By Katrina Elaine Alba
(APRIL 6, 2020) — On March 28 as a patient was wheeled to a hospital in Manila, Dan, the doctor on duty at the triage area, was rushing to save the man in his forties who had difficulty in breathing. He was also trying to save himself from contracting the coronavirus disease.
He said he fears of losing a patient as he quickly inserted a tube on the man’s mouth to help him breathe, but, at the same time, he was also doubly nervous because the highly contagious virus could be transmitted to him even if he was wearing personal protective equipment, including an N95 mask and shoe cover.
“Natakot ako,” Dan told News5 in an interview. “Inisip ko yung mga kapatid ko, family ko, kaibigan ko. Naisip ko din yung health ko. After ba nito, magkaka-COVID ba ko? After nito, mamamatay din ako tulad ng mga doctors na nag-intubate din?”
The patient died two days later. Losing a patient to a dreaded disease has become a big frustration to first responders as the world continued to search for a magic pill or a vaccine that could end the 21st century scourge.
Three weeks after President Rodrigo Duterte placed the entire Luzon area under an enhanced community quarantine, closing schools, shops and travel and asking people to stay home, there are no clear indications the government has stopped the rapid escalation of the disease.
As of Sunday, when the mainly Roman Catholic country of 105 million marked a religious holiday, the respiratory disease has ballooned to 3,246 cases—the highest in Southeast Asia—and a death toll of 152, second only to Indonesia.
Doctors, nurses, and allied health workers have been working round-the-clock, battling both infection and exhaustion as coronavirus cases are expected to surge with the health department’s screening capacity increased through more testing kits and laboratories.
Public and private hospitals have reached full capacity and the government has been rushing to build temporary quarantine areas, converting convention centers and sporting facilities into field hospitals to monitor high-risk patients.
Only those with severe and critical cases were admitted to hospitals due to inadequate facilities and equipment, like ventilators.
Dan, who has been working for a year at the hospital in Manila, said he was used to working for 8 to 16 hours a day before the outbreak.
His day normally starts from 8 in the morning up to 4 p.m., but sometimes from 4 p.m. to 8 a.m. But, these days, his duty lasts for 24 hours in the COVID response unit.
“Nakaka-pagod siya kasi lahat ng pasyenteng dumadating ngayon, may ubo, may lagnat, may hirap sa paghinga,” he said.
“Bago dalhin sa main ER (emergency room), kini-clear muna namin kasi COVID section is very contagious.”
The same goes for Jan Jorge Francisco, one of the two medical fellows for infectious diseases at The Medical City (TMC) in Pasig City.
He and a fellow doctor, with the help of their more experienced consultants, handle all COVID patients—either positive or suspected—at the hospital.
On Friday, he told News5 they have handled 110 out of 150 patients who went to the tertiary hospital.
Francisco said before the pandemic broke, his duty starts at 8 a.m. to 5 p.m., checking specimens in the laboratory, discussing treatments, and checking up on patients. Now it has become a new norm for him to go home at 2 a.m. the next day, and go back to work after six hours. This had been his routine for some 10 days straight.
Normally, Francisco said he sees about 20 to 30 patients a day but the number has ballooned to 50 to 70, adding doctors have been trying to entertain themselves by sharing jokes and laughing to wear off the stress.
“Minsan tawa na lang kami nang tawa,” he said, “Uupo lang ng 5 or 6 p.m., first and last meal na namin. Ano ba yang ginagawa natin?”
The COVID-19 is the third pandemic declared by the World Health Organization (WHO) in the 21st century after the Severe Acute Respiratory Syndrome (SARS) in 2003 and the H1N1 Swine Flu in 2009.
This particular strain, SARS-CoV-2, primarily spreads through droplets—passed by a cough or a sneeze—and manifests within a few hours, a few days, to a couple of weeks.
On Saturday, WHO said the number of cases in 205 countries and territories in the six continents have surpassed the one million mark, with 56,985 deaths.
RESPONDING TO THE CRISIS
Francisco told News5 in an interview that The Medical City had already prepared its facilities as early as January, when the virus was just beginning to spread throughout China. The Pasig City-based hospital has built an Epidemic Rapid Response Team (ERRT), briefing not just doctors and nurses, but the security and maintenance personnel as well. The alcohol dispensers were overhauled and made automatic, while a tent was set up for COVID patients,
“We knew that Wuhan had direct flights to Cebu,” he said. “We said, oh no it’s just a matter of time before it gets to us. We’re very fortunate to have it [ERRT] formed early on. Yung time na nag-lockdown na and surge of patients, we know na what to do.”
But wave after wave of patients being admitted had overwhelmed the hospital staff. Previously, the hospital had only three negative pressure rooms at the intensive care unit (ICU), which allows the air to flow into the room, but not letting it escape and limiting the contamination.
Francisco said they had to work with engineers so they could build 16 more rooms with negative pressure and converted two hospital levels just for COVID patients, even turning an emergency room into an ICU.
Donations were also pouring in for personal protective equipment (PPE), such as masks, gloves, and gowns but the hospital is quickly running through the supplies.
“If you’re handling one floor, if you’re going to see all of the patients, 32 of them, you get to change your gown and your gloves 32 times,” Francisco said.
“With one patient, you need to put on the special gown and the gloves. And when you go out, you change everything. Tatanggalin gown mo, gloves, lagay sa hamper outside the patient’s room and then you repeat that pagdating sa other patient.”
With the global limitation of medical supplies, Francisco said they had already been considering re-using masks, especially N95 ones, after sterilization.
NO CHANCE, NO CHOICE
The lack of medical equipment was the least of their concerns. They are more concerned over their staff getting struck down by the unseen enemy, either through a 14-day quarantine or getting infected which could lead to death.
