By Rose de la Cruz | Published: October 14, 2020
Since COVID-19 began being rapidly spread, especially to medical care personnel and many died in the process, a pandemic of fear gripped the nation.
Many patients suffering from illnesses like gall bladder, kidney infections, heart attack, diabetes and high blood pressures refuse to visit a clinic or hospital for fear of contracting the coronavirus.
Even surgeons, who had to operate on non-COVID patients experience anxiety of contracting the virus from amongst themselves inside the operating room or upon stepping out of the OR — when previous cases showed doctors and medical personnel try to catch their breath or take time out by socializing with each other.
These were among the points raised during the Monday virtual breakfast forum hosted by Melo Acuña entitled “How Safe are our Hospitals?” Guests were Dr. Gerardo Bayugo, undersecretary of the Department of Health for field coordination team; Dr. Antonio Salud, president of the Philippine College of Surgeons; Dr. Rey Sarmiento head of minimal invasive and robotics center of St. Lukes-BGC, and Dr. Arthur Dessi Roman, past president of the Philippine Hospital Infection Control Society.
Dr. Bayugo said that DOH policy is that “as much as possible we don’t mix possible COVID infection cases with non-COVID ones.”
Dr. Salud said that as early as March or April, the PCS came out with a resolution to allow safe surgeries in hospitals. “Hiwalay ang operating rooms ng COVID and non-COVID patients and so with equipment in ORs.”
“Ideally even the staff are different and separate. Most hospitals separate the critical care area for COVID and non-COVID, the diagnostic centers and patients are seen separately to ensure that non-COVID patients do not get infected by the virus,” Dr. Salud added.
Dr. Roman assured that in hospitals where patients need to undergo surgery, there are strategies being taken such as separating patients and screening of patients with a standard checklist of signs and symptoms of COVID. If any of the questions in the list is answered by yes, swab test is to be done.
Thirdly, a person who has to undergo surgery would go through a risk assessment and a risk assessment is done on the surgeons whether the operation to be undertaken will generate aerosol or droplets that could cause COVID-19 on them.
Depending on the risk assessment result, the surgeons and medical team will be given the appropriate PPEs (personal protective equipment) to wear for that procedure.
We also follow standard protocols in disinfecting instruments to be used, said Dr. Roman.
DOH USec Leopoldo Bong Vega said despite the rising number of cases, the Philippines is still in a better spot as it has tested roughly 3 percent of the total population or about 3 million and the positive case is below 10 or at 8 or 9 right now.
This is a good sign, he said, because inasmuch as we have increased our number of tests, our positivity rate has been down and our mortality rate is at 1.8.
In the National Capital Region, Vega added, the number of people tested is about 3,000 in a certain day and now at almost three digits which is a good sign because the strain on health capacity is not there and we were able to expand this at the time we had our general community quarantine.
Vega said, overall, “we are doing good. It is really all about public health and we can drive down everything.”
They further said that patients whose operations had to be postponed during ECQ and would need one now have to undergo rapid test for possible COVID which is done right at the hospital before any operation.
If the test is negative, then the surgery proceeds.
Sarmiento said that even before the pandemic, the minimal invasive surgeons like him have been asked by the Philippine College of Surgeons to come up with guidelines for the protection of both patients and healthcare workers.
During the ECQ, hospitals were hard-pressed to produce transportation to patients needing urgent medical attention.
And since public transportation was stopped, most patients opted to just resort to self-cure at home. But this was bad because sometimes they were already experiencing symptoms of COVID and still refused to get medical attention.
This gives rise to spread of infection in their immediate surroundings and homes.
Because of the pandemic of fear, most patients now resort to virtual medical consultations, such as telemedicine.
But this can only be good for illnesses that are not life-threatening or emergencies.
Most surgeons do not do telemedicine since they need to touch and feel the patient in areas they complain about.
“Pag may bukol kailangan naming mahawakan. Pag naoperahan at tinahi, kailangan naming alisin ang tahi or staples which we can’t do online,” said Salud.
The one hospital command (OHC) was operationalized last August for coordinate care or patient referrals to be transferred to appropriate hospitals or temporary treatment facilities, said Vega.
The one-hospital command is based in MMDA (Metro Manila Development Authority) which has linkages with a lot of local government units and different agencies like the Bureau of Fire for patient transfer or referrals.
“Though not yet perfect, OHC is the pathway for a seamless treatment care from receiving the patient call to transport to hospital or temporary care facilities,” Vega explained.
Before COVID, Salud said, the usual surgeries involved gall bladder problem (which require laparoscopy). But since the pandemic, he added, all cases except for emergencies have gone down.
There is a pandemic of fear among patients. A lot of patients do not consult physically because of the fear of getting infected when visiting clinics or hospitals.
Even in the OR, we cannot practice social distancing so even surgeons are often anxious in doing surgery because we are not sure about how safe our peers are, the doctors said.
This is why PPEs are always worn to ensure we do not get infected by COVID.
We are sure our patients are COVID-free because they are required to get tested through RT-PCR but doctors must ensure that when we go inside the OR we do not only wear PPEs but observe the safety protocols, Salud explained.
Cap On Tests
On the high cost of testing, ranging from P4,000 to P16,000, Vega said the DOH was asked by the Office of the President to prepare an executive order putting a cap to the price of tests.
We still have not come up with the reasonable ceiling.
Salud explained that the cost of PPEs is part of the hospital charges that patients pay except when these are donated.
This is the real situation in medical diagnostics and even curative medicine.