Tuesday, October 26, 2021

The cost of Covid-19 in Cebu

MANILA. In this photo taken recently, a health worker collects nasopharyngeal specimens from a woman in Manila. (File)

MORE than nine out of 10 individuals who get sick with coronavirus disease 2019 (Covid-19) develop only mild symptoms while less than two percent don’t have any symptoms at all.

Contracting this highly contagious disease, however, can still be expensive even for those with zero or mild symptoms.

For patients who are severely or critically ill, the gross medical expenses easily run up to hundreds of thousands of pesos and even up to more than P1 million.

Just how much does it cost to fight off Covid-19? SunStar talked with some recovered Covid-19 patients and the families of deceased patients to find out. Their names have been changed to protect their privacy.

Asymptomatic, BIC

Gilda’s husband and three children - aged 6, 8 and 10 - tested positive for Sars-CoV-2 after another household member fell ill in February 2021. They were all asymptomatic. Both Gilda and her husband were unvaccinated.

Gilda tested negative but when the extraction team came for her family, she signed a waiver and volunteered to go with them so she can take care of the kids.

Asymptomatic and mild cases are brought to either the nearest barangay isolation center (BIC) or an isolation hotel. A BIC is a public elementary school, with the classrooms emptied of school desks and equipped with beds. The meals and accommodation are free.

(A classroom in a public elementary school in Cebu City is converted into a barangay isolation center.)

Gilda and her family shared a room with two other families, which had some members who were coughing and suffering from other Covid-19 symptoms.

Their room had a toilet, but they had to share this with the families in the next room, where the toilet was not functional. There were two electric fans.

There was no advice from the extraction team, but Gilda had the foresight to bring pillows and blankets because their room only had folding beds. She also brought their own electric fan.

The meals were delivered on time. But Gilda said they sometimes had to order food because the kids didn’t like the food served to them. Most of the time, her husband’s relatives brought them food.

“Gasto gihapon. Dili lang mi ka-total sa among gasto (We had to spend just the same. But we did not keep track of our expenses),” she said.

No one provided security. No nurse or doctor checked their vitals. No one monitored them at all, Gilda said.

Other asymptomatic individuals housed in the same BIC were roaming around without face masks, she recalled.

After eight days, the Barangay Health Emergency Response Team (BHERT) came for them and issued certificates declaring that they - including Gilda - have recovered from Covid-19.

Gilda protested that she had tested negative, but the BHERT merely told her that she was presumed to be positive because she had stayed with her husband and children, who were positive.

Asymptomatic, Isolation hotel (Gross expenses: P13,000)

Elena, who is in her mid-twenties, registered for a free reverse transcription polymerase chain reaction (RT-PCR) test at a government hospital in March 2021 and waited six days for her schedule.

Two days after she was swabbed, she found out she was positive. She had no symptoms. She was also unvaccinated.

Having heard about the unpleasant experience of a relative in a BIC, she booked a room in an isolation hotel.

Three days after swab day, which was counted as Day 1 of a 10-day isolation period, she was extracted from her home and brought to the hotel.

The air-conditioned room cost P1,500 a night, with three meals a day. Her bed was more comfortable than those in a BIC and she didn’t need to bring pillows or linen. She had her own toilet and bath, with a water heater.

“The room was clean but they served the same food repeatedly. Good thing my workmates were sending me food everyday,” she said.

The hotel also provided toiletries and drinking water. But she had to bring her own thermometer (P150 to P400), pulse oximeter (P450 to P1,600), and medicines and supplements.

Elena said a nurse called her every morning to ask for her temperature and find out whether she had developed cough or colds. There was no oxygen saturation level check.

She was discharged after seven days and was billed P10,500. Including her miscellaneous expenses, she estimated her gross expenses amounted to at least P13,000.

(A typical breakfast in an isolation hotel.)

Mild, Isolation hotel (Gross expenses: Around P20,000)

Luigi, in his late twenties, immediately went into home isolation when he came down with fever, cough and body malaise in late July, less than two weeks after he received his first Covid-19 shot.

