Resource Estimates & Analysis of Capacity Thresholds for COVID-19 Pandemic in the Philippines (REACT-PH)

Introduction

The strategy of flattening the curve in addressing the COVID-19 pandemic is geared towards ensuring that infection cases do not overwhelm the health care system capacity. It is based on the rationale that when the infection rate exceeds the capacity of the health care system, adequate treatment measures may not be provided, which may result in higher mortality rates. The challenge is compounded by the fact that very little is known about the virus: that a viable vaccine is yet to be developed, that the possibility of reinfection had already been documented in a number of cases, and that the efficacy of current measures being employed to prevent transmission are yet to be determined. Considering these, we cannot discount the possibility of resurgence of infection cases in the event that the government lifts the various levels of community quarantine in place.

The imposition of community quarantine buys us time to enhance the capacity of our health care system such that is not overwhelmed by the demand. As a requisite, this entails the assessment of the capacity and needs of our health care system in tackling the COVID19 challenge. Per DOH directive, all level 2 and 3 hospitals are directed to attend to all patients suspected or diagnosed with COVID 19.

Moreover, the resurgence of cases may be mitigated with carefully planned public health measures. Studies show that viruses in the coronavirus family may persist in surfaces for as long as five days. Disinfection in public places may be an effective measure to mitigate virus transmission.

This project aims to develop a framework for the assessment of the health care system capacity at the LGU level in coping with the demands of an epidemic or pandemic such as that caused by the COVID-19 virus.

Significance of the proposal

This project is hinged around the question: How do we know if the local healthcare system is adequate to deal with an epidemic or a pandemic?

In the Philippines’ case, we know because we have experience firsthand how our national healthcare system had been overwhelmed by the surge of COVID19 cases. We know because we were caught off-guard. Would it have been better if we knew beforehand and so we can take proactive measures towards capacity enhancement? This project addresses this concern by developing a systematic framework for the pre-pandemic capacity assessment.

On a broader scale, we expect the following impacts:

Better chance at providing healthcare towards recovery

The attainment of these objectives will enable us to come up with a strategy to mitigate the exceedance of our health care system capacity. Access to an adequate health service will improve the chances of those who contracted the virus at recovery.

Systemic approach towards resource allocation in a pandemic/epidemic-level event

This will also enable the Department of Health to identify needs and systematically allocate and deploy resources when dealing with a pandemic/epidemic-level event. The output of this study shall enable the following:

1) Guidance for national-level decision-makers in the formulation of policies and strategies to address a pandemic. The resulting framework will allow for a more rationalized quarantine level imposition and resource allocation.

2) Informed strategies and decisions at the LGU level. The framework may aid in identifying the best practices and rooms for improvement in an LGU’s healthcare system in regards to dealing with a pandemic. In the event of a pandemic, guidance may be provided as to how much resource is necessary to cope and respond to the epidemic.

3) Information may be made more palatable to the private sector, which may then assist in the capacity building through public-private partnerships, capacity-building support, or donations.

Literature Review

In order to prevent the number of COVID-19 patients from overwhelming our healthcare system capacity, the Philippine government, on March 13, announced a month-long community quarantine for Metro Manila to be effective after a 48-hour time window. However, due to increasing reported cases outside of Metro Manila, the measure was escalated into an enhanced community quarantine, the coverage of which was expanded to cover the entire Luzon island [2]. The quarantine measure, however, does not reduce the peak case rate, but only defers the occurrence of the peak, thereby buying us time to develop measures that would augment our healthcare system capacity and find solutions to address the pandemic [3].

The first two weeks since the declaration of a global pandemic has seen big hospitals in Metro Manila opting out of accepting new COVID-19 patients due to exceedance of their capacity [4]. This prompted the DOH to declare three government-owned hospitals to be COVID-19 centers: UP-PGH, Lung Center of the Philippines, and Dr. Jose Rodriguez Memorial Hospital and Sanitarium (also known as Tala Leprosarium) [5]. However, LCP can only allocate a wing with 40-patient capacity because the specialty hospital also tends to a lot of respiratory-disease patients [6].

With the current count of COVID-positive patients seen increasing on an exponential trend [7], more hospitals may need to be equipped and augmented to cater to COVID patients.

An indexing framework is increasingly used in representing the resilience, or the adequacy, in contrast with the ideal level, of systems and processes [8, 9, 10]. In the field of health sciences, in particular, indices have been extensively used as gauges to measure the state of health of a person. Indices enhance the ease of communicating hierarchical values, e.g. health status or resilience levels, which may be too technical to convey to non-experts.

Thus, an indexing framework may be useful in conveying local healthcare system capacities, which may be laden with jargons and statistics, to policymakers and lay persons.

Objectives

The main objective is to aid the Department of Health in ensuring that the capacities of our health care system, particularly that of Level 2 and 3 hospitals and facilities being used for triaging are not exceeded.

This will be achieved through the attainment of the following objectives:

a.     To document the indicators, best practices, and critical success factors of a local healthcare system that can cope with the demands of an epidemic/pandemic

b.     To develop a framework and indexing tool for the assessment of the capacity and needs of the health care system at the LGU level in an epidemic/pandemic scenario.

c.     To examine using the developed framework the healthcare capacities of LGUs in coping with the demands of an epidemic or pandemic.

Expected Output

The study shall have the following outputs:

a.     A framework and indexing tool that enable a systematic assessment of the capacity and needs of the health care system of LGUs in dealing with the COVID-19 virus, or any eventuality that may cause a massive surge in the health care demand.

b.     A case study in which the framework is applied for the estimation of the healthcare system capacity of a selected city.

c.     An analysis of the healthcare system capacities of Philippine provinces and HUCs, calibrating with respect their performance in light of the COVID-19 pandemic.

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