Doctors Hospital on Shirley Street.
~ Nearing capacity to house and ventilate COVID patients ~
NASSAU, The Bahamas--As the Bahamas’ coronavirus COVID-19 situation worsens, Doctors Hospital Chief Executive Officer (CEO) Dr. Charles Diggiss said on Tuesday that the hospital is in crisis as it nears capacity to house and ventilate COVID patients.
“It depends on your definition because clearly what we continue to do is to make adjustments and pivot to accommodate increased demand,” Diggiss told The Nassau Guardian.
“So as more and more patients come, our obligation clearly is to accommodate them. So, if crisis is defined as we are really very close or we are exceeding our capacity and resources, then yes, it is safe and simple to say that we are now operating in a crisis mode.
“Can we receive patients, non-COVID patients? We can and we do receive our non-COVID patients and manage them. Can we receive COVID patients? Yes, but that is a challenge because now we have to be pivoting to get the right place where we can put them to get them transferred whenever it is safe to Doctors Hospital West, to get the ones who are recovering to move out back to their homes. So, is it a crisis? Yes. Do we have to continue to function regardless with both groups of patients? Yes.”
Nearly 1,600 new COVID cases have been confirmed so far this month. As of Monday, 93 cases were hospitalised. Of that figure, according to the Ministry of Health’s daily COVID-19 dashboard, 21 cases were hospitalised at Doctors Hospital including eight who were in the intensive care unit.
Diggiss said 23 to 25 cases were hospitalised at Doctors Hospital as of Tuesday.
When asked about the ages of the hospitalised cases, he replied, “Overall, the patient type is younger – that is fair to say. But I do not have the specific data for you. Just to indicate that overall, it is younger, and we are realising as well that the vaccination status is either inadequate or not vaccinated for the most part, for the entire part.”
Doctors Hospital has the capacity to house no more than 30 COVID-19 patients for “the whole health system to be safe”, according to Diggiss.
Asked what he meant by unsafe, he said, “It means that the barriers that we put in place, the physical barriers that we put in place to separate the two populations of patients so that there is no risk of transmission of the virus into protected spaces that those barriers are now being broken.”
Doctors Hospital East, which is the main facility on Shirley Street, can safely house 10 patients with roughly four of them on ventilators, according to Diggiss. He said the hospital was looking at housing an additional two or three COVID-19 patients on Tuesday.
“So, we are getting pushed with more COVID patients in the emergency room right now,” Diggiss said. “That would be up to a total of 13 going on 14 COVID patients in the institution – with four of them on the ventilator – which is quite a lot, meaning we are having to deal with displacing our non-COVID patients.
“We have a 72-bed facility traditionally but given the uniqueness of COVID we can really only accommodate up to 46 patients. That can be pushed to maybe 56. So out of the 56 spaces that we can put patients in at our main facility, we would be compromised if we tried to accommodate more than 14 or 15 COVID patients of the 56.
“When you look at Doctors Hospital West, [Building A in – Ed.] that facility can take 18 patients, and we will max out at four or five ventilated. So, our capacity for ventilating COVID patients in the entire Doctors Hospital Health system is probably 10 and we are probably going to be at that today [Wednesday, July 28]. We can take 18 patients total [with] four or five ventilated in Building A and the peculiarity is that we do have a Building B with 15 rooms and patients, but it is not occupied right now because of the shortage of staff.”
As the hospital exceeds its capacity, Diggiss said hospital officials are faced with “some very difficult decisions about where we are able to house patients” and are looking for additional spaces to put patients, particularly Emergency Room patients. He said patients who are being admitted have a combination of problems.
“So, our non-COVID patients are being displaced by COVID patients and the COVID patients are pretty ill, which puts an additional strain on our resources as far as ventilators go,” Diggiss said. “This is a particularly difficult time which has escalated to a bit of a crisis right now.”
He said the hospital had to stop its elective surgeries. As a result, according to Diggiss, patients who require important procedures, operations or admission to the hospital for the management of chronic medical conditions may not be accommodated “unless it is a dire emergency”. He said this presents challenges for the hospital.
“We run into the issue of keeping it safe for the non-COVID patients,” Diggiss said. “We run into the issue of patients who do not have COVID decompensating or becoming more ill because they are not receiving the treatments, the procedures, or the operations that they require for non-COVID problems.”
Diggiss said the hospital has not had any recent ward outbreaks. However, he admitted that staff shortage continues to be an issue. Diggiss said nurses are key members of staff.
“If, for whatever reason, they become ill with COVID and this is a very specialised group of nurses who need to be available to handle critical care patients, need to be available to handle dialysed patients who have COVID, when they come ill then you can see how that really challenges our human resources in that space,” he said.
“That completely limits our ability to provide care because a ‘regular’ or a non-specialty nurse would not be able to be simply placed to manage such patients.”
He was not able to provide an exact number of doctors and nurses out of the system due to COVID. As it relates to doctors, according to Diggiss, it is “probably not a significant number”. He said there may be “about three” nurses out.
“From a nursing perspective, if we have two, three or four critical care nurses out at one time, that is very significant,” Diggiss said.
When asked what needs to be done to prevent deterioration, Diggiss replied, “There are so many parts to that answer. The immediacy would be all efforts to get increased capacity: more ventilators, more nurses who are able to assist as far as the management of patients with ventilators, and spaces in which the patients can be nurses.
“I would look at that as immediate if nurses were available with the right skill, if ventilators were available, then immediately those 15 spaces at least, we can get those occupied with relatively ill patients or ventilated patients.
“The ability to manage patients who are ventilated in the proper isolation space would to me be a part of the immediate solution just to decompress the bottleneck right now.” ~ The Nassau Guardian ~