State Doctors - COVID 19 Overwhelming System
The news of the untold struggle of health workers leaked out despite the gag orders on the doctors working in the medical fraternity in T&T. It soaked out from the walls of the ICU in Caura and Couva, the step-downs of Brooklyn, Balanda, Tacarigua, Home of Football, Debe, Augustus Long and Arima, the testing tents.
The following is the collective voice of a series of front-line doctors in state health care facilities, breaking gag orders as they are fed up of the top heavy opaque approach to managing the parallel health systems.
“There are just 1000 COVID-19 beds. Active cases are heading to 2000. Doctors are being told to try to discharge COVID-19 patients as quickly as possible.
If this trend of the exponential rise in COVID-19 positive cases and accelerated deaths continues, critical care space will be overwhelmed in a month.
“In San Fernando in the Severe Acute Respiratory Illness ward, people died before even getting into the parallel systems and were listed as COVID-19 deaths based on clinical evidence.
“COVID-19 positive patients aren’t just dying in ICU in Couva but while waiting to be tested, or waiting for test results.
“There are reports of people becoming acutely unwell in COVID-19 tents while waiting for test results, and a man in Arima dropping dead right there in the tent due to shortage of equipment.
“COVID-19 care depends on the time frame in which test results are being made available, and that’s variable. In SWRHA it can take between two and seven days. San Fernando General Hospital gives you the COVID-19 test result within an hour.
“One patient was quarantined at home when his test results came through. He was dead by the time he was brought to ICU.
“We are running out of tests, and are unaware of the plans to restock. We now depend on the Trinidad Public Health Lab or CARPHA. Granted supply chains for tests are difficult globally, but this too is not included as part of the conversation.
“The entire COVID-19 response is coordinated by a closed clique of three doctors and front line doctors, first responders to COVID-19 patients, are unsupported and entirely excluded from the planning, decision-making process and management of COVID-19 patients. There is no line of command.
Each RHA and hospital is doing its own thing, and that is causing chaos.
“Couva’s ICU’s staffing ratio is so low, there is only one nurse per ten patients and only one nurse for four critical patients.
“Those in COVID-19 facilities, including those in critical care wards, often have to wait an entire day to see a doctor.
“Junior doctors with little or no clinical experience assigned to the acute care units in Couva are untrained to look after seriously ill COVID-19 or recognise early respiratory distress or symptoms of septicaemia which could result in more deaths.
“The parallel systems and lack of coordination with front line doctors working in state facilities are creating chaos as there is no uniformity across the state facilities regarding managing patients suspected with COVID-19 who come to regular emergency rooms. It creates a logistical challenge in an already stretched service.
“For instance, there was a report of a pregnant COVID-19 positive patient, and no protocols were in place. The midwives refused the deliver the baby, and the obstetrics team also hesitated.
Had all doctors working in all state facilities been consulted, we would have collectively put systems in place to deal with situations like these.
“Front line doctors who aren’t even given insurance given to those doctors treating Ebola, are expected to run a regular emergency and trauma unit and manage patients who we suspect have COVID-19 without any guidance.
“For example when it was decided by the coterie of three that the system changed, and people who were COVID-19 positive with asymptomatic symptoms were to be sent home and monitored with phone calls, doctors were the last to know. We heard it on the television, and there was chaos in terms of what to do with the patients.
The Ministry of Health drip-feeds information not just to the public on the underlying conditions of people dying from COVID-19.by citing patient confidentiality but also to doctors working in state hospitals. It’s not a violation list of comorbidities but a lost opportunity to alert people of their risks be it obesity, diabetic, blood pressure, cancer, heart, lung disease, HIV, autoimmune diseases like lupus and arthritis.
“Global hope is herd immunity or a vaccine. Until that happens our population is at risk, and managing COVID-19 goes beyond masks and hand washing.”
It’s time front line doctors are brought into the loop of the care of COVID-19 patients to ensure our health service isn’t overwhelmed, and we will have to lockdown again.