“It is the worst nightmare of a hospital manager happening in reality,” the president of the Philippine Hospital Association, Jaime Almora, said in a recent interview.
Data released Monday by the Department of Health confirms this, indicating that 86% of the ICU beds in the National Capital Region are occupied, and 69% of isolation beds and 57% of ward beds have been filled. Covid cases are consistently more prevalent in the NCR, with the total number of active cases reaching 5,129 as of April 12.
The surge in coronavirus cases is real at the The Medical City (TMC) in Ortigas, as per the chairman of the Department of Medicine, Dr. Amiel Cornelio E. Dela Cruz. He tells ANCX that TMC’s Covid-dedicated wards and Covid-dedicated ER and ICU have been in full occupancy for the past two weeks—although it remains open to non-Covid patients requiring hospital care, diagnostic work-up, and surgical interventions.
Home care program
In order to cope with the increasing demand for hospital care of patients with Covid, TMC devised what it calls Covid Home Care program. Dr. Dela Cruz says it aims to attend to patients with mild to moderate diseases, so that their conditions can be managed early. It aims to prevent disease progression to severe or critical state, where the patient will really need hospital ‘critical’ care or ICU admission.
Dela Cruz says they conceptualized the program last year, aiming to accommodate about 30-50 patients only. But due to the current surge of Covid cases, the program has become fully operational even beyond its original capacity. “We are now targeting to accept a total of 100 patients,” he shares with ANCX.
The Covid Home Care program is intended for patients who qualify under these four categories:
- those who are suspected of or positive for COVID-19
- those who have mild and moderate symptoms of COVID-19
- those who are awaiting test results
- those who are completing self-isolation.
In this program, patients will be closely monitored daily via video call with attending physician and nurse. The program also provides laboratory services necessary for screening and monitoring. The hospital offers three different packages:
- P13,000 (a 3-day program for patients who were received at TMC Emergency Department or other ER facilities)
- P33,900 (a 3-day program for patients unable to visit the hospital but need the necessary assessment and diagnosis to rule out Covid)
- P65,000 (a 10-day program for patients with positive RT-PCR results).
Part of the hospital’s home care service, says Dr. Dela Cruz, is providing household members guidance and instructions on the proper care of the patient, as well as proper isolation and quarantine practices for the patient and family members.
Dr. Dela Cruz emphasizes that the program does not intend to replace or substitute ICU or critical care management, which can only be done in the hospital. “Severe cases need to be managed in the hospital. Home care management for critical cases is not at all possible,” he stresses.
In an online forum entitled “What to do When Covid Hits Home” organized by the Santuario de San Antonio Parish, Dr. Anna Lisa T. Ong-Lim, Professor and Division Chief at the Infectious and Tropical Disease Section University of the Philippines-Philippine General Hospital (UP-PGH), stressed important considerations when considering home care for Covid infected individuals.
One thing to observe is difficulty in breathing. “The patient needs to be comfortable just breathing room air (without any oxygen supplementation) and does not have any shortness of breath,” she says.
Risk factors should also be considered. “If they are above 60 years old, they are smokers, obese, or they have non-communicable diseases like cardiovascular disease, diabetes, chronic lung disease, chronic kidney disease, if they’re immunosuppressed for whatever reason, their immune systems aren’t functioning normally, and if they currently have cancer—these patients will not qualify for home care.”
Regarding home setup, Dr. Ong-Lim mentions the following requirements:
- A Covid positive patient should have a separate room and bathroom so that isolation can be implemented properly.
- The room where the patient is staying should have good air flow, with a door that can be kept shut.
- There should be a good delivery system for the daily needs of the patient.
- Contact with the infected or isolated individual should be avoided as much as possible.
- Eating with a COVID patient is definitely not allowed because it would mean the patient would be removing his or her mask in the presence of others, Dr. Dela Cruz stresses.
- “If being with the patient in the same room could not be avoided, wearing of properly-fitted masks, of medical grade if possible, is required of both the patient and the care-giver.”
- “Frequent washing and bathing by the care-givers is necessary, too, to prevent transmission of infection through droplets from surfaces and fomites.”
Dr. Dela Cruz adds that a basic home care kit consisting of medical devices for checking vital signs is necessary. These are:
- blood pressure monitoring device
- thermometer or body temperature scanner
- a portable pulse oximeter (to measure the oxygen level in the blood)
Over-the-counter medications for fever and body pains like paracetamol, as well as mucolytics for cough, may be taken at home, at the right dose and frequency, says Dr. Dela Cruz.