Francisco said he was shocked when he heard the death of Israel Bactol, a cardiologist in the Philippine Heart Center.
“Doon nag-start na kami to question everything that we are doing,” he said, “Why are these people dying? Totally healthy yan, no comorbid disease. Pagka-kami we get exposed, we really are exposed, baka mamaya ma-afflict, marami talaga.”
Some hospitals have already provided halfway houses for their staff who could not go home due to the lack of public transport.
Dan and Francisco are staying alone in separate apartments, walking distance from their hospitals.
They chose not to go home to their families. There was no chance to go anyway.
Francisco has not seen his family in Bulacan for one and a half months.
Dan, on the other hand, who usually goes to Antipolo every week, remained in Manila.
“Both my parents suffer from hypertension. Yung mom ko may diabetes, yung kapatid ko may metabolic syndrome. Minabuti ko na lang din na di umuwi muna. ‘Di ko rin alam e, baka carrier ako.”
‘WE ARE TREATED LIKE THE VIRUS ITSELF’
Other healthcare workers who have chosen to go home after long hours at work, faced a more formidable challenge in their community—discrimination.
Francisco told News5 the story of a nurse who has initially tested positive for COVID-19, but was later cleared and recommended to go home. Only that she could not.
“They were not allowed to go home even if they don’t feel anything already, kasi yung mga kapitbahay nila binabantayan who goes in or out,” he said.
In one community, a nurse who has tested positive became the object of hate as disinformation about her condition was spread.
“There was fake news going around sa area niya na she was already dead, cremated. Oh my god, nakakaawa. Even the children daw, ang sama sama ng tingin sa children,” Francisco recounted.
Food has also become an issue with various restaurants closing or only accepting deliveries, “Bawal daw mag-deliver sa Medical City kasi baka mahawa sila,” he said. “Kami na nga yung nag-te-take care sa mga patients, and we are treated like the virus itself.”
Francisco laughed it off as he shared these stories.
Dan also recounted how he received an irate phone call from a woman, berating them to not let their doctors and nurses go home for fear of spreading the virus, “I felt sad and offended nung time na yun. I listened to her for at least 10 to 15 minutes para malabas niya yung concerns and anxiety niya. I understand kung saan nanggagaling yung fear niya. Nagsimple health education na lang ako how to prevent COVID to ease her anxiety.”
But she quickly hung up the phone.
The provinces were not spared from discrimination.
Anna York Bondoc, a doctor and a former congresswoman in the fourth district of Pampanga, told News5 a story about the municipal health officer in San Luis who was confined at home because of COVID-19 symptoms,
“The staff doesn’t want to go to work kasi nandun na, may dumating na PUI sa lugar nila so they really freaked out.”
She recounted how her husband, Mayor Jayson Sagum, who was also a doctor, had to call everybody, disinfect the place twice and told them, “If you’re scared, I’m also scared. But I’m the mayor and I’m going around, because if I don’t go around, wala na magkakagulo na lang.”
SUPPORT FOR FRONTLINERS
“Everyday may takot ako,” said Dan, Francisco, and Bondoc all shared the same fears.
They said it was not surprising for anxiety to hit healthcare workers during the pandemic, but they still went to work. They had to.
“Pag gising ko sa umaga, una kong ginagawa magdasal,” Dan said, “Minsan humaharap ako sa salamin, kaya ko to.”
He added how he talked with his colleagues and gave each other pieces of advice.
At The Medical City, Francisco said the psychiatry department had reached out to frontliners.
But there were other things that drove the 32-year-old doctor, “I really like what I’m doing. It comforts me that our consultants are the experts in the field,” he said.
“No one will take care of them if not kami. We don’t fear them, we fear the disease. Natatakot kami for the patients,” he added, “It’s really worth it, when you get your patients discharged. It’s really fulfilling that way.”
During the interview, cheers could be heard from the residents of a condominium in Mandaluyong. It had become a habit every 5 p.m. for them to cheer at least 3 minutes for health workers.
“We really feel good,” Francisco said, “We’re not really asking naman to be affirmed of what we are doing. It really touches everyone, naappreciate kung ano ginagawa namin.”
“Di namin in-e-expect nung time na sumabog COVID, nag-ECQ sa Luzon, andaming tumulong na private companies, citizens, kapwa medical practitioners,” Dan gushed, “Nakakaboost ng morale.”
ACTING, NOT REACTING
While Metro Manila is struggling to contain the surge, nearby provinces have started some measures of their own against COVID-19.
The municipality of San Luis in Pampanga is one of the few areas in the province with no confirmed cases so far,
“Pinapaligiran kami ng mga positive na bayan. Very few na lang kaming wala,” Bondoc told News5 on Saturday.
The pulmonologist-turned congresswoman-turned businesswoman said as early as January, she warned her husband, the mayor, to act, “May salat na ko na may hindi magandang mangyayari.”
Being medical practitioners has helped Bondoc and her husband prepare early for the pandemic as public servants.
She said that in February, they bought enough liters of chlorine for distribution, preparing sanitation tents and foot baths, “We put up everything between the first and second week of the lockdown. Dito sa third week, tapos na kami sa lahat eh.”
Now they’re looking to help places, such as building a disinfection tent for the Jose B. Lingad Memorial Hospital, the designated COVID hospital in the province.
She said suspected coronavirus patients in the municipality were all monitored in their homes by the barangay tanod. While those who could not be placed under quarantine at home, stayed in a “PUM hotel,” an evacuation center with beds, manned by municipal employees.
Bondoc said the key to their prevention so far has been leadership, “It’s acting, not reacting. If you react, huli ka na. The solution to this problem is strong leadership, and good planning, plus good execution.” (MM)
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