• Government collects lists of requirements from hospitals 

• Government spent over Rs. 138 b on Covid-19 since March 2020 

• Shortages build fear over likelihood of increasing deaths  

 By Yoshitha Perera    Sri Lanka’s Covid-19 death toll surpassed 1,000 last Tuesday (18) while the number of infected persons has now surpassed 150,000, and the seven-day average for daily new cases has crossed 2,500. In this worrying backdrop, consultants and hospital staff have reached a critical juncture, with a failure in decision-making leading to severe supply shortages. However, addressing Parliament last Tuesday (18), State Minister of Money and Capital Market, and State Enterprise Reforms Ajith Nivard Cabraal said that since March 2020, the Government had directly spent Rs. 138 billion on combatting the Covid-19 pandemic and providing relief to the public. However, several hospitals across the country are already reporting shortages in key equipment needed to care for critically-ill patients, including ventilators and personal protective equipment (PPE). The adequate production and distribution of this equipment is vital at this stage for the caring of patients during the pandemic.  Responding to The Sunday Morning, State Minister of Primary Health Care, Epidemics, and Covid-19 Disease Control Dr. Sudarshani Fernandopullle said that the Ministry had collected the requirement from the hospitals, but it had not calculated an estimation of the cost. She said the Ministry has created a list of critical supply equipment, and any willing donors could check this list and contribute the items listed on it if they wish to assist the healthcare system. She said: “We have collected a list of requirements from the hospitals, but we have not done the costing. If any person is interested, we give them the list, so that person could pick whatever he or she can contribute and provide it accordingly, while indicating it to us.”  When questioned as to what is on the list, Dr. Fernandopulle said that the list includes Intensive Care Unit (ICU) beds, High Dependency Unit (HDU) beds, oxygen concentrators, Continuous Positive Airway Pressure Therapy (CPAP) machines, BiPap machines, pulse oximeters, station monitors, suction machines, etc.  However, speaking to The Sunday Morning, Health Ministry Secretary Dr. S.H. Munasinghe said he could confirm there is no shortage as such as of yet, but the Ministry has planned to purchase necessities before this occurs. He said: "The Government has given the monetary funds, and some of the equipment we have ordered is in the process of being delivered. We had prepared a list by consulting anaesthetics, physicians, and intensivists to procure more critical supply equipment. In this light, we are in the process of ordering more.” Meanwhile, to understand the situation in the Covid-19 treatment hospitals, The Sunday Morning contacted Gampaha General Hospital Director Dr. Priyantha Illeperuma, as the Gampaha District has seen a relatively high incidence of Covid cases. Dr. Illeperuma said that during the Ramadan week, when the country was under a complete lockdown for three days, there was a sudden spike in Covid-19 patients; around 60-65 patients were admitted to the hospital on one particular day. “Although we admitted mild to moderate Covid-19 patients, with the mutation of the current virus variant, about 15 of those admitted patients suddenly developed severe symptoms,” he added.  Dr. Illeperuma said that given the situation, the hospital had to follow existing guidelines and refer such critically-ill Covid-19 patients to hospitals with special ICU facilities.  “We have to transfer these severely ill patients to the Infectious Diseases Hospital (IDH) or Homagama Base Hospital. However, at this point, the authorities of those hospitals have told us that the capacity of their hospitals have also been exceeded, and therefore, outside patients cannot be admitted.”     The Gampaha General Hospital had to deal with severe patients, but at the time, the hospital was reserved only for mild to moderate patients, Dr. Illeperuma added.  He said: “Accordingly, the consultant doctors requested me not to handle severe cases in our normal ward system. Especially with oxygen cylinders, if a number of severe cases like this are reported at once, then one critical patient will have to be given four to five oxygen cylinders per hour. So, in the current setup, it is difficult for us to handle severe patients.”  Dr. Illeperuma said that the consultant doctors at the hospital also requested equipment to handle such severe cases, but due to the complete lockdown, the hospital could not procure them from the Government.    “About two or three among these 15 critically ill patients died, and I do not think they’ll be able to survive in the ICU. I asked for a donation to save the rest. We requested that wall-oxygen be provided as soon as possible, and that the relevant equipment be provided to manage those severe cases. At that time, we got a very good response, we were able to install about 10 wall-oxygen units in one ward within a day and a half.”  Gampaha General Hospital was set up as a single isolation centre from the very beginning of the pandemic in Sri Lanka.  “Now that the third wave has started, we have been advised by the Gampaha Provincial Council to set up our hospital to admit Covid-19 patients with mild to moderate symptoms. As per the criteria received by the Provincial Council, we have only been advised to increase the bed capacity.”  Dr. Illeperuma said that the hospital had commenced modifying three wards with assistance from the Sri Lanka Navy, and there are 120 beds to admit patients.  He added that the hospital was building a High Dependency Unit (HDU) with a 15-bed capacity and the Covid-19 ICU is also under construction. He said: “We’ll be able to accommodate up to seven beds in about a week and a half at the Covid-19 ICU. In addition, a small surgical theatre is being developed for Covid-19 patients.”  Meanwhile, speaking to The Sunday Morning, College of Medical Laboratory Science (CMLS) President Ravi Kumudesh highlighted that the Government has to keep patients at home and treat them, even unwillingly, under the present circumstances.    “We continued to educate on decentralising the hospital system. Instead of bringing patients to the main hospitals, we said from the beginning that those hospitals should be reserved for critically ill patients, and that general patients should be admitted to the divisional hospitals.” At present, there are 493 divisional hospitals and 71 base hospitals in the country. He said: “If we used this setup, we would not have to leave patients at home.”  Kumudesh also added that in parallel with the mentioned methodology, the CMLS suggested decentralising PCR testing. He said: “This allows us to create a point-of-care PCR system and perform about 100 PCRs in one area at a time. Related divisional and base hospitals can be used for this mechanism, but there is a failure in decision making.”  While expressing the views on the fact that there were no funding issues within the Health Ministry, Kumudesh claimed that the health authorities are trying to protect their monopoly and this could be affecting proper decision making.   Main Image © SRI LANKA ARMY