Who will live or die depends on availability of ventilators
GOTCHA - Jarius Bondoc (The Philippine Star) - April 1, 2020 - 12:00am

The dilemma of life and death in Italy and Spain shocked people in other pandemic-torn lands. The two countries’ healthcare systems, once billed among Europe’s best, had surpassed normal capacities. As dozens of severe COVID-19 infectees filed into hospitals each hour, critical care provisions soon ran out. Doctors and nurses with no more spare ventilators began to pull out breathing tubes from elderly patients to use on young ones. Not a few took to the Net to video their anguish. The shortage was forcing them to choose who would live or die. Grandpas and grandmas gasping on beds were being rolled out to the yard, their hands held tight by sobbing health workers till they breathed their last. Next of kin, locked down in homes, would only be told later about the mandatory immediate cremation.

That can happen in the Philippines. The infection rate continues to multiply by the day. Personal hygiene, social distancing, and community quarantines notwithstanding, health resources can also hit the limit. By outbreak containment the Dept. of Health hopes to avert the forecast 75,000 number of infectees. But it is low on supply of test kits and other medical supplies due to ill preparedness. No one knows if the curve of new COVID-19 cases and deaths is beginning to flatten.

Based on the experience of China where the new coronavirus originated, up to a fifth of infections can be acute. Mostly elderly or ailing, a third of those would need intensive care, the World Health Organization says. In the Philippines as of Monday, Mar. 30, there were 1,546 infectees. By protocol, only the moderate to severe are hospitalized. Mild and asymptomatic cases are sent to home-quarantine.

Vital is an inventory of critical care facilities and personnel. If the DOH already has the latest figures, it is not disclosing any. In separate press interviews, officials only claim to have the reports but can’t recall the contents.

Four hundred-forty of the country’s 1,233 hospitals have intensive care units (ICUs) as of 2016 records. Being Level 2 and 3 in capability, those hospitals can handle COVID-19 patients, former health secretary Manuel Dayrit told Rappler. Numbering 318, Level 2 hospitals have up to five ICU beds; the 122 Level 3 hospitals, up to 30. So at best there are 5,250 ICU beds in all. But it can be far less, only 4,300-plus. That’s from a national survey cited by Jose Xavier Gonzales, chairman of The Medical City, the country’s largest hospital and clinic network.

Ideally each ICU bed must have a ventilator. Reality is worrisome. There are only 1,572 ventilators, Gonzales culled from the Philippine College of Physicians, among other sources. “We need at least 600 more mechanical ventilators to cover half the national ICU beds,” he wrote in BusinessWorld. “That would cost around P1 billion – less if we can manufacture these locally.” Quezon City alone needs ten units immediately for its three hospitals, says Mayor Joy Belmonte of the country’s “hospital capital”.

Italy has around 8,750 such breathing machines and Spain 6,000. When the number of severe cases hit the threshold, their critical care systems collapsed. Painful life-and-death selecting set it. The Philippines needs to avert a rerun.

The SARS-CoV-2 attacks the lungs. From difficulty in breathing, severe patients deteriorate into inability to take in oxygen and expel carbon dioxide on their own. Ventilators work in tandem with oxygen tanks. Meds need to be adept in intubating and extubating the windpipe. Since patients cannot eat, they must be fed by nasogastric tube (nose to stomach) and intravenously. Doctors oversee the process. At least two nurses must take turns checking on the patient round the clock.

The government needs to acquire life-saving ventilators, accessories, and parts as it stockpiles on test kits, medicines, and personal protective equipment.

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The DOH has apologized for its website offer of a measly P500 a day and sign-a-waiver condition on volunteer “Healthcare Warriors” against COVID-19. The posting had sparked outrage among health workers and the general public. A new post states:

“We acknowledge the anger and hurt that our call for HealthCare Warriors has caused. As fellow health workers, we would like to offer our sincerest apologies.

“We assure everyone that at this point, the proposed HealthCare Warriors benefit package is a provisional one. It was based on our previous volunteer program for the outbreak response that was implemented last year...

“We would like to thank the hundreds of volunteers who signed up since the call was posted yesterday. As of 12 noon today, we have 690 who have signified interest. No amount would ever be equal to the service you have committed to render our countrymen as you prepare to support other healthcare workers already at the frontlines.

“Muli, humihingi po ng paumanhin at pag-unawa ang inyong Kagawaran. Mabuhay ang health workers ng sambayanang Pilipino. Sa inyo ang aming taos-pusong pasasalamat.”

That humble correction should be enough. Sen. Christopher “Bong” Go, meeting with Health Sec. Francisco Duque and Budget Sec. Wendel Avisado, said doctors, nurses, and orderlies can receive as much as P1,500, plus P500 hazard pay and P500 risk pay, per day. Higher-than-usual pay is allowed under the emergency funds act and declaration of health calamity, as pointed out in this space last Monday.

We do not need health officials making any more excuses, like, “It’s not true that we offered only P500” or “Hindi totoo na nagpapirma kami ng waiver.” The paltry offer and the waiver signing clearly had been stated in DOH’s website. Dutifully relying on the official post instead of just any other source, people screen-shot and circulated it with or without comment. Now that the post was taken down, officials should not make liars out of them. Hand washing of the figurative sense has become a favorite propaganda style of certain officials before and during COVID-19. Stop it. Propaganda is fake news. 

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Catch Sapol radio show, temporarily moved to Fridays, 10 a.m.-12 nn, DWIZ (882-AM).

Gotcha archives: www.philstar.com/columns/134276/gotcha

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