-first. The floor of the pit was about one meter lower than the entrance. We took out the weapons with the help of a rope.”
The results of this episode resonated three years later: On the eve of the 1929 riots, the Haganah in Jerusalem consisted of only about a hundred people and few weapons. The local commander and his deputy were injured in a traffic accident before the flare-up, and Hecht assumed command of the city when the violence erupted. A week earlier, he had ordered the former Hashomer members in Kfar Giladi to send their weapons to Jerusalem, but they believed the real intention was to get control of their arms. When it seemed to them that the tension had abated, they decided not to send any of their weapons, which outnumbered those stockpiled in Haifa and Jerusalem combined. Only after the massacre of the Jewish community in Hebron did the Hashomer group agree to send arms to help save those two cities.
The advance deployment of the Haganah in Jerusalem spared the Jews in the Old City and in the new neighborhoods the fate that awaited their countrymen in other locales during the tumult. Rachel Yana’it, a leader of the Haganah in Jerusalem, wrote that “there was no one like the brave Hecht, with his organizational ability, who felt in every fiber of his being the danger lurking for the Yishuv, and in Jerusalem especially.”
In Slutsky’s account, “During the fraught hours, Hecht displayed sangfroid, self-control, personal bravery and great skill at improvising, the only qualities with which it was possible to take action in the situation that had developed in the city.” At a rally in Paris, in September 1929, Jabotinsky declared, “We have to bow down to the heroes of our defense [the meaning of the word haganah], because it is the Haganah that saved the Yishuv.”
But no one in the Yishuv political leadership bowed down before Hecht, and he, for his part, fatally misread the new map. When the fighting ended, in August 1929, the Yishuv’s leadership recognized its own failure in having left security matters in the hands of the Haganah alone, and they prepared for a sweeping reform. The substantive lesson it learned was that it was untenable that those needs should be left in the exclusive control of people who were obsessed only with such matters; in fact, defense was a mission for the whole Yishuv and it required investment of additional personnel and materiel.
Hecht, who was embittered and frustrated from promises made by functionaries of the Jewish community, suspected that the promises of money and assistance were little more than lip service and would evaporate as quickly as they had been uttered. Backed by the loyal, hard core of the Haganah officers under his command, Hecht decided to turn down the requests from Ben-Gurion and Haganah founder Eliyahu Golomb to take part in the structural changes. For two years, in fact, he refused to share his power or help with the reorganization effort. He stepped back from the political brouhaha and paid the price.
At this time the Histadrut was caught up in a whirlpool of its own suspicions, accusations and investigations regarding the Haganah. The right-wing circles in Tel Aviv tried to tempt Hecht, offering him significant financial resources in order to split the militia’s leadership and head an autonomous force in the city, as had occurred in Jerusalem during the process that led to the establishment of the Irgun.
In May 1931, a Histadrut panel headed by Levi Eshkol, the future prime minister, decided to dismiss Hecht from the Haganah – “for one year.” Eventually, Hecht had come to regret his dispute with Golomb, whom he esteemed, and accepted the proposition that control of the Haganah must not be centralized in the hands of one person. But his removal was to be permanent.
“In the early 1930s I endured a period of great suffering, torment and loneliness,” Hecht wrote, decades later. “The cruel incitement that began in a narrow circle spread apace, and people whom I had never seen before, as well as people I loved and for whom I wanted to work, were incited, so that everywhere I turned – hostility. A psychosis of hatred and suspicions that have no basis engulfed me like a swarm of hornets, each of them trying to sting you and inject you with its poison.”
Hecht's niece, Edith Margalit-Hecht.
But Hecht was not one to polemicize to show he was in the right, as he continued: “I fought hard with myself so as not to react the way people do in such cases. I could have joined a [political] party and fought those who hated me and perhaps also overcome them. But I restrained myself, because I knew how much destruction is involved in battles like that, and we – then as now – are surrounded by people who hate us and are waiting for every failure on our part.”
