Besieged Sibu Hospital Shifts Critical Covid-19 Patients From Full ICU

By Kanmani Batumalai |

Stage Five Covid-19 patients with poor prognosis at Sibu Hospital, Sarawak, are stepped down from ICU after 28 days when they are no longer considered infectious, even though they still require critical care.

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KUALA LUMPUR, April 23 — Sibu Hospital is forced to step down severely sick Covid-19 patients with poor prognosis from critical care to accommodate new cases in its full intensive care unit (ICU).

An anonymous doctor from the public hospital in Sarawak said severely ill Covid-19 patients with a low chance of survival are transferred from the ICU to other wards after 28 days of admission — even though they still require critical care — to make way for new critical Covid-19 cases. Twenty-eight days is the selected period because Covid-19 cases are considered no longer contagious by then.

“Sibu Hospital is in the position to choose the Covid-19 patients to be admitted in ICU based on prognosis. Stage Five Covid-19 patients with a bad prognosis are being treated in the normal ward in Sibu Hospital as the ICU occupancy rate in this hospital is full,” the source, who requested anonymity, told CodeBlue.

“We initially started with a 12-bedded Covid-19 ICU. Then we opened another ICU with 18 beds somewhere in February. So, in total we have 30 beds for Covid-19 patients in ICU.”

The doctor said there are currently 27 Covid-19 patients in Sibu Hospital’s ICU, which contradicts the Sarawak State Disaster Management Committee’s (SDMC) official Covid-19 report yesterday that stated there are only 12 active Covid-19 cases in ICU statewide, including five in Sibu.

According to the anonymous source, 20 Covid-19 patients in Sibu Hospital are on ventilator support, including 15 intubated. SDMC’s report, however, claimed that Sibu Hospital and its Covid-19 quarantine and treatment centres (PKRC) had 14 active intubated Covid-19 patients, out of 20 across Sarawak, as of yesterday.

As Sarawak battles a surge of coronavirus infections, the doctor said Sibu Hospital also receives referrals for critically ill Covid-19 patients from nearby districts like Kapit, Sarikei, and Daro. On average, Sibu Hospital receives six to nine referrals to its ICU daily. Sibu is located in the central region of Sarawak, the largest state in the country.

Sibu Hospital director Dr T. Nanthakumar confirmed that Covid-19 patients in the worst stage of their disease, Stage Five, would be transferred from ICU only after 28 days of admission to ward, if they still required nursing care like trachy suction and rehabilitation.

“They are still in the acute Covid ward, not in non-Covid ward,” Dr Nanthakumar told CodeBlue.

He added that Covid-19 patients with poor prognosis who are intubated for a very long period would be transferred to normal wards once they are no longer infectious.

An acute Covid-19 ward is considered an intermediate ward, where patients require active monitoring, with most of them needing oxygen support. These patients are either awaiting to be transferred to ICU, or those who have been stepped down from ICU.

Dr Nanthakumar stressed that Sibu Hospital is not triaging incoming severe Covid-19 cases for admission into ICU.

“All the new Stage Four or Five Covid-19 patients, like severe acute respiratory infections (SARI) patients, if the Covid-19 PCR test turns out to be positive, they will be admitted to Covid-19 ICU as soon as possible, regardless of good or poor prognosis,” said the Sibu Hospital director.

He also cited the federal Ministry of Health’s (MOH) guideline — Annex 2 of Management of Suspected, Probable and Confirmed Covid-19 Case — that states Stage Five Covid-19 patients who still require ICU care beyond 28 days of illness can be discharged from Covid-19 care, based on recent data that infectious viruses have not been isolated beyond Day 20 of illness, even in those critically ill. This means that Covid-19 patients are no longer considered infectious, or able to spread the coronavirus, after 20 days of sickness, even in critical cases.

“Although there is a surge in cases, Sibu Hospital is still able to manage the situation.”

Dr T. Nanthakumar, Sibu Hospital director

According to the anonymous Sibu Hospital source who spoke to CodeBlue, when some critical Covid-19 patients or their family members decide not to attempt any active resuscitation, then these patients are likely to spend their final days in the acute Covid-19 or normal ward. However, before reaching that stage, medical officers will first discuss with family members if the patient is unable to give consent.

“Patients who have very poor premorbid status such as advanced cancers, poor and lung heart function, will be given comfort care as they will not be benefited from critical care,” the doctor told CodeBlue.

The medical officer also said Sibu Hospital has limited ventilators, but some of the equipment that takes over the body’s breathing process when one’s lungs fail can be used for others when some Covid-19 patients improve.

It is to be noted that Sibu Hospital currently manages five PKRC for low-risk patients, with a total of 818 beds and six normal wards with 149 beds. All these treatment centres and wards are covered by Sibu Hospital medical officers.

The doctor also said Sibu Hospital is unable to open a new Covid-19 ICU ward due to limited manpower, facilities, and equipment. According to the doctor, Sibu Hospital’s Covid-19 team has three general consultant physicians, five medical specialists, 60 medical officers from the general Covid-19 team, eight anesthetists, and 16 medical officers from ICU.

“Sibu Hospital is still a hybrid hospital which also treats non-Covid patients. With this hybrid system, our doctors in Sibu Hospital have reached their breaking point,” said the doctor.

“We are tired, exhausted, and burnt out. Our aim as doctors is to provide the best standard of care to every patient in the hospital, regardless of race, nationality, and status. If this continues, I believe the standard of care will drop tremendously.”

Anonymous Sibu Hospital doctor

“We need manpower, so that the current batch of workforce are able to take turns to rest.”

Last week, Health Minister Dr Adham Baba announced that an estimated 300 to 500 health care workers, including doctors, nurses, medical assistants, and lab technicians, will be deployed to Sarawak from various parts of Peninsular Malaysia.

According to SDMC’s Covid-19 report, Sibu reported 1,251 new Covid-19 cases in the past 14 days as of yesterday, the second-highest in Sarawak behind Bintulu’s 1,532 new infections detected in the same period.

Over the past fortnight, from April 9 until 22, Sarawak reported 7,325 new Covid-19 cases, comprising a quarter of 28,935 nationwide cases in the same period. Sarawak also reported a record high 960 fresh infections on April 16. From April 9 to 22, Sarawak recorded 29 of the nation’s 99 official Covid-19 deaths.

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