Beyond capacity and overwhelming incompetence

July 19, 2020

by Maricar R. Piedad

The Philippines has been in varying intensities of community quarantine for 124 days—a world record in terms of the longest lockdown response to COVID-19. But the fight against the virus is still far from over, and now it seems like the country is back to square one—overwhelmed hospitals, rising number of cases, and overall chaos. All those days in lockdown have been wasted because of the Duterte administration’s louche decisions and inaction on building up the healthcare system’s capacity for COVID-19 response.

The government, more than ever, should acknowledge the graveness of the crisis. It should prioritize implementing solutions to flatten the curve rather than push business-as-usual measures towards so-called recovery when the imminent threat of the pandemic continues to stare every Filipino in the face.

So far, the measures it has taken—lockdowns, limited triage testing, and waiting for a vaccine from other countries—have been passive.

On the verge of collapse

The current healthcare system is now operating close to its maximum capacity with cases exceeding 63,000; already reaching the projection of cases 60,000-70,000 by the end of July and cases is increasing by almost 1,000 daily. Still, government has no clear and concrete plan to expand testing triage and capacity.

The sluggish COVID-19 testing is prolonging the country’s fight against the virus. Only a small portion of asymptomatic cases are being detected because of the absence of mass testing. Compared to the rest of the world, the Philippines has a low number of asymptomatic cases. But this is mainly because less than one percent of the country’s total population has been tested for COVID-19, almost six months after the first reported case. As of writing, only 1,009,511 individuals have been tested.

According to the adjusted estimates of the University of the Philippines (UP) as of July 13, the mean number of hospitalized patients is 23,747 and it can reach up to 28,024. As of now, the total hospital bed capacity is at 15,548, with 1,661 ICU beds, 10,410 isolation beds, and 3,477 ward beds. There are only 1,938 mechanical ventilators available. This means that hospitals may need to double their total number of beds before the end of July to accommodate these patients.

However, hospital bed capacity only increased by about 2,019 beds since last month’s total bed capacity of 13,529, according to the Department of Health (DOH). There was also no significant addition to the mechanical ventilators available which are important to treat critical cases. There was also no notable increase in the COVID-19-dedicated ward and ICU beds. Considering that more suspected and probable cases will be needing hospitalization, the influx of patients seeking medical attention will be beyond the country’s healthcare capacity. The exponential increase in the number of confirmed COVID-19 cases will overwhelm the healthcare system in no time and hospitals will be forced to deny patients due to the lack of facility.

The ICU bed occupancy rate, which is a huge indicator of critical care capacity, is already at 41.2% as of the latest DOH data drop. Ward beds are at 57.1%, and isolation beds are at 48.4% occupancy. Majority of the ward and isolation beds occupied are also located in private healthcare facilities. This is despite public hospitals having more COVID-19-allocated beds. This could mean that majority of COVID-19 patients are compelled to receive treatment from private institutions charging higher hospital bills and out-of-pocket expenses due to limited benefit packages from the Philippine Health Insurance Company (PhilHealth).

Out-of-almost-empty-pocket

Ballooning COVID-19-related expenses of Filipino patients is another major issue that the government should address. The medical bills of some COVID-19 patients have ranged from hundreds of thousands to millions of pesos, depending on the severity of the case. For instance, the bill of one recovered patient reached Php1.312 million for a 15-day confinement. According to the patient, a huge chunk of the medical bill were charges for laboratory tests, doctors’ professional fees, intubation, and the ventilator and respirator she used throughout her admission. Though all her medical expenses were fully covered by PhilHealth, this is no longer the case for COVID-19 patients admitted in accredited hospitals from April 15 onwards.

At the start of the pandemic, the Duterte administration assured the public that it has individuals infected with COVID-19 covered. However, PhilHealth announced in early April that it would no longer shoulder all expenses and would instead implement case rate packages for confirmed and probable cases effective April 15. According to PhilHealth Circular 2020-0009, patients with mild pneumonia can avail of a maximum coverage of Php43,997, while moderate and severe pneumonia patients can have a maximum amount coverage of Php143,267 and Php333,519, respectively. Critical patients, on the other hand, can access a Php786,384-worth maximum benefit.

But PhilHealth computations for these packages contradict the government’s assurances and may not be enough to cover the numerous medical procedures COVID-19 patients must undergo. Medical expenses in excess of the case rates will be paid out-of-pocket, and the amount could be considerable. If the patient with the Php1.312 million medical bill for example had been confined after April 15, PhilHealth would have just paid the Php333,519 maximum coverage for severe pneumonia patients. The remaining Php978,481 or almost 75% of the patient’s total medical bill would have to be paid out-of-pocket.

The abrupt economic shutdown resulted in most Filipinos losing income and struggling with the recent rise in the cost of living, especially the poor and vulnerable. Many of them can ill-afford to pay for medical expenses and may no longer consult doctors despite having symptoms.