He consulted a doctor online and monitored his oxygen saturation level, temperature and blood pressure with the following gadgets: pulse oximeter (P450 to P1,600); digital thermometer (P150 to P400); and blood pressure monitor (P2,700 to P3,700).

He underwent an RT-PCR test on the sixth day for P1,591 in a private hospital, net of the P3,409 Philippine Health Insurance Corporation (PhilHealth) benefit that is granted only when a doctor’s order is presented.

He was found positive after 24 hours, extracted the next day and brought to an isolation hotel. The air-conditioned room cost P1,500 a night, with three meals a day.

A nurse monitored his vital signs daily while his telemedicine doctor, courtesy of his health insurance, called each day, and prescribed antibiotics and cough medicine.

On top of his expenses for the room and meals, Luigi said he also had to spend around P5,000 for his medicines, supplements and miscellaneous expenses.

He was declared clinically recovered after eight days, but his certificate stated that he had no signs and symptoms. Upon discharge, however, he still had a residual cough.

The hotel billed him P12,000. Including the RT-PCR test, medical gadgets and miscellaneous expenses, Luigi spent around P20,000.

Moderate, CIU (Gross expenses: P5,000)

Sana, a twentysomething government employee, came down with fever after an official domestic trip in March 2021. She was then unvaccinated.

She spent P3,500 for a swab test in a private laboratory since she didn’t have a doctor’s order to avail herself of the P3,409 PhilHealth subsidy and the queue for a free swab test at a government hospital was too long.

Her test results came out three hours later. She was positive.

She got a call two days later from a contact tracing team, which advised that she will be extracted and brought to a BIC. Her colleagues, however, facilitated her admission to a government-run temporary treatment and monitoring facility (TTMF) that is accredited with PhilHealth as a community isolation unit (CIU).

A CIU is a public or private non-hospital facility set up in coordination with the national government or local government units to serve as quarantine facilities for Covid-19 cases. It must also be certified by the Department of Health.

The facility, to which Sana was taken, proved to be much better than a BIC. Sana had her own air-conditioned room with a toilet and bath. She didn’t need to bring her own pillow and blanket, although she was advised to bring her own personal provisions and ensure that her own mobile phone was loaded and charged.

Prior to admission, a nurse called to evaluate her symptoms and ask for her PhilHealth number. She was classified as a moderate case.

Upon admission, she was given a kit containing a thermometer, blood pressure monitor and pulse oximeter so she could take her own vital signs and report these to the nurse on duty three times a day.

Sana wrote her report and messages on a small white board that she hung outside her door. The staff who brought her meals, which are also left outside the door, collected the information. For urgent concerns or any alarming sign, she texted or called the nurse or doctor.

The meals, medicines and supplements were free, as well as the services of the doctors and nurses.

When her oxygen level went down and her fever went on for several days, the doctors debated on whether to endorse her to a hospital while the nurse on duty came to check on her every two hours.

“I think they were helping me so that I wouldn’t have to be admitted in a hospital,” she said.

Sana pulled through and was discharged after 13 days, with a residual cough and no bill. She did shell out P3,500 for the swab test and for some miscellaneous expenses.

Under PhilHealth Circular 2020-0018, a package rate of P22,449 is reimbursed to an accredited CIU for each claim filed in behalf of a Covid-19 patient confirmed through RT-PCR test.

As of May 31, 2021, there are 30 CIUs in Cebu that are accredited with PhilHealth.

Moderate, Level 3 hospital (Gross expenses: P250,000 to P300,000)

Lisa’s father (80s), mother (80s) and brother (50s) tested positive in late July 2021. All were unvaccinated.

Lisa’s mother developed moderate pneumonia and was brought to a private level 3 hospital, where she had to stay in the emergency room for several days because all private rooms designated for Covid-19 patients were taken.

She was given oxygen support and treated even while in the ER, though. She was eventually transferred to a private room.

She was discharged from the hospital after 10 days, with an occasional need for oxygen supplementation.

The bill amounted to around P300,000, including the medicines, supplies, diagnostics and imaging, and the physicians’ professional fees.

