PGH COVID-19 Fight is “de-mistified” during an interview with the PGH Director Dr. Gap Legaspi April 17, 2020
During the Webinar portion of the recently concluded Board of Governors electronic meeting, the PGH Director Dr. Gerardo Legaspi spoke about how PGH is faring in their fight against Covid-19. I was struck at how well prepared they were, and that the coordination of the different Government Hospitals and private hospitals were more organized than what I saw at least in our part of the western suburb of Chicago. They were prepared for battle against something that was more of a surprise attack from an unseen enemy. PGH was designated as one of the COVID Referral Center, accepting only the COVID positive patients and moderate to severely ill cases that cannot be managed elsewhere (Tala Leprosarium and the Lung Center are the other 2 Covid centers)
When the Quarantine was enforced March 15, PGH was already aware that COVID-19 was lurking and the cases, mostly in more affluent Private Hospitals, were already climbing. It would just be in a matter of time, that PGH will be overwhelmed. Meeting with other heads of hospitals, PGH was singled out as one that can handle the sick cases. The PGH Covid Crisis Committee was created and In 7 days, 2 PGH wards were converted into a COVID-19 enclave. Compartmentalized with effective barriers for the healthcare workers and the patients, the whole place was fitted with a unidirectional air-flow set up. These wards accommodated 130 cohort rooms that included a 20 bed ICU. 40 rooms in the UPMASA Operation Wildfire private ward were designated as isolation rooms for a total of 170 beds. The hospital had 27 respirators and added 15 (repaired ones) for a total of 42 with an additional 30 standby from private outsourced companies (There are only 1500 respirators in the whole Philippines).
Fearing a problem in manpower, PGH adapted a seemingly paradoxical approach of “personnel reduction scheme”. Personnel (Doctors, nurses and other essential healthcare workers) were assigned into three 1-week work shift teams. I team will work for 1 week and then rest for 2 weeks. During the working week, the team members were booked into nearby hotels, in rooms donated by its owners. Food and essentials were supplied by PGH and the Bayanihan Program organized through the Chancellor. They were shuttled to and from the hospital. The other teams stayed home in a 2-week rest and “quarantine” period. The hospital was transporting a total of 1000 personnel per day costing P30,000/day
They estimate a need of 21,000 PPEs/month and stockpiling on these PPEs both purchased and donated, PGH was able to build a reserve of about 1.5 months. PGH is hoping that a locally designed and manufactured PPE branded as PGH will be out in production soon. This will have an output of 10,000 PPEs/day when fully operational. Masks will be another issue as N95s have to be designed to fit the individual’s face properly.
At the end of the work-shift, or whenever a team gets out of the COVID ward, they pass through decontamination process. With PPEs on, they go through a misting tent – an “alcohol mist compartment” to lessen the viral load potentially being carried out of the unit (normally we drink the alcohol after working). The workers then take showers before finally donning on fresh clothes. Consultants who came from the Wuhan region were greatly impressed at the innovations. PGH is not without help from outside either because the DOH sent 30 doctors and 60 nurses and technicians who form part of the pool of workers in the COVID 19 wards.
Our own fight within the PGH is something to be proud of. With the expertise and hard work of our Internists, Pulmonologists and ICU personnel, a 50% de-escalation of severely ill is the norm. Out of the more than 160 severely ill COVID patients, 37 have now been discharged improved. 11 beds out of 20 are occupied in the ICU because most die upon arrival or upon transfer to the bed. The rest prevented from getting critical with aggressive treatment from our Pulmonary experts using high flow nasal cannulas, bronchial toilet, and availability of medicines from Hydroxychloroquine, Lipolivir, Tocilizumab, and others. Our Hematology Department has started using convalescent plasma for treatment. Workers in the COVID-19 ward are hardly infected. Out of 26 positive tests among PGH healthcare workers, only 5 are workers from the COVID-19 wards who are equipped with Level 4 protection. The rest is acquired within the community of PGH – during conversations when we let go of our guards (no masks, etc) stressing the importance of masking and social distancing.
The logistical challenges of manpower, supplies, and the “Fort” secured for at least 1 ½ months, the battle is brought to the communities. The task is to identify and isolate the enemy, contain the situation and then move on to the next community. A group of Family Medicine and Public Health front liners are now instituting 250 tests per day and with the development of rapid testings, the hope is to raise this to 1000 per day. With a grant from the Lopez family and final accreditation of our locally developed testings, this will bring an additional 1500 test per day for a total of 2500 tests per day capability. The ones identified can be transferred to MEGA- quarantine facilities such as the converted Rizal Memorial Stadium, the PICC and other facilities capable of housing 1000 patients. Note that even our Genome Center is helping and they can even identify the origins of the virus (Geographic) and follow how they mutate and change (which makes it even scarier).
Given this story, we among the audience in the webinar, cannot help but shed tears and at the same time felt pride for the gallant battle being fought. The innovations and knowledge acquired by these warriors are phenomenal and worthy of a story to write. Like the “Misting Tent innovation”, this report on the PGH war is made clearer to us. In other words, “demystified”. Like parents worried about their “faraway kids”, we are relieved to know that they are faring well. As parents, we are also ready to help in any shape or form if needed.
It is still unfolding and the fight still needs support because like the PGH Director said, the end game is not here yet. Like chess, we just started the middle game. This is the battle we are all helping. Pictured here is the unloading of PPEs just recently purchased from UPMASA’s COVID 19 PGH Assistance Fund Raising.
A great big hand to the brave healthcare workers of PGH and all over the world!
Thank You!
Report filed by Henry Echiverri MD, Chair, UPMASA BOG, April 21, 2020
UP Medical Alumni Society America