POSTSCRIPT / April 26, 2020 / Sunday

By FEDERICO D. PASCUAL JR.

Philippine STAR Columnist

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How PGH prepared for COVID-19 fight

THE NETWORK of public and private hospitals with limited resources fighting the coronavirus (COVID-19) pandemic that had leaped from China to ravage the rest of the world count on frontline medical and healthcare personnel giving their all, including their lives in some cases.

We were moved by their professionalism and dedication as gleaned from the webinar during the April 21 governors e-meeting of the UP Medical Alumni Society America where PGH Director Dr. Gerardo Legaspi shared details of how the Philippine General Hospital braced for the battle. Other hospitals, we assume, went through similar preparations.

Below are excerpts from the webinar notes of Dr. Henry Echiverri, chair, UPMASA Board of Governors:

I was struck at how well prepared they were, and that the coordination of the different government and private hospitals was more organized than what I saw at least in our part of the western suburb of Chicago. They were prepared for something that was more of a surprise attack by an unseen enemy.

The PGH was designated as one of the COVID referral centers, accepting only the positive patients and moderate to severely ill cases that cannot be managed elsewhere (Tala Leprosarium and the Lung Center are the other COVID centers).

When the Quarantine was enforced March 15, PGH was already aware that COVID-19 was lurking and the cases, mostly in more affluent private hospitals, were already climbing. In a meeting with other hospital heads, PGH was singled out to handle the sick cases.

The PGH Covid Crisis Committee was created and in seven days, two PGH wards were converted into a COVID-19 enclave. Compartmentalized with barriers for healthcare workers and patients, the place was fitted with a unidirectional air-flow setup. These wards accommodated 130 cohort rooms that included a 20-bed ICU.

Forty rooms in the UPMASA Operation Wildfire private ward were designated as isolation rooms for a total of 170 beds. The hospital had 27 respirators and added 15 (repaired ones) for a total of 42 with an additional 30 standby from private outsourced companies. (There are only 1,500 respirators in the whole Philippines.)

Fearing a problem in manpower, PGH adopted a seemingly paradoxical approach of “personnel reduction scheme.” Personnel (doctors, nurses and other essential healthcare workers) were assigned into three one-week work shift teams. A team will work for one week and then rest for two weeks.

During the working week, the team members were booked in nearby hotels, in rooms donated by the owners. Food and essentials were supplied by PGH and the Bayanihan Program organized through the Chancellor. They were shuttled to and from the hospital. Other teams stayed home in a two-week rest and “quarantine” period. The hospital was transporting 1,000 personnel per day costing P30,000/day.

They estimate a need for 21,000 Personal Protection Equipment/month. Stockpiling on PPEs, purchased and donated, PGH built a reserve for about 1.5 months. A locally designed and manufactured PPE branded as PGH may be produced soon at an output of 10,000 PPEs/day. Masks will be another issue as N95s have to be designed to fit the individual’s face properly.

At the end of the work-shift, or whenever a team gets out of the COVID ward, they pass through decontamination. With PPEs on, they go through a misting tent – an “alcohol mist compartment” to lessen the viral load potentially being carried out of the unit. The workers then shower before donning on fresh clothes. Consultants from the Wuhan region were greatly impressed with the innovations.
 
The PGH is not without help from outside either. The Department of Health sent 30 doctors, 60 nurses, and technicians to join the pool of workers in the COVID wards.

Our own fight within the PGH is something to be proud of. With the expertise and hard work of our internists, pulmonologists, and ICU personnel, a 50-percent de-escalation of the severely ill is the norm. Out of the more than 160 severely ill COVID patients, 37 have now been discharged improved.

Eleven beds out of 20 are occupied in the ICU because most die upon arrival or upon transfer to the bed. The rest are prevented from getting critical aggressive treatment from our pulmonary experts using high flow nasal cannulas, with bronchial toilet, and availability of medicines from Hydroxychloroquine, Lipolivir, Tocilizumab, and others.

Our Hematology Department has started using convalescent plasma for treatment. Workers in the COVID ward are hardly infected. Out of 26 positive tests among PGH healthcare workers, only five are from the COVID wards who are equipped with Level 4 protection. The rest is acquired within the PGH community – during conversations when we let go of our guards (no masks, etc.), stressing the importance of masking and social distancing.

With the logistical challenges of manpower, supplies, and the “Fort” secured for at least 1-½ months, the battle is brought to the communities. The task is to identify and isolate the enemy, contain the situation and then move on to the next community. A group of Family Medicine and Public Health front liners are instituting 250 tests/day and with the development of rapid testing, they hope to raise this to 1,000/day.

A grant from the Lopez family and final accreditation of our locally developed testing will bring an additional 1,500 tests/day for a total of 2,500 tests/day capability. Those identified can be transferred to mega-quarantine facilities such as the converted Rizal Memorial Stadium, the Philippine International Convention Center and other facilities capable of housing 1,000 patients. Our Genome Center is helping and they can even identify the origins of the virus (geographic) and follow how they mutate and change.

Given this story, we in the audience in the webinar cannot help but shed tears and feel proud for the gallant battle being fought. The innovations and knowledge acquired by these warriors are phenomenal and worthy of a story.

Like the “Misting Tent innovation,” this report on the PGH war is made clearer to us – in other words, “demystified.” Like parents worried about their “faraway kids,” we are relieved to know they are faring well. As parents, we are ready to help in any way if needed.

(First published in the Philippine STAR of April 26, 2020)

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