Battle-hardened hospitals around the world learn how to deal with Covid-19

Health workers in hazmat suits walk outside the Manila Covid-19 Field Hospital in Manila on Sept 7, 2021. PHOTO: REUTERS

As coronavirus cases surged around the world, hospitals grappling with shortages of equipment and manpower had to get creative in adding beds and nursing staff, while government officials redirected supplies and emergency response teams to places that are most in need.

To ensure that the limited beds in hospitals were reserved for the sickest patients, administrators rolled out home isolation programmes and beefed up telemedicine systems.

And as the pandemic wore on, their experience from earlier waves of infections helped them gird for similar situations - although the Delta variant spread so unexpectedly quickly that it overwhelmed some areas nonetheless.

The Philippines' health system reached a near-breaking point when the extremely infectious variant ripped across the country in August and September.

Hospitals quickly filled up with patients, and doctors and nurses began quitting due to low pay and poor working conditions. They took to the streets to protest, and even threatened a general strike.

To ease pressure on hospitals, the government built well-provisioned field hospitals and isolation facilities. It made sure there would be enough oxygen tanks for everyone, and those who want to get tested would be tested.

India too learnt from the devastation of its second wave driven by the Delta variant. Beds were added in government and private hospitals, oxygen supplies redirected from industrial uses, and medical students were drafted to help in Covid-19 wards.

In the wake of India's oxygen shortage crisis, many large hospitals now have oxygen plants within their premises, mandated in many states for hospitals with more than 50 beds.

Chemists have been asked to keep stock of Covid-19 medicines, including for "black fungus", an after-effect seen in some patients. Delhi's government is also training 5,000 youth to be health assistants, in case of a third wave.

In the United States, which quickly became the epicentre of the pandemic in spring last year and may experience its fifth wave soon, hospitals figured out how to quickly convert auditoriums and corridors into Covid-19 wards. Plans for field hospitals and alternate care sites were drawn up, able to be swiftly set up if needed.

Hospital officials in New York, Maryland, Virginia and elsewhere stockpiled personal protective equipment and got better at treating patients, learning not to put them on ventilators so quickly but to try less invasive methods of providing them with oxygen first.

Telemedicine, home isolation

Hospitals also prioritised patients, remotely treating milder cases via video appointments or isolating those who did not require urgent care at home or in other facilities.

In the US, some rural intensive care units (ICUs) started using telemedicine, enabling doctors at larger and more central hospitals - which were short on beds - to look after patients who were less sick, from afar.

Doctors in the city would check in on patients in rural hospitals, monitoring their vital signs on the screens and coordinating with local staff by their patients' beds.

In Thailand, a surge in Covid-19 cases from July sent hospital admissions in Bangkok soaring. Patients had to wait for days to secure a bed while the health authorities rushed to set up field hospitals for mildly to moderately affected patients.

Thailand also rolled out a home isolation programme for patients with mild symptoms, who received meals, medicine and medical items such as thermometers and oximeters, and did regular consultations with doctors through video calls.

The insurance regulator then ordered insurers to expand the coverage of their existing products to include treatment under the home isolation scheme.

In environments where home isolation was difficult, like slums and construction sites, a "community isolation" model was used. Entire groups of people were isolated and supported with medical facilities such as mobile X-ray vehicles when needed, with the help of civil society organisations.

The movement tapped Thailand's strong grassroots health network of more than one million village health volunteers, who gave crucial information and monitored the condition of those in far-flung communities.

The home isolation and community isolation models also spurred the development and use of new telemedicine technology.

Last September, Huawei Thailand signed a memorandum of understanding to provide 5G technology to two public hospitals that could be used for remote health monitoring and diagnosis.

Burnout and living with virus

But governments and hospitals also found that medical staff, increasingly exhausted as the pandemic wore on, were perhaps their most limited resource.

The US government sent federal Covid-19 response teams to help stricken states, and some states deployed their National Guard troops to hospitals as a stopgap way of easing staffing shortages.

A member of the Kentucky National Guard assists staff with restocking PPE at a hospital in Kentucky on Sept 16, 2021. PHOTO: AFP

In Malaysia, many doctors and nurses were already suffering burnout even before active Covid-19 cases hit a peak of over 260,000 in August, when ICUs were full and nearly 3,000 patients were admitted to hospitals daily.

A study in January found that 53.8 per cent of healthcare workers suffered burnout.

This led the health ministry to begin mental health screenings for front-liners in June and allow unrecorded leave to avoid symptoms of extreme stress.

Despite the need for more healthcare workers, two in five of 56,000 public sector medical officers are on contract.

A study in January found that 53.8 per cent of healthcare workers suffered burnout. PHOTO: REUTERS

A strike by these doctors in July prompted the government to offer hundreds of permanent positions and work on offering them pathways towards specialisation.

Almost two years on, people across the world are learning to live with Covid-19, and getting vaccinated and preparing for home care.

In Manila, for instance, people stocked up on flu medications, antibiotics, antivirals and even oxygen tanks, in case an outbreak hit their homes.

Additional reporting by Raul Dancel in Manila, Nirmala Ganapathy in New Delhi, Tan Hui Yee in Bangkok and Shannon Teoh in Kuala Lumpur.

Join ST's Telegram channel here and get the latest breaking news delivered to you.