Burning Out

Aside from the health infrastructure, the government also needs to reinforce the country’s human resource for health. Even before the pandemic, Filipino doctors and nurses were already treating patients beyond their capacity.  According to the Philippine Health Review 2018, there are 3.9 doctors and 8.6 nurses for 10,000 people. This medical worker to patient ratio is a far cry from the World Health Organization (WHO)-recommended 10 doctors and 20 nurses for every 10,000 population.

A Philippine Institute of Development Studies (PIDS) study also noted that, in a 24-hour set-up, 1 doctor and 2 nurses will be needed to treat 6 ward patients. Critical care patients will need 1 doctor and 1 nurse each as well as other special healthcare workers such as a pulmonologist, intensivist, infectious disease specialist, and mechanical ventilator technicians.

The available healthcare workers in the country will not suffice. With no significant addition to the health workforce, the country’s doctors and nurses will be overwhelmed and exhausted. There will also be a greater risk of infection for medical workers since having more patients could mean more exposure to COVID-19. There are already 3,805 healthcare workers infected and 35 of them have already died. 

The DOH decision to reassign physicians under the Doctors to the Barrios program is another sign that there are not enough doctors in COVID-19 treatment hospitals and reinforcements are urgently needed. However, only 5,216 health workers have so far been hired to fill the DOH-approved 9,297 slots for emergency hire. This slow hiring means medical frontliners continue to work beyond their capacity to treat the piling number of COVID-19 patients. The DOH itself has also noted the difficulty in hiring health workers because many of them have private services that they cannot leave. It also does not help that the entry level salary for healthcare workers is low. For example, a medical laboratory technician—which is under salary grade 6, can only earn up to Php 15,524 per month.

The country’s shortage of personal protective equipment (PPE) is also contributing to the huge number of infected health workers. According to the WHO, the global shortage of PPEs is affecting healthcare workers worldwide. This shortage could have been eased if the country had the means to manufacture its own PPEs, such as a local textile industry. But the country is reliant on imported PPEs. The Philippine Exporters Confederation Inc. (PhilExport) stated that despite factories’ willingness to produce PPEs, they cannot simply do so because of the lack of fabric and other materials. Had there been a Philippine industry for essential health protection needs, infection among front liners and in general would have been minimized.

Overcoming incompetence

The Duterte administration’s failed COVID-19 strategy in ending the current health crisis exposes its incompetence and lack of sensibility. The 124 days spent in lockdown and the opportunity costs incurred during this period have been wasted because the government failed to effectively intervene and keep the healthcare system from collapsing. It should now set its priorities straight and put all hands on deck to amplify health responses.

The government is not prioritizing funding for the healthcare system and social amelioration but it is pushing for ill-timed programs that will allegedly help in the country’s economic recovery. A concrete example is the continuation of the Duterte administration’s “Build, Build, Build” program despite the more pressing need to reallocate more funds for COVID-19 response.

The Philippine Program for Recovery with Equity and Solidarity (PH-PROGRESO) of the government shows that it is more inclined to save big businesses first before the Filipino people. The huge budget allocated for private corporations’ benefit should be realigned to help the overwhelmed healthcare structure. Fiscal measures for health and economic recovery should go hand in hand instead of pitting one against the other since overall economic performance is very much reliant on the well-being of the Filipino work force.  

Inadequate and relaxed response to COVID-19 hinders the Philippine economy from fully opening. It has only been two months since the gradual operation of businesses and since workers returned to their respective workplaces but the government is already losing control of the situation. Aside from the uncontrollable spread of the disease, hospitals are now reporting that they reached their maximum critical care capacity. Forty-eight hospitals already reported that their ICU beds are now full, and it is alarming that 50% of these hospitals are located in the National Capital Region (NCR). Meanwhile, Cebu City—which is the new epicenter of the disease in the country, is also nearing the danger zone in its critical care capacity. If the population of the Philippines’ major economic hubs keep on getting sick, then it will be much harder for the economy to recover its losses.

The government must protect first the Filipino people from the COVID-19 threat. Majority of Filipino workers are at risk of contracting the disease. The economy cannot recover without a healthy workforce to power it. According to UP’s analysis, half of the Philippines’ major economic contributors are considered high risk spreaders of COVID-19, such as construction workers, security guards and commercial drivers. Many of them are minimum wage earners lacking adequate social benefits and protection. This makes them more vulnerable to infection and with limited means to pay for expensive COVID-19 treatment.

The government should speed up the efforts in broadening and building up testing and hospital capacity.  More than ever, it should make healthcare accessible and affordable for every Filipino. This includes making COVID-19 testing and treatment free for all. The pandemic will not be over as long as infected Filipinos are not isolated and treated due to the lack of facilities and expensive healthcare.

In the end, the entire Philippine economy will suffer if Filipinos are not protected from this disease. The economic downgrade will be far greater if the coronavirus crisis lasts longer. The government cannot afford another lockdown since it will not only endanger the economy but will also bring intense hunger and more hardship. It must act now and prevent the health system from collapsing and the Filipino people from succumbing to both the pandemic and to poverty.