By Francis Allan L. Angelo
Western Visayas’s healthcare resources will be overwhelmed if coronavirus disease 2019 (COVID-19) cases surge.
This was one of the findings of a policy note by the University of the Philippines COVID-19 Pandemic Response Team entitled “Estimating Local Healthcare Capacity to Deal with COVID-19 Case Surge: Analysis and Recommendations” published on April 20, 2020.
“The rising number of cases of COVID-19 infections on a daily basis is a serious concern as there are limits to hospital care capacity for patients with serious symptoms (e.g. difficulty in breathing). Should the number of infected people rapidly rise, there may come a time when the hospital care resources will be overwhelmed,” according to the policy note.
The surge could happen if the enhanced community quarantine (ECQ) is lifted amid the presence of COVID-19 cases (detected or otherwise) in a location. Health experts call this the second wave of infections.
The UP team said its estimates in the policy note can be used as a guide for planning particularly 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,” it added.
Citing its latest model run, the UP team estimates the number of confirmed COVID-19 cases to reach 9,000 to 44,000 by the end of April 2020.
As of April 22, the Philippines has 6,981 positive cases with 722 recoveries and 462 fatalities. Western Visayas has 55 COVID-19 cases with eight deaths and 11 recoveries as of Thursday.
The policy paper cited that around 81% of Filipinos who contract COVID-19 “will exhibit uncomplicated or mild illness.”
“These patients do not require hospitalization, but isolation is necessary in order to prevent viral transmission. Approximately 14% will develop severe illness requiring oxygen therapy, while the remaining 5% will require intensive care unit (ICU) treatment.”
Table 1. shows the estimates on the number of Filipino COVID-19 patients who will require hospitalization.
PEAK SCENARIO
In case the COVID-19 crisis peaks, where a COVID-positive person can infect two others (R0=2), the UPV team’s simulations show that “about 51,933 Filipinos will need hospitalization, approximately 13,194 of whom will need ICU treatment.”
R0 stands for reproductive rate or R naught in statistical parlance. It tells the average number of people who will contract a contagious disease from an infected person. It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated.
Outside of Metro Manila, the biggest bulk of severe and critical patients would come from Regions III (Central Luzon), IV-A (CALABARZON), VI (Western Visayas), and VII (Central Visayas).
For Western Visayas, the estimated number of patients who will require hospitalization (severe and critical) during the peak scenario is between 840 and 1,119 depending on the reproductive rate. The estimated number of critical cases who require admission in the intensive care unit (ICU) is from 213 to 284.
HOSPITAL BEDS
The Philippines has 456 hospitals classified either as Level 2 or 3. Excluding those classified as specialty hospitals, these hospitals combined will have a total bed capacity of 67,119. Approximately 41% of these beds are in government-owned hospitals while the remaining 59% are in private hospitals.
Given the peak case scenario, is Western Visayas’s healthcare resources, especially hospital beds, ICU units, and health care workers, enough to cope with the sudden surge in cases?
Based on data presented by the policy paper (Figure 2), Region 6 has a total of 4,823 beds in both public and private hospitals (Level 2 and 3 classifications), which means that its bed capacity is 17% to 23% sufficient to accommodate the projected surge in cases (840 to 1,119) during the peak scenario.
But the real concern is in the number of ICU beds in Western Visayas totaling 150 only. If the peak scenario is projected at 213 to 284 critical or ICU cases, the region will suffer a severe shortage of ICU beds between 143% and 190% (see Figure 3).
The UP estimates indicated that provinces and regions lack ICU beds that can accommodate critical COVID-19 cases.
“On the projected availability of ICU beds corresponding to critical COVID cases at the provincial and regional levels (Figure3), we estimate that it is beyond the capacity of most provinces to handle the surge of the COVID-19 crisis in the Philippines at its peak. There is a lack of available critical care beds because across the country, there are only a little over 2,000 ICU beds to cater to the projected 8,800 to 19,800 critical COVID-19 cases.”
On a national scale, the UP team stressed the importance of drastically reducing COVID-19 cases.
“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. Approximately 35,000 additional beds are required to accommodate the peak number of cases in a scenario wherein the reproductive number (R0) is 2. Certain regions (I, III, IV, V, VI or Western Visayas, and VII) may need to stretch their capacities to accommodate the cases during the peak,” the policy paper noted.
HEALTH CARE WORKERS
Are there enough health workers who can attend to COVID-19 cases in Western Visayas if COVID-19 cases suddenly spike?
According to the UP policy note, handling critical patients requires 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,” the paper added.
If the reproductive rate is R0=2 (two persons infected by a COVID-19 patient), 14,500 doctors and 13,200 nurses are needed to attend to the cases.
“As of 2018, there are 40,775 doctors and 90,308 nurses in the country. Peak-time critical COVID-19 cases alone would require the attention of approximately 21% of our healthcare workers. Note that this is over and above the already heavy regular workload of our health human resource.”
In Western Visayas, the ratio of health care workers and beds per 10,000 population is 2.9 doctors, 6.8 nurses, 1 medtech, and 5.9 beds (see Table 2).
The figures and table indicate that Western Visayas’s doctor to population ratio (at 10,000) is way below the World Health Organization (WHO)-prescribed ratio of 1 doctor for 1,000 persons (or 10: 10,000). Even the national ratio of 3.7 doctors per 10,000 population is far from the ideal number.
Region 6 also lacks nurses (6.8 per 10,000 population) if compared with the WHO-prescribe ratio of 1:1,000 or 10:10,000.
PREPARE
The UP paper noted that the ECQ imposed by national and local governments reduced the spread of COVID-19 as represented by the Reproductive Number, R (see Figure 4).
By controlling the spread of the virus, the Philippines managed to get the hospital care system to deliver services to those in need.
“We attribute this downward trend mainly to the ECQ. As of 19 April 2020, the Reproductive Number, R, for the Philippines is at 1.072. 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,” the UP paper added.