Even though the price he eventually paid was the near-total erasure of his memory from the public record, he did not regret choosing the path of silence after 1931. “I am not sorry that I did not get swept up into the maelstrom of slanders and lies that surrounded me on every side [and] which I am still not free of. I was dealing with people for whom everything is legitimate when it comes to their victory and their rule, and for whom all the organizational structures within which they operate are a cover for their personal desires.”
As for Ben-Gurion, Hecht’s anger toward him did not prevent him from taking the side of the leader who ousted him in the 1954 “Lavon Affair” – the failed covert Israeli operation in Egypt named after the then-defense minister.
“I admire Ben-Gurion for his ability to stand up even to his own party in a case where it is liable to be harmful to the state’s security, and stubbornly refuses to yield, and only those who know nothing or who are ill-intentioned will accuse him,” Hecht wrote in 1960.
“It is easy to dispense with Lavon, but Ben-Gurion must not act according to the atmosphere that has now been created. Certainly I don’t think that it is impossible to get along without him – the people will not disappoint. There will be no lack of Jews who will be ready to replace him, and it’s possible that we will be more successful during their rule.”
For his part, Ben-Gurion, too, wrote about his clashes with Hecht in his diary, in September 1929: “Yosef came to see me this evening. I said to him: Until two weeks ago I had complete faith in you, and even now I believe in your devotion to your work, but I have no faith in your loyalty to the Histadrut. We knew that you are working in the name of the Histadrut, but you are now apparently relying on other forces [i.e., Hashomer and the right-wing groups]. We do not wish to remove you from the job, but an affiliation between that job [command of the Haganah] and the Histadrut is a necessary condition for its organization and its success. And if we will not be sure of your affiliation, we will organize the job without you.”
‘Not an iota of skill’
After being forced out of the Haganah, Hecht returned to his farm in Givatayim and shunned public activity. In 1954, he moved to Moshav Mikhmoret, where other members of his family lived. He died 50 years ago, on April 25, 1970, maintaining his silence to the last.
“I will say without any pretense that I did not feel that I had an iota of military skill,” he wrote in his notebook. “However, from the experience of 10 years of responsibility and running an illegal military organization, I do not admit the existence of military ‘geniuses’ but of good organization! Every fighting force, the largest and smallest, depends on a surprise [factor], and an underground organization requires this more than all the others.
“The person best suited to head an organization like this is [someone] who knows how to do things with the participation of a minimum of indispensable people and no more, in every operation. It is clear that ultimately this will boomerang on the responsible person, because his behavior will stir many against him out of anger and rage, or out of misunderstanding. To defend my people, I was ready to seize on any means.”
Hecht possessed the qualities of a natural commander. He never participated in an officers course and had no connection to the political arena. In his decade commanding the Haganah he was a loyal Histadrut member, but one who also fought vigorously to preserve his organization’s national (as opposed to partisan) orientation. “I was against giving the Haganah a party or class character; I saw it as the future Jewish army, and that is what I fought for,” Hecht said.
Though he was a man of few words, he maintained an ongoing conversation with the leaders of the Yishuv, who sought him out. He hosted prominent Zionist leader Chaim Weizmann, as well as Jabotinsky, at Haganah training exercises, much to Ben-Gurion’s chagrin – they were political rivals of his – and when the war reached Jerusalem, he determinedly opened the organization’s ranks both to Haredim from Mea She’arim and to communists, despite the grumbling this aroused.
“Every person has victories and failures,” he wrote in the notebook. “It is impossible to ask of someone that he publicize his failures to strangers who will not understand him; his conscience will be quiet only if he does not boast of his victories. I knew my weaknesses better than others did. I never pretended to be a paragon of perfection. However, there is one thing I know and about which I have a clear conscience: I always saw the good of the nation before me, and wars of factionalism, parties and classes were alien to me and are alien now, too.”
