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COVID-19: Situation with Treatment More and More Confirmed Cases of COVID-19 Are Recorded Daily

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COVID-19: Situation with Treatment More and More Confirmed Cases of COVID-19 Are Recorded Daily COVID-19: Situation with treatment More and more confirmed cases of COVID-19 are recorded daily. Official data already show about 60% of the beds in the hospitals of the first wave occupied. Given that statistics do not display hospitalized with suspicion, the actual situation might be even direr. Considering this, R2P decided to conduct monitoring visits to the treatment facilities to see the situation from within. In September, our monitors visited seven in-patient medical facilities and two probationary units located in or serving the population of Popasnianskyi raion of Luhanska oblast, Bakhmutskyi, Volnovaskyi, Yasynuvatskyi raions and Toretska MCA of Donetska oblast. Data was collected through interviews with informants. Although our respondents were carefully chosen and usually held administrative positions in each institution, the information might be subjective. Where it was feasible, data was cross-checked with multiple sources. Hospitals: The hospitals' total maximum capacity was 451, although some of the beds were in reserve. The number of beds in each facility, along with other indicators, can be observed in the table below. Special isolation wards were in operation only in Rubizhne central city hospital (CCH), Myrnohrad infectious disease hospital (IDH), and Volnovakha raion central hospital (RCH). The isolation ward in Kostiantynivka IDH is under reconstruction until the end of the year. After that, it can be deployed again. Elsewhere patients were accommodated in regular wards (normally hosting 2 – 4 patients each) on separate floors, ensuring safe access to sanitary facilities. Wards equipment ranged from new to being in satisfactory condition. Some beds needed replacement in Kostiantynivka intensive treatment hospital (ITH) and Toretsk CCH. Informant at BITH shared a concern that the infectious disease unit's (IDU) building was not designed but rather repurposed for the unit's needs. Thus it might not meet all the requirements and demands. Facility Capacity Reported Reported Confirmed Hospitalized, Hospitalized, total reserves cases Max Min occupancy (as of 28/09/2020) Rubizhne CCH 36 16 20 18 33 2 Bakhmut ITH 55 63 10 41 63 0 Kostiantynivka ITH 114 21 0 5 21 0 Kostiantynivka IDH 70 65 0 35 70 35 Myrnohrad IDH 75 64 45 37 75 3 Volnovakha RCH 46 19 16+30 3 15 0 Toretsk CCH 55 26 60 31 28 4 As of the day of the visit, monitored hospitals hosted 274 patients with either confirmed or suspected COVID- 19 status. Most institutions described a steady rise in hospitalization cases related to coronavirus since, at least, August. Almost all of them seemed to have backup plans for refurbishing other units in case of need or even using tent wards to accommodate people with less severe symptoms; however, it remained a suboptimal solution. Informants would prefer to redirect the flow to other, so-called second-wave medical centers. According to the estimates, on average, hospitalization lasts between 14 and 21 days, Toretsk CCH indicated seven days only. Regarding lung ventilators occupancy, monitors were informed that patients could spend three to six days connected to them. Getting test results in time remained one of the most serious issues. Average waiting time could reach up to two weeks (3 – 14 days), especially in Donetska oblast. There were even cases of people dying before their results arrive. Besides, it prevented hospitals from releasing people who allegedly recovered. IDHs fully switched to serving COVID-patients, so no other patients were received at the moment. The situation seemed the same in IDU of Bakhmut ITH and Rubizhne CCH. Overall, if hospitals admitted or serviced other patients, it was done in separate units, so that this business went as usual, and people kept coming. There was a tendency spotted, though, to opt for outpatient care if possible. Also, pediatrics units may have fewer cases to handle. More people seemed to address their concerns to the hospitals by phone. Volnovakha RCH and Toretsk CCH pointed out to a higher number of pneumonia cases, which might be seasonal. On the other hand, coronavirus cannot be excluded, but since testing capacities are overloaded, there is no definite way to tell. Coronavirus patients were normally delivered to the hospitals by emergency medical service teams (EMST); sometimes, before that, sufferers might be advised to be hospitalized by their GPs. Hospital employees in protective clothing met subjects at the separate entrance and transferred them to their rooms via special routes. EMST cars are disinfected after delivery by the receiving institutions. People were admitted to COVID-19 facilities based on PCR or EIA test results, doctor's diagnosis, and/or lungs image. Emergency wards typically confirmed reception with hospitals in advance. Alternatively, patients could be transferred from other medical units when suspicion for COVID-19 had arisen. Bakhmut ITH and Volnovakha RCH, in theory, confirmed a possibility