As President Rodrigo Duterte decided to once again loosen quarantine restrictions in Metro Manila and 4 adjoining provinces, hundreds of patients continue to suffer while waiting for admission in hospitals overwhelmed by the surge in coronavirus cases.
Data obtained by Rappler from the Philippine College of Emergency Medicine (PCEM) showed that, as of Monday, April 12, at least 310 COVID-19 patients needing hospital care were still waiting for beds across all 14 of its training institutions in Metro Manila – the center of the pandemic in the country – and Cavite.
The 14 hospitals, though just a fraction of the 159 health facilities in the region and a neighboring province highlights the strain under which public and private hospitals operate as infections have yet to significantly decline.
PCEM’s data showing the number of confirmed or suspected COVID-19 patients waiting in emergency departments for admission includes those in the following facilities:
The Department of Health currently does not disclose in its COVID-19 tracker how many patients were queued across emergency departments in the region.
So far, only anecdotes of patients hopping from one hospital to another have reflected the challenge patients and their families go through to seek care as the drastic spike in COVID-19 cases battered hospitals.
When the government’s coronavirus task force decides on the level of quarantine restrictions to implement, one of the major considerations is the "health care utilization rate" or the capacity of the hospitals and other health centers to cater to COVID-19 patients.
But after weeks of hospitals reporting full beds and patients facing difficulty finding facilities that would take them in, many have pointed out the discrepancy between official statistics that indicated available space in facilities and the situation on the ground.
Latest figures from the DOH as of April 10 showed the health care utilization rate in Metro Manila was at 65.4% or a “moderate classification,” with 6,397 out of 9,780 beds occupied. The numbers, however, only count ward beds, isolation beds, and intensive care unit (ICU) beds dedicated to COVID-19 patients.
Screenshot from DOH COVID-19 tracker
“The ED (emergency department) numbers are not included in any census reports currently,” PCEM president Dr Pauline Convocar told Rappler in an interview.
“That’s why when they say the system is overwhelmed, the numbers do not show yet in the dashboards at 80-100% health care utilization rate, when the EDs are already operating at 110-150% occupancy rate with boarding of days to weeks,” she added.
Emergency department operations at 110-150% capacity in these hospitals have been the case, even after adding additional facilities to meet surge capacity, Convocar said.
By the DOH’s standards, facilities operating at 85% of its capacity are already considered to be under its “critical” level classification.
Convocar said health experts and emergency medicine specialists were pushing for such figures to be included in the DOH’s public tracker as it was part of indicators that reflected the current capacity of hospitals to cater to COVID-19 patients.
Emergency department numbers, she added, could also help to reflect 3 things in the state of the health system: demand of patients seeking care, supply or space in other parts of hospital where patients need to be admitted, and efficiency of referral systems among hospitals.
“Queuing or overstaying and boarding in the ED are functions of an overwhelmed system. For supply, it indicates no vacancy. For the ICU, it indicates demand [for space]. It reflects increasing COVID cases or an inefficient system – [whether in a] referral network or delays in processes [of admitting patients],” she said.
Though capturing just a glimpse of how overwhelmed hospitals were during the surge, figures showing over 300 patients waiting for admission in just 14 hospitals is already a “significant number,” Convocar said.
“This (figures) does not include your non-PCEM emergency departments [that have] emergency medicine specialists as well as your private and LGU (local government unit) hospitals. Such a small sample but already significant numbers [of patients are] queuing,” she said.
Convocar, who herself treated COVID-19 cases, said that, in the past few days alone, the longest a patient had stayed in an emergency room while waiting for proper admission into a ward was one week.
On Monday, Health Undersecretary Maria Rosario Vergiere said the government had been able to improve the health system's capacity to treat more COVID-19 patients. This was after some 2,200 ward beds, 700 isolation beds, and about 164 ICU beds were added to several hospitals.
Health experts, however, have long pointed out that the number of beds alone doesn't make up for the health system’s response to the pandemic. Especially for severe or critical cases, more health workers are needed to attend to patients.
Health workers are likewise part of a workforce already in shortage in the Philippines.
In the meantime, the DOH said 136 doctors and nurses from other regions were expected to be redeployed to provide additional support to 7 DOH hospitals, 2 specialty hospitals, and 1 regional hospital in Metro Manila.
Data reflecting how several emergency departments of major hospitals in Metro Manila were coping comes as the Duterte government decided to shift the region and 4 nearby provinces to a modified enhanced community quarantine.
The Healthcare Professionals Alliance Against COVID-19 (HPAAC) earlier warned the loosening of quarantine restrictions was being done while case numbers remained “perilously high” and no necessary changes that would impact the surge were being implemented.
“The government still has no clear plans and efforts to fix the root causes, and the nation continues to suffer because of this,” the group said.
World Health Organization Western Pacific Regional Director Takeshi Kasai had also earlier warned the Philippines was nearing a "red line," where the number of cases exceeded healthcare capacity. – Rappler.com