The nightmare

SKETCHES - Ana Marie Pamintuan (The Philippine Star) - April 7, 2021 - 12:00am

A guy feels a cold and cough coming on, with the accompanying itchy throat and slight fever. He’s been around long enough to recognize the symptoms, and he knows exactly what his problem is… under normal circumstances.

But these are abnormal times, and there’s another possibility: they could be symptoms of COVID.

He pushes this thought to the back of his mind, believing it to be an impossible scenario because he has strictly adhered to all the COVID health protocols. For the next few days, as he begins sneezing and coughing, he zaps the pathogens with his usual medications as he goes about his livelihood. And they work: the cold and cough and slight fever disappear.

But then he begins feeling flu-like enervation, and rashes appear. Suddenly he’s worried. Was it COVID all along? What if he had already infected members of the household and his fellow workers?

He books an RT-PCR swab test online, but will need to wait two days for his turn because there are so many people wanting to be tested even if it costs P5,000. What will he do with his life in the meantime? Should he begin isolating?

By the time he gets the positive swab test result – a wait of about two days – he would have spread the COVID virus to countless others.

*      *      *

Despite all the horror stories about COVID, there are also many stories especially of key government officials being mild or asymptomatic and isolating but working from home through their illness.

Obviously this setup is only for people with en suite accommodations at home for isolation, and with access to telemedicine doctors.

Millions of people lack such dwellings, and have no choice but to find isolation facilities away from home so they don’t infect the rest of the household – if the coronavirus hasn’t been transmitted already.

Others, especially those with comorbidities, prefer to have doctors on standby in case their mild or asymptomatic affliction takes a turn for the worse – a possibility even before the arrival of the more infectious variants, although about 81 percent of COVID cases are said to be mild or asymptomatic.

Hospitals in the National Capital Region and the provinces of Bulacan, Cavite, Laguna and Rizal – NCR Plus – began filling up with all sorts of COVID patients weeks ago – mild, asymptomatic, moderate and of course severe.

At this point, nearly all of those patients are still there, mostly recovering, but unwilling to leave the safety of their hospital beds. Doctors themselves are reluctant to let go of even patients whose conditions have become much improved, unless tests show that they are completely out of the woods.

And so we now have a hospital “nightmare” in our hands – as described by Dr. Jaime Almora, president of the Philippine Hospital Association. Last week Almora also said that we have already “lost the battle” against COVID as healthcare facilities have become overwhelmed.

Last Monday, Almora told us on One News’ “The Chiefs” that there are some private hospitals, notably the smaller ones, that have refused to admit more COVID patients. He explained that this is partly because of a circular issued last December by the Philippine Health Insurance Corp., prohibiting co-payment (a flat fee or predetermined rate paid by the patient to a hospital, outside PhilHealth coverage) by COVID patients.

Also, even if the government compels all private hospitals to expand their COVID room and bed allotments, Almora stressed that it would be hard to get personnel with the training and willingness to man such facilities.

*      *      *

At the rate infections are going, a million cases by month’s end could be a conservative projection by the OCTA Research Group.

The week opened with 8,355 COVID cases, bringing the total past 800,000 for the first time. Of the total 803,398 cases, 17.9 percent of 143,726 were active. There were 10 new deaths recorded, bringing the toll to 13,435.

Since the coronavirus variants believed to be causing the surge are said to be up to nine times more infectious, there’s a possibility that we haven’t seen the worst yet.

In Metro Manila, epicenter of the surge, most of those infected have no choice but to opt for home isolation, because there is simply no more room in hospitals.

While at home, the virus continues to spread, infecting every member of the household especially in cramped dwellings.

The continuing weak access to testing slows down containment efforts. And with the long period of waiting to be tested and to obtain results, the virus finds even more opportunities to spread.

Almora’s preferred ammunition in this war, in fact, is rapid testing of everyone at least in the high-risk areas starting with the NCR Plus.

He’s pitching for the rapid antigen test, which can be self-administered. A nasal swab, he stresses, doesn’t hurt as much when you yourself are probing your own nasal passage. While antigen tests are not as accurate as the swab or saliva RT-PCR, he says the swift result can always be subjected to confirmatory testing.

Unfortunately, the test is still awaiting approval by the Food and Drug Administration. And not everyone can afford their own test kit, even if it’s cheaper than the RT-PCR, just as there are millions of Filipinos who will get a saliva or swab test only if it’s free.

*      *      *

PhilHealth covers testing in the Philippine Red Cross, whose facilities operated 24/7 throughout the Holy Week. But PhilHealth continues to pile up debts to the PRC.

Despite this problem, the PRC is moving to address the crisis. Sen. Richard Gordon, always gung-ho even in the worst of times, has started talking with Ateneo de Manila University and several other schools that have agreed to convert part of their facilities into temporary isolation centers.

The PRC will provide free ambulance service to transport patients to the isolation centers, where their condition will be monitored and they will be provided free meals and shower rooms. Any patient who develops moderate or severe symptoms will be transported for free to hospitals in a Red Cross ambulance.

Gordon is also talking with several LGUs for the expansion of isolation facilities where mild and asymptomatic patients can be transferred so hospitals can be freed up for the more serious cases.

Almora suggests recruiting healthcare workers from COVID low-risk areas to temporarily augment the personnel in the NCR Plus and man expanded isolation facilities.

Whether the healthcare professionals will agree to this setup remains to be seen. But with this nightmare in our hands, we cannot give in to despair. We have to consider every suggestion and hold on to whatever seems doable.

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