The Lung Center of the Philippines
During the Pandemic

By Dr. Eileen A. Aniceto

The year 2020 brought a different kind of challenge, one that changed the landscape of healthcare delivery and access in the world and in the Philippines. The COVID-19 pandemic shut down most of the specialized services of the hospital just as effectively as the fire that gutted it in 1998. This time, however, the entire country was brought down to a standstill.

The hospital becomes a referral center for COVID-19

Emergency room visits for COVID-19 sky-rocketed while non-COVID related consultations plummeted. Many elective diagnostic and surgical procedures which were major sources of hospital income had to be postponed. In-person office visits had to be deferred or shifted to telehealth visits while all other forms of health care delivery had to be revised to ensure compliance with community mitigation measures and government mandates like social or physical distancing and health screening for hospital visits, often requiring an RT-PCR swab. All of these changes had severe adverse financial impacts on the healthcare system. The Lung Center of the Philippines, having been designated as a COVID-19 referral center for severe to critical cases, was thrust to the frontlines of the country’s COVID-19 response and can be said to have borne the brunt of the impact of the pandemic.

In the early part of 2020, little was known about the disease, only that it is caused by an influenza-like virus that was highly transmissible, that targeted primarily the lungs and had a high mortality rate. At that time, the LCP already had an 8-bed isolation unit converted and retrofitted just for this purpose, a result of previous encounters with cases during the SARS, the Avian Flu and 2009 H1N1 pandemic. A triage system was adopted very early on, where suspected cases of COVID-19 or Persons Under Investigation (PUIs) were directed to and managed in the isolation unit, but the system was quickly overwhelmed by the huge surge of cases in March of 2020. The Hospital Emergency Management System – Incident Command System (HEMS-ICS) was quickly activated and meetings of special action teams were conducted in the open-air parking area at the back of the hospital to quickly respond to developments in the pandemic.

The strategic goals of the LCP-HEMS-ICS were:
● To increase bed capacity for COVID-19 to meet rising cases
● To ensure and maintain personnel safety
● To provide a high quality of health care for COVID-19 patients

When patients began to inundate our emergency rooms, with 60 to 80 consultations per day, the 8-bed
isolation unit was quickly filled to capacity, we had to plan on how to increase bed capacity for COVID-19 to accommodate as many patients as our healthcare system can support. Wards were emptied of non-COVID patients and retrofitted with exhaust systems, CCTVs and patient monitors. Plastic dividers separate COVID from non-COVID areas. Each ward was converted to accommodate between 22 to 30 beds for COVID-19, with designated beds for critical care and general care. At the height of the pandemic, we had increased inhospital bed capacity of over 200. From an initial 6-bed COVID-19 ICU, we had a total of 80 critical care beds by retrofitting rooms with CCTVs and cardiac monitors. Additional accommodations were added over the course of pandemic: the Philippine Red Cross established Emergency Field Hospital which could admit up to 64 cases from June to October, 2021; a 16-bed
modular hospital built by DPWH became functional at the latter part of 2020; a 10 bed modular hospital and COVID-19 triage facility donated by a private foundation available by 3rd quarter of 2021; and the most recent addition is the 102-bed modular hospital. As of October 2021, with 4 of the 6 hospital wards dedicated to COVID-19, plus 6-bed medical ICU also built by DPWH, the LCP has an effective bed capacity of 179, with potential of additional 90 beds, once the staffing requirements are met.

The COVID triage and reception areas were makeshift tents in the LCP parking lot in the beginning. But since conditions there were less than ideal, and when the pandemic did not show signs of slowing down, the newly opened OPD building was converted to serve as COVID triage, OPD and ER extension for mild cases. These were again transferred to a new modular facility which was built and donated by a private foundation in the middle of 2021, where it remains at present.

The LCP has been lucky to have been the recipient of donations of mechanical ventilators and High Flow Nasal Cannula systems both of which are crucial in the management of the moderate to critical cases of COVID19. Currently, we have a total of 107 mechanical ventilators and 58 High flow nasal cannula systems. An oxygen manifold system was obtained in addition to the liquid oxygen supply to the main building to provide consistent oxygen supply to all COVID wards, including the external COVID infrastructure.

The year 2021 ended with the hope that this pandemic will be over soon, with the nationwide vaccination rates reaching 80% and the COVID-19 census finally going down hopefully for good. The Lung Center of the Philippines as of the end of 2021, is preparing for the reopening of full services for non-COVID medical conditions at the same time securing the COVID-19 facility that will house the COVID-19 services that the Center will continue to provide in the succeeding months of recovery.

Through all these, we managed to keep the majority of our hospital personnel free of the COVID-19 virus, by providing an adequate supply of PPEs, routine and as needed RT-PCR testing, support for meals,
transportation and shelter, and mandated salaries and additional benefits to all medical, nursing, allied and administrative staff. As of the end of November 2021, a total of 483 out of the more than 1,200 regular, job order and DOH augmentation personnel contracted the virus during the 20 months of the pandemic, with just 1 (0.2%) recorded mortality.

All hopes were dashed as the year 2022 was ushered in with the news that the Omicron virus circulating the world in record time has reached the Philippines. The new strain caused milder symptoms, that is true, but with such infectivity that in a matter of days, our hospital personnel afflicted jumped from 0 at the start of the year to almost 200 by the end of the first week. The country has also reached a daily high of 26,458 new cases by the end of the first week and it kept on increasing. We have all the COVID facilities and medical equipment ready and regardless of the crippled manpower, we are committed to serve to the best of our ability, as a “regionally competitive and locally responsive premier institution for lung and other chest diseases, providing quality healthcare through excellent service, training and research.