COVID Overwhelms Manila Hospitals

This photo taken on 6 April, 2021 shows a man wearing personal protective equipment walking into a makeshift ward built for COVID-19 patients at a hospital in Manila. (AFP Photo) 

For Gio Pineda, a young doctor in the Philippines capital of Manila, the past few days have been among the most harrowing of his life. Pineda has been manning the triage section of his hospital’s COVID-19 emergency unit.

With the more than 40 beds occupied by patients in critical condition, and the hallway lined with more patients in wheelchairs, Pineda had to decide who would get treatment and who would not.

He turned away more than half the people who came begging him to take in an ailing loved one, many of them struggling to breathe. Some even knelt in front of him, begging to at least be allowed to wait in the hallway.

“Many of them said we were already the eighth or ninth hospital they tried, and if it were up to me, I really would have taken them in,” he said. “But there really was no room left.” Patients are rushing to hospitals in Manila and its surrounding provinces amid an exponential spike in cases of COVID-19 that began in March. 

Many hospitals are at maximum capacity and even patients in dire need of treatment are being sent home. Many have died waiting for a hospital to call them back. On Sunday, the health department reported 10,098 new infections, bringing the overall case count to 936,133. Some 15,960 people have now died from the disease in the Philippines.

At the hospital where Pineda works, doctors can now only take in a new patient when an earlier one has died. They are forced to choose from among those waiting outside who is most in need of attention.

“I was like playing God. That’s how I felt having to decide who gets a chance to live and who, sadly, will be left to their demise,” Pineda said.

Although the Philippines is one of Southeast Asia’s worst-hit countries, average daily cases of the coronavirus had dropped to a more manageable 2,000 in late 2020.

But the new wave – thought to be the result of more contagious variants of the virus – appears to have caught the healthcare system unprepared. Angelo Barrera, a game developer from Manila, lost his father to COVID on 28 March, after 20 hospitals turned them away because they had no beds. 

“I need you to understand that this is the government’s fault,” Barrera said in a social media post that has gone viral.

“Every hospital is full. Home care is the only option. Medical machines are in high demand and in low stocks. Access to emergency care is non-existent. How can I not blame the incompetence of the people leading us?” Barrera continued. 

Duterte: ‘Many More Will Die’

But even as the pandemic accelerates and people point the finger at his government, Philippines President Rodrigo Duterte has shown little urgency to tackle the surge. “There is nothing we can do about it,” Duterte said in a televised address a week ago.

A few days later, when pressed on the slow pace of the vaccination drive, Duterte said: “We have a long way to go. I’m telling you, many more will die because of this, I just can’t tell who.”

Critics have condemned Duterte’s statements, saying they betrayed a defeatist attitude towards the pandemic.

“The lack of a sense of urgency – I think that’s the fundamental problem,” said Dr Anthony Leachon of the government’s pandemic response. Leachon is a health reform advocate and a former president of the Philippine College of Physicians.

“People are dying in their homes. People are expecting a leader in command, or even just a compassionate leader that they can depend on,” he added. Duterte has also been under fire for his low profile. Before last Monday’s speech, he had not been seen in public for almost two weeks. To dispel rumours that he was ill, the president’s office released photos of him playing golf and riding a motorcycle, and a video clip of him jogging.

All these as the country grappled with its highest-ever daily caseloads of the coronavirus, forcing the capital region and nearby provinces into another hard lockdown.

“The messaging is wrong,” Leachon said. “It may result in Filipinos getting demotivated to put up a fight against the pandemic.” ‘It’s political’

Duterte insists his administration’s response to the crisis has “lacked nothing”, but experts say the surge in infections could have been better managed if the government had taken steps to improve testing and contact tracing when the local epidemic somewhat stabilised in the second half of 2020.

Leachon notes the government task force in charge of the pandemic response lacks members with the right expertise. The COVID-19 testing chief, for instance, is an economist who insists that widespread testing is unfeasible, despite other developing countries managing to do so. Many of the officials who make up the task force are military and police generals, reflecting Duterte’s preference for taking a law-and-order response.

Leachon, who received the Outstanding Filipino Award for Medicine in 2010, used to be part of that task force, but he was sacked in June 2020 after his criticism of certain policies offended some in Duterte’s cabinet.

“It’s political. When you actually suggest something, if it is opposite to their opinions, they don’t follow it, even if it’s backed by research,” Leachon said.

13 Deaths On A 12-Hour Shift

At the Quirino Memorial Medical Center, one of the largest COVID-19 referral hospitals in Metropolitan Manila, doctors and nurses are steeling themselves as they face an overwhelming number of critical patients every day. The hospital has a 50-bed emergency ward especially for COVID patients, but there have been so many cases in the last three weeks that at some point, they have had to squeeze in 57 patients, said Mylene Mangalindan, the facility’s head nurse.

“That was despite very stringent screening at triage,” Mangalindan said. “There’s too many of them, and we are understaffed.”

“I’ve noticed the doctors are getting exhausted. Maybe it’s because there’s been a lot of casualties among us, and the majority were doctors,” said Mangalindan, who also came down with COVID-19 last August. ‘

Nurses Leaving, Funds Dwindling

The Philippines is also suffering the consequences of being the world’s leading exporter of doctors and nurses, said Dr Jose Rene de Grano, president of the Private Hospitals Association of the Philippines. Salaries of medical staff in the Philippines are so low that most of them find jobs overseas after a few years of working in local hospitals.

From January to October last year, even as the pandemic took hold, some 10,000 Filipino nurses left the country to work abroad, according to government data.

At home, government hospitals offer relatively higher salaries than private ones, so nurses at private hospitals tend to quit as soon as they find jobs at public institutions.

Without the medical staff, hospitals are unable to make more beds available for coronavirus patients even if they wanted to.

Meanwhile, the pandemic has discouraged people from going to hospitals unless they absolutely have to, causing revenues to plunge. Sent off with a prayer

To cope with the still-rising number of COVID-19 patients needing hospitalisation, in late March the government hired more agents for its hospital command centre, to take calls from patients and direct them to vacancies.

But unable to provide aid beyond 1,000 pesos ($20) for poor individuals, the government has slightly eased lockdown rules in the capital region to allow people to get back to work.

Local scientists like Leachon worry that will leave the country in COVID-19 limbo, especially given the slow rollout of vaccines. Only one percent of the 110 million population have received at least one dose so far, and the stock is dwindling fast. The remaining doses needed are only expected to trickle in throughout the year.

Pineda, the young doctor, says he understands the desperation of patients and their families.

Although he tries to explain why he has to send them away, often they are convinced only when he takes them over to the emergency ward and shows them the grim reality of the situation through the small window in the door. And then they continue their desperate search for a hospital bed and life-saving treatment.

“At those times, my only prayer is that they find an institution that can take them in, that they find a hospital or clinic with a bed, medicines, and a doctor or nurse who can attend to them,” Pineda said.

“And that hopefully they won’t die at home or on the road.” – Al Jazeera

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