Taking Sisyphus out of our healthcare system

The beginning of March seemed to bode well for our hospitals and our healthcare workers (HCWs). The Medical City (TMC) received an initial 1,000 Sinovac vaccines on March 5. By March 23, with the arrival of the AstraZeneca vaccines, we had already administered close to 5,000 doses.

But it has not been enough. By March 27, the number of active COVID-19 cases breached 100,000, and there were nearly 10,000 reported new infections. Testing has ramped up to 45,000 per day, yet the positivity rate is an alarming 17% (the World Health Organization’s standard for infection control is 5%). By comparison, on Feb. 28, when Department of Health Secretary Francisco Duque supervised the safe arrival of the first Sinovac shipment, there were less than 30,000 active cases and positivity rate was 7%.

We have, for far too long, been pushing a rock up a hill in our healthcare system, only to see it roll back down. When statisticians warned about an uptick in July 2020, the second lockdown resulted in a peak of around 6,000 instead of the dreaded 10,000. Now the dreaded R naught measure has gone up, on the first anniversary of COVID-19. (R0 is a mathematical term that indicates how contagious an infectious disease is) Should the country lock down again? We have already done so.

Two-thirds of active cases are in the NCR and Calabarzon, versus just half last month. Our hospital in Pasig tried to catch the fast-rising wave of March COVID-19 cases. We doubled our COVID bed capacity, and it is still not enough. We are now forced to use our 16 COVID emergency room cubicles for ICU support. Our ER has again been turned into an ICU extension.

There are two big differences in this year’s COVID-19 wave. Last year, no one who was sick of anything other than COVID wanted to come to the hospital. This year, both our non-COVID emergency room and non-COVID rooms are 70% full. Non-COVID patients, by postponing elective surgery and preventive cancer screenings, are coming back sicker and staying as in-patients longer.

The other major difference is that last year, PhilHealth poured in cash to save lives. This year, PhilHealth can fill no coffers. Imagine running a business that burns cash to accept non-paying customers, with no recourse for getting that cash back other than a vague assurance.

Our initial optimism about the vaccine has turned into anxiety for two reasons. First there is the Dengvaxia scare — willingness to vaccinate has dropped from over two-thirds to less than 40%. Second, there is no confidence that, despite the primarily foreign funding for 70 million vaccines, there is a plan to actually administer vaccines on the ground.

While private enterprises have worked to secure vaccines for their employees, only the National Government can muster the vast resources needed to execute a massive national vaccination program so we can catch up with the rest of the world. Witness, for example, the turn-around that enabled America to administer more than 100 million doses in less than 100 days.

We need to erase the stigma that Dengvaxia imposed on vaccination. We need to figure out how to work together to vaccinate more, faster. We have only jabbed a third of our 1.3 million HCWs. But we also have 10 million Filipinos over 60 who can still contribute to the economy but cannot do so because they are confined at home.

Our own experience in Guam may be helpful. A decade ago, the territory was deeply under-bedded, with only a third of the hospital beds it needed. The local newspaper ran a daily front-page counter of available hospital capacity (nearly always full). This daily post was gone by the end of 2015. Perhaps publicly organizing a similar countdown to herd immunity will focus our national mindset. Indonesia is currently vaccinating 400,000-500,000 persons per day. For the 70 million people we need for herd immunity, that’s 280 days.

Harping on mistakes, rather than resolving problems, is not going to be productive. We need to focus on saving lives, not saving face.

Jose Xavier B. Gonzales is the Chairman of The Medical City.