CRITICAL NUMBERS AT A GLANCE
MANILA, Philippines – As the Philippines battles the COVID-19 pandemic, Metro Manila’s private hospitals are starting to close their doors to new patients suspected of being infected, saying they’ve reached their maximum capacity.
From Monday to Wednesday, March 23 to 25, at least 6 private hospitals announced that they can no longer guarantee room admission.
In their announcements, the hospitals spoke about the number of patients under investigation and COVID-19 positive cases that are currently admitted in their intensive care units (ICUs), healthcare workers under quarantine, ventilators in use, and supply of protective equipment.
The reason for hospitals reaching their maximum capacity, said former health secretary Manuel Dayrit, is that many hospitals are already busy even without the COVID-19 pandemic, working at around 70% to 80% of their capacity. “So COVID[-19] now fills up whatever capacity [is] still not engaged and then it overflows. So now they no longer have capacity to accept COVID[-19] patients. And the nature of COVID[-19] being so contagious, it also jeopardizes their ability to accept non-COVID[-19] patients.”
One way around this, he said, is to designate specific hospitals for COVID-19 patients so that others can still operate for patients suffering from other ailments or have other emergencies like heart attacks and strokes.
So far, the government has designated certain public hospitals to handle the surge. There are 12 DOH hospitals mandated to handle COVID-19 patients and 3 COVID-19 referral hospitals, where mild PUIs who are at high risk of deterioration, and moderate to critical PUIs are sent. These 3 are:
Still, the numbers continue to climb – as of Friday, March 27, there are 803 confirmed cases of COVID-19 in the Philippines, according to the DOH – and numbers are expected to reach 75,000 by June if the virus isn’t contained.
Are our hospitals, both private and public, ready for this pandemic? Below, we look at our healthcare system’s physical and human resources based on what they need to care for COVID-19 patients.
According to Dayrit, Level 2 and 3 hospitals, which have ICUs, can care for COVID-19 patients.
Level 2 hospitals have all the basic requirements for minor care, plus additional facilities like an ICU and specialty doctors for gynecology and pediatric services.
Level 3 hospitals, on the other hand, can cater to patients who are in need of high-level specialty interventions like physical rehabilitation or dialysis treatment. (READ: Know your hospital: A guide to getting the best care)
According to the 2018 Philippines Health System Review, we have 318 Level 2 and 122 Level 3 hospitals – a total of 440 out of 1,233 hospitals have ICUs as of 2016.
One measure of a hospital’s capacity is the number of beds they have.
Around 68% or 69,544 of the Philippines’ hospital beds are in Level 2 and 3 hospitals: there are a total of 30,781 beds in Level 2 and 38,763 beds in Level 3. The 2018 report, however, does not specify how many beds there are per ICU.
However, some hospitals, like the Lung Center of the Philippines, have begun to allocate certain areas of their hospitals and repurpose their non-ICU beds to care for COVID-19 patients.
Doctor Norberto Francisco, chief of clinical trials and research at the Lung Center, said more than 60 beds are now dedicated to COVID-19 patients, though their isolated ICU originally had only 8 beds. Roughly 3 out of the Lung Center’s 8 wings are being used for patients they can’t turn away, like those battling cancer, tuberculosis, or pneumonia.
Ventilators, other equipment
Dayrit and Francisco agreed that COVID-19 patients need ventilators because of the nature of the disease. Ventilators are crucial to supporting COVID-19 patients who are in critical condition because these help them breathe when their lungs fail.
The main organ involved in COVID-19 is the lungs, said Francisco, because most of the receptors of the novel coronavirus are in the respiratory system.
Only ICUs have ventilators, according to Francisco, and typically one ICU bed would have one ventilator.
Dayrit estimated that a Level 3 hospital would have a maximum of 30 ICU beds, while a Level 2 would have a maximum of 5 ICU beds.
Since there are 122 Level 3 and 318 Level 2 hospitals in the country, a high estimate for the number of ventilators we have is 5,250.
As of 2016, Level 2 hospitals have an average of 96.8 beds each, while Level 3 hospitals each have an average of 317.7 beds, according to the same 2018 report.
Aside from ventilators, however, a lot of other equipment are needed for patients in critical care.
“If they have come to a point that they will need ventilators, they might also need a lot of IV fluids, a lot of support medicines to keep their blood pressures within normal range. They might also need oxygen supply, because their oxygen might also go down. Some will even have to be dialyzed,” said Francisco.
He added: “These are all life-supporting measures, which keep the patients alive while waiting for their own immune system and their own bodies to recover.”
Personal protective equipment, other needs
Supplies and equipment could also mean personal protective equipment (PPE) and COVID-19 test kits.
Francisco said that the Lung Center has a steady supply of PPEs, thanks to donors, but they need to keep coming. “To give you an idea how many PPEs we use each day can be anywhere from 200 to 500. Ang dami. So halimbawa, bigyan kami ng 5,000, ilang araw lang ‘yon,” he said. (To give you an idea how many PPEs we use each day can be anywhere from 200 to 500. We use so many. So for example, if we’re given 5,000, that will only last a few days.)
The Lung Center is also one of the 5 World Health Organization (WHO)-accredited laboratories in the Philippines that can test novel coronavirus samples. For them, testing one person for the novel coronavirus would require 3 sets of PPEs – one each for a doctor, a nurse, and a laboratory technician.
The WHO says that healthcare workers involved in the direct care of COVID-19 patients should use the following PPEs:
Those involved in aerosol-generating procedures performed on COVID-19 patients need the following PPEs:
People who are assigned to clean a patient’s room need these PPEs:
Doctors, nurses, technical staff
Each patient also needs a doctor, a nurse, and a medical technologist or specialist who knows how to use the equipment needed to help them.
If there are ventilators, said Dayrit, you would need someone who can intubate the patient. "So we should have staff that can do intubation. These are usually anesthesiologists who do that or maybe even the pulmonologists who are skilled to do that," he said in a mix of English and Filipino.
As of 2017, the Philippines has a total of 40,775 doctors, 90,308 nurses, and 13,413 medical technologists, according to the Philippines Health System Review 2018.
Most of these doctors, nurses, and medical technologists are based in the National Capital Region (NCR), where most of the reported positive cases are located.
The 2018 report also says that as of 2017, there are 3.9 doctors, 8.6 nurses, and 1.3 medical technologists for every 10,000 of the population.
The number of medical personnel assigned to a COVID-19 patient will depend on the severity of the infection. Mild cases may not need a lot, while a patient in the ICU would need two to three personnel to care for them.
The table below shows the number of doctors, nurses, and medical technologists per region as of 2017. Scroll left and right to view the whole table.