Overwhelmed, exhausted and mentally down!

This is the feedback that the Sunday Times is receiving from the major dedicated hospitals that are treating COVID-19 positive patients, not only those with symptoms but also asymptomatic patients in the high-risk categories.

These are the hospitals which have been bearing the brunt of the COVID-19 flood of patients which includes the critically-ill, some of whom die, despite their best efforts.

The hospitals handling this category of patients include that the National Institute of Infectious Diseases (NIID), Angoda; the Colombo East (Mulleriyawa) Base Hospital, the Homagama Base Hospital, the Teldeniya Hospital, the Hambantota Hospital, the Welikanda Hospital and the Batticaloa Teaching Hospital, the Sunday Times learns. Even though there was an indication that there were nine such hospitals, we could not get confirmation on what they were.

These hospitals and intermediate care centres (where the asymptomatic or mildly symptomatic are being managed) total 79, with a capacity of around 11,500 beds.

This was as the number of COVID-19 infected people in the second wave inched towards 1,000 a day and 3-4 deaths per day.

Many were of the view that the time seems right to ease the burden, gradually becoming unbearable, from these COVID-19 dedicated hospitals and have one or two dedicated COVID-19 wards in all major hospitals.

“This seems to be the way forward, as otherwise the few hospitals treating these patients currently would collapse and the staff would be affected,” sources said, explaining that even staff should be rotated so that the burden is equitably distributed among all.

Numerous queries to the Health Ministry by the Sunday Times over the last few months on this issue have elicited the response that it is being considered.

The Sunday Times understands that the staff in the dedicated hospitals treating severely ill patients is on a rollercoaster from which they cannot get off. They are physically drained and mentally down as well because around them is much sadness and tragedy.

“Usually, in normal wards they would see a few deaths but many other patients would recover and go home. Not so in these ICUs, where the exhausted staff, constantly in Personal Protective Equipment (PPE), see a lot of sadness which is getting to their mental status as well,” said a source.

Another distraught health worker added that the staff intubate these patients and attend to them under difficult conditions, a routine that they have been following for a long time and there is no satisfaction because some of these patients would die. Maanasikawa wetila inne.

Tragic plight of patients needing critical interventions but turn positive

A closer look at COVID-19 designated hospitals has also thrown up grim images of other disastrous consequences.Citing the example of someone meeting with a road traffic accident (which is quite common), a source said that the moment the victim is rushed to the nearest hospital, a rapid antigen test is done and if he/she is found to be COVID-19 positive, the person is immediately transferred to an isolation area in that particular hospital, sometimes with very basic facilities, until transfer to a COVID-19 hospital.

“Has anyone checked whether these patients are attended to – in case they need an emergency operation for severe internal injuries, a neurosurgery intervention, a cardiology intervention like an angiogram and stenting etc?” said many experts.

Others pointed out that there is also a problem when they are sent to a COVID-19 hospital, which may not have such facilities or the multi-disciplinary specialist skills needed. So for the hapless patient who is facing a double whammy, he/she would have to be treated for COVID-19 and recover without the other prompt and critical interventions needed.

For many of these patients, the ‘golden hours’ are long past and that would bring terrible consequences, they added.

Other patients left in the lurch

When certain hospitals are designated as COVID-19 hospitals, all other patients (from paediatrics to gynaecology, surgery to medical to orthopaedic and more) who have been receiving treatment at them are left in the lurch and shut out, the Sunday Timeslearns.Has anyone taken an audit to see how many have died, asked several sources even from among the public, with one pointing out that she used to access the very efficient services of the Mulleriyawa Hospital and never went to the National Hospital of Sri Lanka (NHSL), but that pathway has been shut now.

“I was very satisfied with Mulleriyawa’s handling of things,” she said, while another complained of the same thing happening at Homagama. Now her whole family and all her neighbours have to go to the Colombo South (Kalubowila) Hospital which is quite far away.

According to this family, they sometimes prefer not to and ignore their illnesses.

It is difficult to save people who have uncontrolled chronic disease such as cancer, diabetes, hypertension and chronic kidney disease (CKD) when they contract COVID-19, said many health experts when asked why the death toll is rising.

The Sunday Times learns that those with CKD have to have regular dialysis, not only when they have severe COVID-19 but even moderate disease and sometimes there is a dearth of dialysis machines in these hospitals.

The hospital system treating COVID-19 is also getting strained by the fact that in some cases the so-called COVID-19 positives being sent after Rapid Antigen Testing turn out to be negative when RT-PCR testing is carried out.

There seems to be some gap here, sources pointed out, explaining that when they take the case histories of such people there has been no contact with COVID-19 infected.

These experts suggested that as Sri Lanka seems to be heading towards a critical situation, the possibility of isolating them in their homes, should be explored. They should be transferred to a hospital only if they develop symptoms.

While some were vociferous about “inaction” and that even one year after, the health authorities had not looked carefully at systematic expansion, others were more empathetic that the whole health sector [from the Health Ministry down to the grassroots encompassing officials, doctors, nurses, minor staff, Medical Officers of Health (MOHs), Public Health Inspectors (PHIs) and more] has been assailed by an unprecedented situation which it is managing with much grit.

“No one can imagine the gargantuan task they are handling and it is very easy to criticize from outside the fringes, seated in armchairs,” some said, stressing the logistical nightmare of the whole programme.

Though many are strictly adhering to the preventive health measures, there are some people even those at high-level who flout these basic requirements. It is natural for the numbers to rise, others pointed out.

Another asked: “Do you know that just because a group leaves an intermediate care centre today, we cannot send in others due for isolation that very minute? The place has to be disinfected and the facilities checked out. Transport has to be organized for large numbers.

“Centres may be temporarily shut down for maintenance and it is very difficult to hire people like plumbers even after paying them, as they are reluctant to come into a place where COVID-19 patients are.

“As such, it may be better to keep the asymptomatic and mildly symptomatic people in their homes under PHI supervision, while advising them about isolation. In homes where such isolation is not possible, they could then be taken to these centres.”

While there have been many complaints of very poor facilities including lack of running water and terrible food at the intermediate care centres, the Sunday Times also learnt of an unseen side, not oft brought to light.

“People break the taps, rip off the toilet doors and use them as cricket bats, steal the bedding, taking mattresses folded into three with their belongings when they leave and also the TVs or just destroy the facilities,” said a source.

Others spoke of the difficulties posed when handling such a large number of patients and a large number of places distributed throughout the country.

Another answer to this burgeoning problem is to vaccinate people quickly – race against the virus – to get a respite from this heavy burden, several sources urged.

With changes to the discharge policy for those who turn positive for COVID-19, here is the latest update from the Chief Epidemiologist Dr. Sudath Samaraweera.

Positive but asymptomatic and not in a high-risk category – sent to Intermediate Care Centres after becoming positive, they are discharged from these centres after 10 days without an ‘exit’ RT-PCR test. This is due to evidence that they are not infectious after 8 days. However, they have to be in home quarantine for 4 days.

Positive but mildly to moderate asymptomatic and not in a high-risk category – sent to an Intermediate Care Centre after becoming positive, they are discharged 2 weeks after the onset of symptoms without an ‘exit’ RT-PCR test.

Positive with severe symptoms with or without being in a high-risk category – sent to hospitals after becoming positive, they are kept there for 3 weeks or more depending on the illness. They are discharged after a negative RT-PCR test or an antibody test.

Those in quarantine at quarantine centres – they have to be in quarantine for 14 days, undergoing both an ‘entry’ RT-PCR test and ‘exit’ RT-PCR test on Day 12. Once released from the centre, they do not have to be in home quarantine, as earlier.