MANILA, Philippines – Experts at the University of the Philippines (UP) said the Luzon-wide lockdown has helped slow down the rate of coronavirus infections in the country, but the health care system should be prepared for a “surge” in cases once the enhanced community quarantine (ECQ) is lifted.

The UP COVID-19 Pandemic Response Team said this in its latest report, “Estimating Local Healthcare Capacity to Deal with COVID-19 Case Surge: Analysis and Recommendations,” released on Monday, April 20.

“The enhanced community quarantine reduced the Reproductive Number…which helped get the hospital care system to deliver services to those in need. We attribute this downward trend mainly to the ECQ,” said the UP team said which tracked the number of cases until April 17.

From April 18 to 21, the number of new cases ranged from 140 to 207.

The experts, however, anticipated an increase in COVID-19 cases once the lockdown is lifted as they called for the necessary preparations to help the country’s health care system cope with an increase in coronavirus patients.

They said that based on their latest estimate, the number of coronavirus cases in the country may reach 9,000 to 44,000 by April 30, the end of the Luzon-wide lockdown.

“We should prepare early for this expected surge of COVID-19 patients once the quarantine is lifted,” the experts said. 

On Monday, April 20, President Rodrigo Duterte met with health and disaster response experts to discuss the government’s next steps in addressing the coronavirus pandemic. 

Though there was no decision yet on whether to ease or lift the lockdown, Cabinet Secretary Carlos Nograles said that a modified community quarantine was among the options being considered by the government. 

Health care system

The UP experts estimated that over 50,000 people may require hospitalization at the peak of the coronavirus pandemic in the country, a number that would overwhelm the local health care system.

They said that based on their outbreak peak scenario – that one COVID-19 patient infects two people – “our simulations show that about 51,933 Filipinos will need hospitalization, approximately 13,194 of whom will need ICU treatment.”

They estimated that outside Metro Manila, the biggest bulk of severe and critical patients would come from Central Luzon, CALABARZON, Western Visayas, and Central Visayas.

They said that 81% of corovonavirus patients will exhibit “uncomplicated or mild illness” and would only require isolation not  hospitalization, but “approximately 14% will develop severe illness requiring oxygen therapy, while the remaining 5% will require intensive care unit (ICU) treatment.”

The team of experts said that there are 456 hospitals in the country classified either as Level 2 or 3 with a total bed capacity of  67,119. Approximately 41% of these beds are in government hospitals while the remaining 59% are in private hospitals.

According to the report, there would be a problem handling the critical cases because the country only has over 2,000 ICU beds for the projected 8,800 to 19,800 critical COVID-19 cases.

According to the 2018 Philippines Health System Review, the Philippines has 318 Level 2 and 122 Level 3 hospitals.  A total of 440 out of 1,233 hospitals have ICUs as of 2016. (READ: IN NUMBERS: What hospitals need to treat COVID-19 patients)

“We estimate, based on our projections and assuming a scenario with a reproductive rate of 2, that 3 provinces adjacent to NCR, namely, Bulacan, Cavite, and Rizal, may face a serious shortage of hospital beds for handling severe and critical cases,” the UP team said. 

The report said that coronavirus patients alone would fill up the total hospital bed capacities in these provinces. 

“If we are not able to ‘flatten the curve’ or significantly reduce the transmission of the COVID-19 virus in the Philippines through the enhanced community quarantine, the health care system will be overwhelmed way beyond their capacity as clearly seen in the relatively low number of hospital and ICU beds,” the experts said.

They said that “around 35,000 additional beds are needed” in a scenario where a COVID-19 patient infects two people.

Frontliners

According to the report, the Philippines has  3.7 doctors per 10,000 population, which is below the World Health Organization-prescribed ratio of 1 doctor for 1,000 persons. 

Each patient also needs a doctor, a nurse, and a medical technologist or specialist who knows how to use the equipment needed to help them.

As of 2017, the Philippines has a total of 40,775 doctors, 90,308 nurses, and 13,413 medical technologists, according to the Philippines Health System Review 2018.

Most of these doctors, nurses, and medical technologists are based in Metro Manila, where most of the reported positive cases are located.

“Peak-time critical COVID-19 cases alone would require the attention of approximately 21% of our healthcare workers. Note that this is over and above the already heavy regular workload of our health human resource,” the UP experts said. 

The DOH said that a total of 766 health workers have been infected with the coronavirus as of April 17. Of this number, 339 are doctors and 242 are nurses. At least 22 health workers have died.

The UP team said its estimates provided in the report can be used as a guide for pandemic-related planning.

As of Tuesday, April 21, the Philippines recorded 6,599 cases of the coronavirus, with 437 deaths and 654 recoveries. – Rappler.com