The amount was reduced after the hospital deducted the 20 percent senior citizen’s discount and the PhilHealth benefit package.

Under PhilHealth Circular 2020-0009, the package rate for moderate pneumonia in a private room in a level 1 to 3 hospital is P143,267. This is for confirmed cases with RT-PCR tests.

As Lisa’s mother was about to be discharged from the hospital, her brother was brought to another private level 3 hospital.

His chest x-ray showed that he was suffering from pneumonia even though he didn’t have cough.

He was prescribed, among others, the anti-inflammatory drug tocilizumab, but the hospital had run out of supply.

Lisa said they had to scramble for a vial, which was then being sold for more than double the maximum retail price (MRP) set by the government at P14,566.97 for a 200mg/10mL vial and P28,830.84 for a 400mg/20mL vial.

The staff at the hospital’s pharmacy helped Lisa’s family secure the drug from the government at a price below the MRP.

Lisa’s brother was discharged from the hospital after seven days, with a bill of around P250,000, excluding the tocilizumab that was sourced outside the hospital. He was also granted the PhilHealth benefit package for moderate pneumonia.

Severe, Level 2 hospital (Gross expenses: Around P800,000)

Lisa’s father was admitted to a private level 2 hospital in another city because the level 3 hospitals near their home had a long list of patients waiting to be admitted.

After a couple of days in the ER, Lisa’s father was moved to the only available room which was semi-private.

He should have been in the intensive care unit (ICU), but the hospital did not have ICU staff nor equipment. He was endorsed for transfer to a level 3 hospital, but this did not push through as the receiving hospital was also short of ICU staff.

An oxygen mask and high flow nasal cannula therapy aided his breathing, but his oxygen saturation level continued to fall. As his condition worsened, the doctor suggested endotracheal intubation.

But the family did not want him to suffer the pain and trauma of an invasive ventilation.

He passed away while his wife, who was still admitted in another hospital, was encouraging and showing him how to breathe via video call.

Lisa and the rest of the family also stayed with him virtually until he breathed his last.

The family was billed around P700,000 for 11 days in the hospital, including the ER fees and charges which the family had settled prior to the patient’s transfer to the semi-private room. The PhilHealth benefit package and the 20 percent senior citizen’s discount were deducted from the bill.

A confirmed Covid-19 patient with severe pneumonia in a private room or ICU in a level 2 or 3 hospital is entitled to a PhilHealth benefit package amounting to P333,519.

Lisa said they spent another P72,000 for the cremation of her father’s remains. The amount, which included the urn, was already net of the 20 percent senior citizen’s discount.

Severe, Level 1 hospital (Gross expenses: Over P200,000)

In early August 2021, Ana’s father had to stay for four days in a medical tent put up by a government-run level 1 hospital before a ward bed became available.

Three days after he was transferred, he succumbed to Covid-19. He was in his early sixties and unvaccinated. He also had an underlying medical condition in his lungs.

Ana said he had agreed to get vaccinated, but Covid-19 got to him first.

The hospital bill was around P60,000, but Ana said this was offset by the senior citizen’s discount and PhilHealth benefit package for severe Covid-19.

While she didn’t spend anything for the hospital, Ana had to pay for the medicines, such as the antiviral remdesivir and anti-inflammatory tocilizumab, and medical supplies for non-invasive ventilation.

“I lost count of my expenses. The P150,000 that I prepared was depleted. This doesn’t include yet the food expenses and the gasoline expenses as we went searching for tocilizumab,” Ana said.

Because of the surge, tocilizumab was scarce and the prevailing price then was around P60,000, more than double the maximum retail price set at P28,830.84 for a 400mg/20mL vial.

On top of these, Ana said she was billed P55,000 for the cremation of her father’s remains. Less the senior citizen’s discount, she ended up paying P37,000.

“Perhaps it was God’s will that Papa was not accepted in a private hospital (due to lack of staff). I can’t imagine how much our expenses would have been. Our family has accepted that God has a reason for allowing it to happen,” she said.


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