of accepting people who came on their own. In case of hosting both suspects and people with confirmed COVID-19, they were accommodated separately. However, suspects often had to share a room with other suspects. The situation here was complicated by the delay in getting test results and limited room capacities. Receiving units were separated into clean zones and dirty zones. Documentation was stored in the clean zones; staff resting areas were typically there as well. Patients resided in dirty zones being confined to their rooms. Upon entering such zones, hospital personal must wear PPEs. Some hospitals could be particularly strict about the protocol, forbidding them to use toilet and drink water while inside. Employees spent between four and six hours in the dirty areas, at least. Upon exiting, they must change and undergo disinfection in the buffer zone. Non-reusable PPEs had to be disposed of. Premises were disinfected 3 times a day. Laundry was done in a separate washing machine using special chemical additives. Catering was organized two-three (Kostiantynivka IDH, Myrnohrad IDH, Toretsk CCH) times a day. Meals were cooked in the food unit of the hospital and delivered to the patients' rooms. Food had to be consumed inside. However, the informant at Volnovkha RCH mentioned delivery only to the patients with severe symptoms. Everywhere, except for Myrnohrad IDH, utilized utensils were reusable. Therefore they were disinfected after every use. NHS fully covered catering only in Kostiantynivka IDH and Myrnohrad IDH. Other facilities also named local government, businesses, hospital's budget among their funders. Treatment was covered by NHS, sometimes partially by local authorities. For example, our respondent informed that in Volnovakha RCH, 80% of the treatment costs were covered by the state (source was not specified), 20% - by the hospital’s own budget. Patients had to source their own medications for non-COVID related illnesses or if they wanted something that was not in the National List of Drugs. Psychological assistance was not provided anywhere but in Toretsk CCH. The stock of drugs, ventilators, and other equipment was reported to be sufficient or ample. Many pieces of equipment have been purchased quite recently, such as ventilators, oxygen masks, etc. Toretsk CCH seemed to be missing respiratory humidifiers. Kostiantynivka IDH referred to having a CT as their unfulfilled dream, which remained too expensive for the hospital. PPE reserves were also either ample or sufficient. However, it was hard to give a precise estimate, especially when it comes to non-reusable PPEs, given that the development of the epidemic is not clear. In most of the institutions, provision improved or already was sufficient. Toretsk CCH, on the other hand, pointed out to the lack of overshoes and gloves. All medical facilities received some assistance during the course of the epidemic. Among major donors were international and local charities, NGOs, local authorities, and businesses. The central government and NHS also provided help. The main areas where assistance was in hand were purchasing equipment and supplying PPEs. During quarantine restrictions, transportation of employees from rural areas was often arranged. In Toretsk CCH, staff resting areas were refurbished with the support of international donors. Overall, among sources of income were named NHS, local government subsidies or special assistance programs, central government target programs or subsidies, local territorial communities. From non-NHS resources, hospitals often pay utility costs, catering, equipment overhaul, or servicing. Medical reform effect on the hospital’s finances was positive for Kostiantynivka ITH, and Myrnohrad IDH, negative for Kostiantynivka IDH, Volnovakha RCH, Toretsk CCH, and not clear in case of Bakhmut ITH as it was said that the hospital "had survived it," informant at Rubizhne CCH did not provide any comment. When respondents explained some of the negative factors, it was usually that the tariffs do not cover the actual costs of treatment (e.g., UAH 4000 for every infectious disease case regardless of its severity or length). The shortage of doctors remained the main challenge in Rubizhne CCH, Bakhmut ITH, and Volnovakha RCH. The latter also informed about difficulties with filling nurse vacancies. Neither facility reported having lay- offs. Only three recognized employees quit their jobs. Bakhmut ITH attributed it to the regular attrition, Kostiantynivka IDH, and ITH confessed that some of their staff left because of the risks associated. Another thing that came up was that even full staffing might not be enough to deal with COVID-19. In this regard, Kostiantynivka IDH recalled a special practice of associated staff members, who were trained accordingly but called upon only in case of an outbreak. So far, there appeared to be no significant changes in the workload and scheduling at Rubizhne CCH and Volnovakha RCH. Kostiantynivka ITH adjusted shifts, so each lasted 24 hours while the load was declared more or less the same. All other institutions confirmed an increase in the workload and its intensity. Staff there were asked to work overtime.
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