By Vann Marlo M. Villegas, Reporter

The common public perception of hospitals during the pandemic was: Dangerous places, heroic healthcare workers, everyone wearing PPE — and astronomical bills for a few days of confinement for COVID-19, assuming you survived.

The professional view is somewhat different. Yes, the workers are heroic, but they’re also exhausted from long nerve-wracking shifts. They have to be shuttled to and from home because of the lack of transport. PPE costs money, especialy if everyone in the world is trying to stock up at the same time. And for every gain in “business” (for want of a better word) caused by lots of people falling ill, there is also the offsetting loss of non-COVID-19 (coronavirus disease 2019) patients who weren’t able to go to hospitals because of the lockdown — including core clientele like the elderly and the long-term ill.

The ultimate reality check for the healthcare professional was that you could actually die doing this job — and not just because the virus was deadly, but because the tools to do the work properly weren’t available.

“The initial problem then was the PPE, and this is the reason why many of the health providers, the doctors and the nurses were infected with COVID — because there was lack of PPE,” Jaime A. Almora, president of the Philippine Hospitals Association, said.

Rustico Jimenez, president of the Private Hospitals Association of the Philippines, Inc. (PHAPi), said the country was not prepared for the pandemic, and the government should have acted sooner in procuring PPE earlier in the year, when the caseload consisted of three visiting Chinese nationals over the Lunar New Year holiday.

As of June 12, the DoH estimated that 2,846 healthcare workers were infected with COVID-19, or about 12% of the cases at that point. The breakdown at the time was 1,032 nurses, 751 physicians, 184 nursing assistants, 113 medical technologists, 56 radiologic technologists, and 377 other professionals.

A total of 1,806 have recovered and 1,007 remained active cases. Thirty-three died, including three nurses, 24 physicians, and six from other health-related professions.

As of early June, the Office of the President reported that the DoH had procured 6 million sets of PPE for P12.1 billion, with 1.458 million sets distributed.

Saturnino Javier, a cardiologist who is the medical director of Makati Medical Center (MMC), said the hospital had to improvise and adapt when the pandemic hit.

The patient surge quickly filled the emergency room and intensive care unit, while healthcare workers started falling ill or had to be quarantined because they had been in contact with sick colleagues or patients.

Occupancy rates also started trending down because of the loss of non-COVID admissions — while PPE costs surged.

“So the impact was a double-whammy,” he said in the BusinessWorld Insights forum in early June, adding that doctors were unable to consult with patients because their clinics had to close, all while the hospital had to pay a hefty premium for in-demand PPE, which he described as “exorbitantly priced” by “unscrupulous distributors and manufacturers.”

Mr. Almora said chronically ill patients like those undergoing hemodialysis could not come in for their sessions due to the lockdown.

One other wrinkle that went unnoticed by the public was that 96 hospitals which had been initially rejected for PhilHealth accreditation ultimately had to be accepted by the health insurance system in order to keep hospital beds open in case COVID-19 cases surged.

Mr. Almora said the PHA, which sits on the PhilHealth accreditation committee, said the hospitals, including 92 in Metro Manila, might go out of business if they could not admit PhilHealth patients. He warned the committee that without the hospitals, “the healthcare delivery will be incapacitated.”

Mr. Jimenez of the private hospitals’ association said before the pandemic, his industry was understaffed by around 23,000 nurses, who had been transferring to government hospitals because of the attractive pay, apart from those who left to work overseas.

“So ‘yung mga na-train naming mga nurses, usually after one year or even two years, even if stable na sila sa mga private hospitals, because of the need for extra money, they will go to government hospitals. And then of course added to that, yung brain drain natin talaga (The nurses we trained, even if they were in stable jobs with us after one or two years, went to government hospitals because of the extra money — adding to the nurses we lose overseas from the brain drain),” he said.

He also noted other worker shortages elsewhere in the healthcare system — 3,000 pharmacists, 2,000-3,000 medical technologists, and about 2,500 radiologic technologists, he said.

