Patient management and hospital facilities: Is the COVID picture portrayed by authorities real?

 COVID patients sleeping on the floor at DGH Nagoda, Kalutara

"Photos and videos of COVID patients sleeping on the floor with bare minimum facilities in some hospitals went viral on social media"

"Most hospitals have requested for more oxygen supplies as the number of patients who require oxygen is gradually on the rise"

"Most government hospitals are affected by the dearth of health staff as it poses a challenge to ensure nutrition and wellbeing of patients"

"Nurses and doctors are overwhelmed with work and expanding facilities alone wouldn’t suffice, affirm health authorities"

The sudden spike in COVID cases in Sri Lanka has overwhelmed hospitals thereby prompting decision makers to request asymptomatic patients to remain at home. While several concerns have been raised with regards to this decision, it does seem that there’s no other option to control the present situation. In the meantime, photos and videos of COVID patients sleeping on the floor with bare minimum facilities in some hospitals went viral on social media. 
In this backdrop the Daily Mirror contacted several main hospitals in selected districts to inquire into the present situation. But contrary to what was being shared, the picture shown to this paper was rather positive. 

D G Hospital Nagoda, Kalutara requires more oxygen

With several photos of COVID positive patients sleeping on the floor at District General Hospital (DGH), Nagoda going viral on social media, the Daily Mirror spoke to Hospital Director Dr. Chintha Gunaratne. “We are in the process of arranging two temporary wards for these patients. So far there are 40 COVID positive patients in isolation wards. If a COVID patient is admitted we do the initial management and then refer them to a treatment facility depending on the severity of symptoms,” said Dr. Gunaratne. 
When asked about facilities including oxygen, Dr. Gunaratne said that they have requested for more oxygen supplies as the number of patients who require oxygen is gradually on the rise.

8 infected pregnant mothers at Colombo North Teaching Hospital, Ragama

Another video of COVID patients sleeping in a packed space went viral on social media. This was reportedly taken at Colombo North Teaching Hospital, Ragama. However when inquired, Hospital Director Dr. Sampath Ranaweera said that so far around 120 COVID positive patients are at the hospital. There around 80 more positive patients at Kandana Hospital. So far, four patients are critical and are referred to ICU care and six patients are in High Dependency Units. Eight pregnant mothers are also among those who have been admitted with COVID symptoms,” said Dr. Ranaweera.

Situation under control at D G Hospital, Gampaha A post allegedly exposing the situation at District General Hospital, Gampaha did its rounds on social media. According to the post which has been compiled by a respiratory physician at the Hospital, the oxygen supply is fast running out and capacity at ICU facilities are at a maximum. The dearth of health staff has posed challenges to ensuring nutrition and wellbeing of patients. However, when the Daily Mirror contacted Hospital Director Dr. Priyantha Illeperuma the situation seemed to be have been taken under control. 

“We have established three wards that can accommodate around 120 COVID positive patients. Around 60-70 of them have been admitted so far. The Sri Lanka Navy is in the process of setting up High Dependency Units which will include 14 more beds. A COVID ICU Care facility will also be included with 10 more beds. We have received two ventilators for patients who require oxygen. An operation theatre is also being setup at the ICU care facility for patients that require surgeries. Out of the 120 beds we have allocated 15 of them for pregnant mothers and there’s a separate Labour room as well.

“In order to manage severe patients we need to give oxygen from cylinders and in one hour we need to give around six to seven cylinders. But this is a heavy workload for the staff. Thereafter our respiratory physician shared his thoughts and received donations. From them we were able to install Wall mounted oxygen flow meters to cater to around 10 patients,” he added. 

When asked about the availability of healthcare staff he said that if a staff member tests positive they are being investigated. “In most investigations it has been clear that their close contacts have been outside the hospital.” he said. 

A press release dated May 15, 2021 was also circulated requesting a number of equipment for COVID treatment units at DGH Gampaha. The requirements included NIV/CPAP Machines (20),  Multipara Monitors (20), Wall mounted oxygen flow meters (100), Finger Pulse oxymeters (100), Digital BP apparatus (20), Non-rebreathing masks (200), High flow oxygen machines (5) and High flow oxygen nasal cannulae (100). 

Drop in admissions at National Hospital, Kandy 

With more cases being reported from Kandy, the Daily Mirror spoke to Kandy National Hospital Director Dr. Chandana Wijesinghe who said that he observes a drop in the number of admissions. “This could be due to the lockdown or because those who have symptoms are unable to visit the hospital due to travel restrictions. We can only observe the difference once travel restrictions have been lifted.” he said. 
On Sunday only 16 COVID positive patients were at the National Hospital treatment ward while four patients were in ICU care. “But around 500 patients who have tested positive have been admitted to satellite hospitals coming under our purview. We are in the process of improving oxygen facilities and setting up High Dependency Units which will be in use within next two or three days,” said Dr. Wijesinghe.
When asked about pregnant mothers he said that COVID positive pregnant women are being referred to the Katugastota District Hospital.

Enough space for admissions at Teaching Hospital, Karapitiya 

Around 4709 cases were detected from Galle as at May 18, 2021 while several areas in Galle District continue to be isolated. However, Karapitiya Teaching Hospital Director Dr. Shelton Perera said that there’s enough space to accommodate COVID patients. “The daily number varies, but it could be between 50 and 70. There are two patients in ICU care and we have five ICU beds. Oxygen and other facilities could be managed for the time being but we cannot be certain about the situation in future.”

