Philippines’ healthcare overwhelmed if COVID-19 cases not controlled, UP experts say

22-Apr-2020 Intellasia | GMAnetwork | 2:06 PM Print This Post

The country’s healthcare system would be overwhelmed if the transmission of the cases of coronavirus disease 2019 (COVID-19) cases is not “significantly reduced,” said experts from the University of the Philippines (UP).

The experts also said that with the Enhanced Community Quarantine in place, the country may well be on its way in the objective to “flatten the curve” or curb the spread of the disease.

However, they also expect a surge in cases once the quarantine is lifted so preparations should be in place.

The UP COVID-19 Pandemic Response Team said in the study, “Estimating Local Healthcare Capacity to Deal with COVID-19 Case Surge: Analysis and Recommendations,” that was released on Monday.

The COVID-19 cases continue to increase daily has posed a serious concern because “there are limits to hospital care capacity for patients with serious symptoms (e.g. difficulty in breathing).”

In the latest model run by the experts is based on the estimate number of confirmed COVID-19 cases to reach 9,000 to 44,000 by the end of April 2020.

A majority or around 81 percent of Filipinos who contract COVID-19 will exhibit uncomplicated or mild illness, who do no require hospitalisation but isolation to avoid transmission, while 14 percent will develop severe illness requiring oxygen therapy, while the remaining 5 percent will require intensive care unit (ICU) treatment.

Bed capacity

In a scenario that one patient can infect two people, 51,933 would have to be hospitalised and 13,194 of them will have to be admitted to the ICU.

There are 456 hospitals in the country classified either as Level 2 or 3 with a total bed capacity of 67,119. Approximately 41 percent of these beds are in government-owned hospitals while the remaining 59 percent are in private hospitals.

The bulk of severe and critical patients outside Metro Manila are expected to come from Central Luzon, CALABARZON, Western Visayas, and Central Visayas.

The team points out in the study that there is a lack of available critical care beds because across the country as there are only a little over 2,000 ICU beds to cater to the projected 8,800 to 19,800 critical COVID-19 cases.

Bulacan, Cavite, and Risal are also at risk of a “serious shortage” of hospital beds for severe and critical cases, since COVID-19 patients alone could fill up the total bed capacity of these provinces.

The study also noted that Malabon and Navotas do not have Level 2 or 3 hospitals within their boundaries, “thus, it is imperative to capacitate Level 1 hospitals in these areas to address the situation.”

“If we are not able to “flatten the curve” or significantly reduce the transmission of the COVID-19 virus in the Philippines through the enhanced community quarantine ECQ, the healthcare system will be overwhelmed way beyond their capacity as clearly seen in the relatively low number of hospital and ICU beds,” the experts pointed out.

As of Tuesday, the DOH reported that there are 6,599 COVID-19 cases with 654 recoveries and 437 deaths.

Medical frontliners

Health human resource is another key determinant to the capacity of the healthcare system to absorb the surge of patients, the experts said.

“To handle critical patients, there should ideally be one attending physician for every two patients, and one-on-one nursing. Additionally, there should be one intensivist, one pulmonologist, and one infectious disease specialist for every five patients.”

In the scenario described earlier in which one COVID-19-positive patient can infect two other people, this means that around 14,500 doctors and 13,200 nurses would be needed.

“Peak-time critical COVID-19 cases alone would require the attention of approximately 21 percent of our healthcare workers,” the study said. “Note that this is over and above the already heavy regular workload of our health human resource.”

The UP Team also found that there are – on the average – 3.7 doctors per 10,000 population in the Philippines.

The ratio is below the World Health Organization-prescribed ratio of 10 doctors for every 10,000 people.

“The estimates provided in this document can be used as a guide for planning. These include: the number of hospital beds, ICU beds, and human resource availability. The number of medical equipment and supply of PPEs will also need real-time monitoring to guide administrators, decision-makers, and donors on the allocation of resources and triaging services.”

The DOH on Monday announced that doubling of confirmed COVID-19 cases in the Philippines was cut down by half by the enhanced community quarantine.

Infectious disease expert Dr Edsel Salvana from the University of the Philippines National Institutes of Health earlier noted that the three-day doubling time from March 28 to 31 has slowed to 14 days from April 4 to 18.

“At a little over 200 cases a day holding steady for the last few days, there is little doubt the ECQ has succeeded in slowing down the spread of COVID-19,” he said in a Facebook post.

The statement reflects the UP experts’ observation of a “downward trend” and attributes this to the ECQ.

However, the same experts project an increase in COVID-19 cases after the quarantine is lifted.

“Should the ECQ be lifted on 30 April 2020, we expect the number of Covid19-related cases and the value of R to again rise. We should prepare early for this expected surge of Covid19 patients once the quarantine is lifted,” they said.

Hospitals at capacity

Meanwhile, with less than ten days before the official end of the Luzon-wide quarantine and with no announcement of an extension, the operations of several hospitals across Metro Manila have reached their capacity with the continued increase of COVID-19 cases in the country.

The Philippine general Hospital, one of the first healthcare facilities to become a designated coronavirus referral centre, has already exceeded its capacity for COVID-19 patients.

In March, The Medical City and Makati Medical centre both announced that they had reached full capacity for COVID-19 cases.

The country’s national reference laboratory – the Research Institute for Tropical Medicine (RITM), meanwhile, had to scale down its operations after some 40 staff tested positive for COVID-19.


Category: Philippines

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