Mr. Javier said a “good number” of nurses also left during the height of the pandemic due to personal or health issues.

“You cannot impose on anyone to stay, especially if there are offers of higher salaries elsewhere,” he said during the Insights forum. “This is a reality we confront and are still confronting at the moment.”

He added that MMC’s human resource department is working on measures to encourage nurses to stay, including more career advancement opportunities, flexible working hours, and increased benefits.

“But if the bottom line is salary, we really cannot compete with European countries and the US especially when the demand for nurses in those areas is higher,” he said, adding that the government could do more to discourage brain drain.

According to the Office of the President report, in early June there were 1,912 COVID-19 admitting hospitals, 24 of which were designated DoH coronavirus referral hospitals, with a total capacity of 13,627 beds.

Mr. Javier said MMC is resuming operations gradually and “in a very cautious manner” to ensure the safety of patients and employees.

“And as we move to the new normal, this is now a situation where we try to manage fear,” he said.

Aside from a no-mask, no-entry policy, MMC has imposed zoning protocols in the emergency room, while entire floors of the hospital have been designated cold and hot spots to separate COVID and non-COVID patients.

Mr. Javier also said that many of the clinics have been retrofitted to ensure that they can deal with any possible breach in containment protocols.

Telemedicine has had to be roped in for patients who cannot visit hospitals, with more appointments now possible via telephone, though the need to fill up questionnaires remains unavoidable, he said.

“This is being encouraged as we partially resume operations and all our doctors have been encouraged and we support them in whatever platform they would like to utilize — whether telemedicine or the telehealth modality,” he said.

Mr. Almora of the hospitals’ association said its more than 1,900 members are on the alert for a surge in cases as the lockdown eases and people revisit their old routines of moving around more freely, including trips to the provinces.

Mr. Jimenez of the private hospitals’ association also said members are trying to adjust. They have been advised to maintain separate paths for navigating hospitals for non-COVID patients. “We segregate already there,” he added.

With doctors’ clinics also sporadically open, the association advises changing of air filters, even in operating rooms.

“Slowly we were able to cope but still about 50% only are functioning,” Mr. Jimenez said, adding that some hospitals are allowing only emergency rooms to function and others are operating only partially as doctors slowly come back.

The DoH has resorted to emergency hiring of healthcare workers. Health Undersecretary Maria Rosario S. Vergeire said 9,297 positions have been approved for hiring and 3,807 have been hired. Some 1,289 nurses were also deployed to government hospitals under the nurses deployment program.

The onset of the rains means hospitals will need to be ready to accommodate more patients with seasonal conditions.

Mr. Jimenez of the private hospitals’ association said the workload is expected to rise for child vaccination, dengue, chicken pox, measles, and typhoid fever. Flooding also raises the risk of leptospirosis.

Mr. Almora of the hospitals’ association noted that the main fear is respiratory illnesses whose symptoms resemble those of COVID-19.

Ito ’yung kinakatakutan namin so kailangan ma-i-isolate (We’re all afraid of these cases and will need to isolate patients)…We have to treat them like they are COVID cases until proven otherwise,” he said.

He said the procedure might be to rapid-test suspected cases and isolate them until the results are validated.

Mr. Javier said he expects limited operations to continue for more than a year — the time he expects it to take for a vaccine to be available.

“The treatments are only empirical. I mean medicines used for other diseases are now showing signs that they are good for COVID. So if we wait for all these to function properly (and verify that they are) safe for patients — personal lang ito siguro more than a year pa yan (my personal view is that it’s more than a year away,” he said.

“I hope with the new-normal operations in place, we will be able to bounce back. While we are doing that, we hope not to let our guard down in terms of managing the pandemic in our midst,” he said.

“But at least… I can see somehow a changing perspective because patients (are) coming back, somehow increasing already, maybe not very dramatic but you see on a day-to-day basis, the numbers are improving and to me it’s a good sign,” he added.