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‘We are forced to play god; who should live who should not’
With lots of patients needing oxygen we may soon see scenes like in India. Pic by Indika Handuwala
It is heartbreak time for many doctors and nurses conscientiously performing their duty, risking their lives for COVID-19 patients.
While most of them are exhausted but working at full speed, with the hospital system being overwhelmed, they have been forced to ‘play god’, in the light of limited ICU beds and beds with live-saving oxygen-providing facilities.
With some private hospitals allegedly turning away COVID-19 patients, the flood of sick people turns for help to the state hospitals in the much-beleaguered Western Province which comprises the Colombo, Kalutara and Gampaha districts.
“Yes, it breaks our heart to make these choices, knowing for sure that the patients we keep out of the ICU would inevitably die,” said an emotional Physician, explaining that this “hard choice” they make in consultation with the Consultant-in-charge of the ICU is taking a massive toll on their mental health.
It is an ethical dilemma, many said with much poignancy. “We are supposed to save lives, not be the judge of whom we save and whom we leave to die, due to lack of facilities.”
One described the experience of having to make such a decision. In a heavily-burdened COVID-19 ICU, a precious bed had fallen vacant. Two elderly patients, both in their 60s, needed this bed to save their lives.
“Then came a transfer of a critically-ill 24-year-old who also needed an ICU bed. What choice did we have,” was the heartrending question posed by the doctor.
Agonizing over the decision, the ICU bed was allocated to the young person. There were, of course, no guarantees that the person would survive. What of the other two elderly patients?
They are in a normal ward and may soon be face-to-face with death, murmured the doctor who walks into the ward, hoping against hope that they are alive.
Traumatized, these healthcare staff is, as distraught families of patients somehow get their mobile numbers and keep calling them to save their mothers or fathers who are under their care.Sometimes it is a losing battle as the rising death toll indicates.
Lots of patients need oxygen, another Physician told the Sunday Times, stressing that if the Delta variant continues to spread at this rate without a curb, “we may see scenes like in India sooner than later”.
This is in addition to healthcare workers also falling victim to COVID-19 even though fully-vaccinated, it is learnt.
Whatever the reason they are being hit by the virus – due to it being in the community or the removal of masks while eating together during working hours or sharing congested and crowded restrooms – urgent action needs to be taken to prevent this. Otherwise, the hospitals will take a worse hit and may even have to close their doors to patients, many said.
Numerous doctors also conceded that “minissu asaranawela”. When people hear that they have got exposed to the virus, they are unable to do the test to confirm whether they are infected or not.“Yannathenak ne,” they said.
Even when patients go into hospital for other procedures, the wards get infected with COVID-19 and, in turn, infect these patients. Then, if they are asymptomatic or mildly symptomatic, they are asked to return home, finding their own transport and contact the Public Health Inspector (PHI) of their area. These patients, mostly from humble homes, go back and infect everyone at home as well.
Doctors and experts conceded that there are also many social issues that ensue when the notice is posted on the gate that a house has positive patients. In some villages, no one will get close to that house and some of the patients and their families may be starving due to their inability to stock food as they just don’t have the money, while the ground level public health workers including PHIs are also overburdened.
| Do not take steroids if asymptomatic or mildly symptomatic “Do not take steroids if you are COVID-19 positive and are in home care as you are asymptomatic or mildly symptomatic,” stressed a senior Physician, pointing out that such use of steroids could have disastrous consequences. The Physician said that taking steroids in the early stage of COVID-19 is very dangerous, as they suppress immunity and would allow the virus to spread within the body. “We give steroids when the patient’s condition due to COVID-19 begins to deteriorate and the body is caught up in a ‘cytokine storm’. A cytokine storm is an uncontrollable inflammatory response by the immune system to meet the invading COVID-19 virus,” he added.
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| Highlights from Health Promotion Bureau media briefingHere are the highlights of Friday’s media briefing at the Health Promotion Bureau.The Head of the Disaster Preparedness and Response Division of the Health Ministry, Dr. HemanthaHerath stated: As at Thursday, 3,039 new cases have been reported. The death toll was 156 deaths on Thursday. At the 224 treatment centres, there were 34,345 beds of which 32,607 beds were occupied. 95 ICU beds were occupied. 20,362 RT-PCR Tests and 7,098 Rapid Antigen Tests were conducted. Consultant Nephrologist Dr. Anura Hewageeganaof the National Institute of Nephrology, Dialysis and Transplantation, Maligawatte, requested anyone with the following issues who have contracted COVID-19 to contact the respective hospital and clinic where he/she is registered: Those with advanced kidney disease Those on immune-medication for nephropathy (kidney disease) Those who have undergone kidney transplants Consultant Physician Dr. Upul Dissanayake of the National Hospital of Sri Lanka (NHSL) said: The way the virus infects a person is mostly through the nose and mouth. So touching any contaminated surface with your hands will not infect you, unless you touch it and then touch your nose, mouth or eyes. This is why a person needs to wash his/her hands frequently. It is very important to wear the face mask properly over the nose and mouth, especially in closed spaces. The virus is inhaled through the nose (this is how you get infected) and then exhaled through the mouth (this is how you infect others). The virus can also be exhaled when sneezing, coughing, laughing, singing etc. The virus may remain air-borne for around 16 hours, especially in closed, air-conditioned areas. It is important to switch off the AC and open the windows for the air to flow through in such places. Peradeniya Hospital managing influx of patients well The Peradeniya Teaching Hospital which has as its ‘catchment’ area the whole of the Central Province, is managing its COVID-19 influx of patients well, the Sunday Times learns. The hospital has 120 beds including 8 Intensive Care Unit (ICU) and 40 High Dependency Unit (HDU) beds, said Director Dr. Arjuna Thilakarathna. In addition, it also has 40 maternal and child beds. He explained how when patients are on the path to recovery and can be transferred, they send them to three step-down hospitals with a bed capacity of 140 to balance the incoming flood of very ill patients. The step-down institutions are the Kadugannawa (65 beds), Hataraliyedda (50 beds)and Geli Oya(25 beds) Divisional Hospitals. The teaching hospital also manages the 450-bed Penideniya and 80-bed Giragama Intermediate Care Centres (ICCs). Meanwhile, with an urgent need to accommodate psychiatry patients who are affected by COVID-19, the Peradeniya Hospital has made arrangements to convert one of the two normal psychiatry wards (male and female) they have, to treat the former. “We are hoping to open the 40-bed ward for male psychiatry patients with COVID-19 this week,” said Dr. Thilakarathna, adding that the Kandy National Hospital is hoping to do the same for female psychiatry patients with the virus. Both hospitals will manage other psychiatry patients in the remaining wards respectively.
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