A SOLID public health strategy will play a major role in how economic, social and security scenarios will pan out. Our almost knee-jerk reaction to a global pandemic that started last year has lately been a controversial point of debate among different stakeholders. People’s opinions drive systems now instead of the other way around. A red alert zone for systems thinkers among us. Hence, I end my personal take on the current situation and give way to the so-called four imperatives if we are to reduce the toll on our country that coronavirus is laying. This is a collaboration among Dr. Brian Michael Cabral, former health secretary Esperanza Cabral who is a fellow of The Outstanding Women in Nation Service (TOWNS) awardee, and Michael Sy. The material is divided into four parts, namely, knowing the enemy, taking care of the ill, protecting the front-liners and protecting the citizenry. For this week, I shall share the first two imperatives in toto.
Knowing the enemy
Well, we know what the enemy is. It is a highly infective, potentially lethal virus. But we don’t know who and how many among us have it. Only a little more than 2,000 unique individuals have been tested in the 2 months that our one and only testing center has been doing the tests. There is a backlog of thousands of individuals who have been exposed to the virus and are ill who are awaiting their test results. Many have died without their doctors knowing whether their patients really had Covid-19 or not. The promised 24 to 48 hours within which results can be obtained is the biggest painful joke RITM has played on us. We know patients who have had to agonize for 12 days before they got their test results. In clinical practice, we do tests if they will potentially affect the management of our patients. If we have to wait 12 days to get a Covid-19 test result, we might as well not do the test. It is a waste of time, money and effort.
From a public health standpoint, we need to know how many cases we are dealing with so we can plan and act accordingly, revise our plans and react accordingly. At the moment, it is like we are playing “pin the tail on the donkey.” So yes, we need to test on a massive scale, for us to get an idea of where the enemy is and who they have captured. One set-up can be:
a. Screen at the community level, over the phone, or online and pre-approve for testing.
b. Consolidate and take test samples at multiple, at scale, sampling sites in the municipality or city preferably near the testing laboratories
c. Deliver sample to laboratories for testing.
d. Deliver results to the city or municipal health offices for proper disposition
An example of a mega sampling site might be the St. Luke’s extension clinic in Malate. Designed for TB testing and visa medical screening, it is equipped to handle hundreds of cases a day. This could serve as the off-site testing facility for the Philippine General Hospital in order to segregate patients prior to recommending their transfer to PGH for care. Proximity wise, it could not be any better. Less than a kilometer away, Pedro Gil could even be cordoned off in order to prevent public contamination. We need massive testing!!! Those 100K test kits have been sitting somewhere for a week. At this rate, we’ll finish those in months when all might be for naught. We need to test 100K now!
Taking care of the ill
We need to figure out where to put persons under investigation (PUIs) and persons under monitoring (PUMs) while waiting for test results. Our scarcest resources are our medical professionals. We need to consolidate the care we give to Covid persons/patients to make our scarce human resources as effective and efficient as we can. We need facilities that can accommodate these hundreds, even thousands of PUIs and PUMs and mildly ill Covid-19 patients. We don’t have that. No country did, not Singapore, not China, etc. Everybody built makeshift ones - we should too. Take over Araneta, Arena, Ultra, Rizal Memorial, The World Trade Center and make them makeshift hospitals. House the health care professionals in nearby hotels and shuttle them to the Covid facilities. It will make taking care of the patients and health care professionals easier. We need dedicated facilities for seriously ill patients too. Having hospitals with “designated Covid wings” will not work as well as dedicated Covid hospitals. You can’t play shifting manpower, PPEs, ventilators, etc on a daily basis.
One will go mad doing it and you’ll sacrifice both the front liners and the ill. You can’t predict demand - you have to consolidate demand - and hence supply. All otherhospitals will be “referring hospitals” after triage to these mega-sites. Consolidate. Consolidate. Consolidate. It’s about reducing resource variability (PPEs, ventilators, beds, etc) and increasing effectiveness at the point of care - for both patients and front liners. We are expecting thousands to fall ill at the same time. If it doesn’t happen, great! If it does, at least we’re prepared - albeit a bit late now. Better late than never.