In an interview with ANCX, health reform advocate Dr. Tony Leachon advises Covid patients to keep themselves hydrated with water or electrolyte drinks, and take Vitamins C (which boosts immune system and prevents inflammation), Vitamin D (keeps bones strong and strengthen immune cells), and Zinc (helps the body fight bacterial and viral infections).
Should the patient exercise or just rest? “If a patient does not have fever or chills or body pain, and most importantly, does not have difficulty of breathing, light to moderate exercises, as tolerated, would actually be good,” says Dr. Dela Cruz.
Advanced planning and preparation for the conditions of a Covid patient will keep household members from panicking. “By knowing ahead when a patient needs further evaluation and care—like dropping of oxygen levels below the mid-90s range, signs of respiratory distress like labored breathing, or persistently high fever—the family caregiver will be able to respond properly and quickly, and will know what actions to take.”
If a patient starts to have difficulty of breathing or when the oxygen saturation levels begin to drop, it would be good to first administer oxygen through a nasal cannula at home, and call his or her attending physician, while waiting to be brought to the nearest hospital, says Dr. Dela Cruz. This home remedy will certainly be of big help while waiting for further management in the hospital.
It’s important not to panic in times of emergency. This entails being prepared for when Covid strikes our home. Below are some numbers to keep in your directory.
University of the Philippines’ Endcov.ph
The portal features a highly detailed map where users can zoom in or zoom out to see street or satellite views of the general locations and numbers of Covid hospital, testing centers, quarantine facilities, referral centers, and non-Covid hospitals nearest you. You can access the site thru this link.
Makati Medical Center HealthHub
Call or email MMC HealthHub at 8888-8999 local 2189, or email MMCHealthHub@makatimed.net.ph to get an appointment schedule. Service hours are 7AM to 5PM from Monday to Friday and 7AM to 3PM on Saturday.
The Medical City’s Covid Home Care
Check out this link for inquiries https://sites.google.com/view/covidhomecare
VRP Medical Center’s Telerounds Home Quarantine Pass
VRP offers this home care package for asymptomatic to mild Covid-19 cases only. The program includes 14-day telerounds by a physician daily to monitor patient’s condition, telerounds by a nurse on duty to check vital signs, a home care kit (thermometer, oximeter, and vitamin C supplement for 14 days), Covid-19 panel test, post Covid care consultation and medical clearance. For inquiries, call 8464-9999 local 361, Monday to Saturday, 8AM to 5PM or leave a message at 0917-8412416. Rate for the Quarantine Pass is P20,000. https://www.vrp.com.ph/telerounds-home-quarantine-with-hospital-care/
Offers swab RT-PCR swab testing in the following branches: Las Piñas, NS Amoranto, Sucat, Valenzuela, Alabang, Ortigas, McKinley West, San Juan, Lipa-Batangas, Calamba-Laguna, Sta. Rosa-Laguna, Angeles-Pampanga, Baliuag-Bulacan, Bacoor-Cavite, Kawit-Cavite. Strictly by appointment only. Home service is within Metro Manila only. Doctor’s prescription is required. Send a text or Viber message to 0917-6285669 or email firstname.lastname@example.org Check out their rates here.
Offers RT-PCR, Rapid Antigen, and Rapid Antibody Tests. Branches are located at #857 Lot 3, Mayon Street, Brgy. N.S. Amoranto, Quezon City (tel. nos. 8708-3520 / 230-2370; email ad: email@example.com. and at Unit 105 G/F, M Place @South Triangle #116 Panay Ave., Quezon City (tel. no. 2828-36959. firstname.lastname@example.org. The centers are open from Monday to Saturday from 6AM to 5PM, and on Sunday from 6AM to 12PM (Mayon branch), 6AM to 3PM (M Place branch).
Transcare Emergency Medical Services
Provides critical and non-critical ambulance transport within Luzon. Van is equipped with ventilators, pumps, infusions, and serviced by a physician. To book, call (02) 8514-4243 (PLDT); 0936-9232149 (Globe); 0928-389-0790 (Smart), 0999-8896563 or email email@example.com. They also have a Covid hotline for swab tests, 09090000006.
Provides 24-hour transportation to ill and injured patients, and medical airlifts anywhere in the country. They also provide emergency quick response, doctors on call, Covid antigen test, and decontamination service, among others. To book, call 8839-2520 to 30. Open 24/7.