Facilities expanded at D G Hospital, Nuwara Eliya 

Another 2498 cases were detected from Nuwara Eliya as at May 18, 2021 and several areas have been isolated. However, DGH Nuwara Eliya Director Dr. Mahendra Seneviratne said that they have expanded facilities to include 80 beds. “We see a lot of admissions relating to COVID and as at Sunday there were around 50 patients. But we only admit severe patients and others are sent home.”
He said that facilities including oxygen supplies are still manageable.

ICU bed capacity to be expanded at Teaching Hospital, Jaffna 

As per the official figures released on May 18, 2021 as many as 1889 COVID cases were detected from Jaffna. However, the Jaffna Teaching Hospital is equipped with resources to cater to the needs of the patients. “We have converted two medical wards to serve COVID positive patients and around 400 beds have been arranged at Kopai Training College for asymptomatic patients,” opined Hospital Director Dr. S Sribavanandarajah. “There’s a separate operation theatre and we are planning to expand ICU bed capacity from four to 15. Around 40 patients that have been admitted need attention.” said Dr. Sribavanandarajah. 
When asked about oxygen facilities he said that there’s a plant from which they could get the required supply while also sourcing from Point Pedro Hospital if the need arises.

D G Hospital, Tissamaharama to seek donations 

A patient at Hambantota District General Hospital succumbed to COVID-19 on Sunday, even after receiving a continuous supply of oxygen. He was initially diagnosed while receiving treatment at Tissamaharama General Hospital. “Once he was diagnosed we referred him to the Hambantota Hospital because that is the main treatment Centre here,” opined Tissamaharama DGH Director Dr. Wasantha Wijeweera. “While he was here he didn’t show any complications as well. A similar incident happened to another patient who was referred to the Neville Fernando Hospital sometime back. She too was completely normal while she was receiving treatments here.”

However when asked about facilities Dr. Wijeweera said that they do not have sufficient wall mounted oxygen facilities to be given to critical patients. “Right now we are managing the situation with oxygen cylinders and can only treat one or two patients with what we have. But if there are more patients than that we will be unable to treat them.  Some patients may need more than one cylinder depending on the severity of the illness. The government is doing its best to curb the pandemic and the Ministry of Health is already overwhelmed with the demand.

Therefore we have opted to request donations from the private sector.
 “We are in the process of establishing a new ward at the hospital premises and it would cost around Rs. 500,000. It is an old building and needs refurbishing as well,” he added.

If a suspected COVID patient who arrives at the Hospital tests positive for COVID-19 without showing symptoms he is referred to an Intermediate Care Centre in the area. “Three such centres are situated at Angunukolapelessa, Ambalantota and Middeniya. If they show mild to moderate symptoms we admit them to the ward and do treatments. Critical patients are sent to Hambantota Hospital. However there’s a waiting list for critical patients in certain hospitals,” he continued. 

Dr. Wijeweera expressed gratitude to several parties who have donated their oxygen cylinders at this crucial hour. “A few garages and hotels in the area donated the oxygen cylinders they have. Right now we have 17 cylinders and out of them, six are at the theatre.” the doctor said. 
The Daily Mirror also contacted Anuradhapura, Ratnapura and Moneragala hospitals and according to hospital spokespersons the facilities are in place and are manageable as at present. 

What about healthcare staff?

Even though hospital facilities are being expanded the Government Medical Officers Association (GMOA) has raised concerns over staff capacity. “Nurses and doctors are overwhelmed with work and expanding facilities alone wouldn’t suffice,” opined GMOA Secretary Dr. Senal Fernando who made these remarks at a press briefing. “Around 5000 patients are unable to visit hospitals and get the required treatments due to lack of facilities and healthcare staff.” said Dr. Fernando.  Dr. Fernando said that an efficient health surveillance system should also be established to monitor the situation during the upcoming weeks. 

Oxygen demand may exceed national oxygen capacity 

“If transmission keeps on increasing, the number of severe cases needing oxygen will increase. At some level it will exceed national oxygen capacity,” observed international medical researcher and Director at Institute of Health Policy, Dr. Ravindra Rannan-Eliya. “So of course fatality rates will increase. It should be noted also that some severe cases need continued oxygen support for several weeks,” said Dr Rannan-Eliya. 

When asked about the cost of supplying medical oxygen, Dr. Rannan-Eliya said that even though he is not aware of the costs, it is increasingly difficult to obtain equipment such as concentrators (extract Oxygen from the air), because of the Indian crisis. “India is placing emergency orders for such equipment in China and government should request the same if it is likely that we will run out of capacity.”  the doctor said. 

He further said that it is crucial to meet this demand for obvious reasons, but the most crucial need is to slow transmission, so that daily infections start falling. “This is more important than the current oxygen problem because only that will prevent us needing the additional oxygen. All of this was predictable. If MOH had invested earlier in adequate testing, we would never have got to this position where we are forced to spend huge amounts of money to stop people from dying.” explained Dr. Rannan-Eliya. 

COVID Patients at Homagama Hospital