KUALA LUMPUR, July 23 — At least 29 Covid-19 patients died on Eid al-Adha at Ampang Hospital after oxygen pressure dropped, as the stricken facility struggles to admit scores of critically ill coronavirus patients requiring respiratory support.
Ampang Hospital’s record number of deaths on July 20 comes on top of 23 Covid-19 fatalities reported on July 16, sources said, making it 52 deaths in two days. On average, the Selangor facility recorded about 10 deaths per day from coronavirus this month. In June, Covid-19 deaths in Ampang Hospital averaged at about four per day.
Publicly, the Ministry of Health (MOH) reported 93 Covid-19 fatalities nationwide on July 20, including 31 in Selangor. It is unknown if 29 of the 31 deaths came from Ampang Hospital alone; MOH may not officially report coronavirus-related mortality to the public in real-time.
Health care workers told CodeBlue that the higher death figures in Ampang Hospital this month were attributed to Covid-19 patients’ rapid deterioration, oxygen pressure imbalances due to the hospital’s high-volume usage, and increased admission of coronavirus patients requiring high-flow oxygen therapy.
“The patients we cater to all need oxygen therapy. We are seeing a lot more patients coming in, many of them are young, and we’ve been asked to absorb as many cases as possible. We usually do try to accommodate, but that has made oxygen levels at the hospital go haywire.
“Unfortunately, these patients are deteriorating a lot faster now, sometimes within hours, regardless of age. Coupled with the low oxygen pressure, that’s why we’re seeing more deaths,” Dr Alias (pseudonym), an Ampang Hospital doctor, told CodeBlue on condition of anonymity.
Dr Alias said many who died had comorbidities like high cholesterol and hypertension. Some of the fatalities were aged above 60, but many were young, with some in their early 20s.
Another doctor at Ampang Hospital, who spoke to CodeBlue, said some Covid-19 patients deteriorated fast as they were not intubated immediately due to the lack of intensive care unit (ICU) beds and ventilators.
“They will usually be monitored for a few days before they finally do get intubated. By then, the infection is already quite bad and the prognosis is deadly,” said Dr Anne (not her real name), who requested anonymity.
“It always comes to a point where priority will be given to those we think will have high chances of survival to be intubated, and admitted to ICU for closer monitoring,” she said.
The lack of nursing care is another major causative factor for patients’ rapid deterioration, Dr Anne said. Unlike ICUs, normal wards do not have doctors and staff nurses monitoring patients 24 hours round-the-clock, she said.
“We go in by shifts to check on the patients, take blood, and serve medication. Oftentimes, the patients are found dead inside the ward without us knowing what exactly happened to them.”Dr Anne (not her real name), doctor at Ampang Hospital
Higher Oxygen Use, Lower Pressure
On July 20, the day of Eid, oxygen pressures at the fifth level of Ampang Hospital were running alarmingly low. Dr Anne said if drops in oxygen levels could be detected early, doctors and staff nurses could arrange for certain patients to be transferred out to levels with sufficient oxygen.
“But most times, due to lack of manpower, there will be delays in the transfer of patients,” Dr Anne said. Ampang Hospital recorded its highest single-day Covid-19 deaths that day with more than two dozen cases.
A board depicting oxygen pressures at the hospital on July 19, a day earlier, as of 3pm, showed at least five wards having below-normal oxygen pressures of between the 3.8 and 3.9 bar. Most of these wards were at the fifth and sixth levels of Ampang Hospital.
Another four wards — also on the same two levels, with one on the fourth level — had minimal oxygen pressure of between 4.0 and 4.2 bar. Normal oxygen pressure is above 4.2 bar.
“What we need to do now is to balance the oxygen pressure in each ward. We need to look at how many patients are on high-flow masks, how many are on nasal prongs for us to balance out the capacity per ward.
“The problem is most patients now require upgrades to their oxygen therapies. So even if, for example, we’ve set that Ward A will have two intubated patients on ventilators, 10 high-flow mask patients, and the rest are on face masks and nasal prongs, that’s just not the number we’re going to get that day,” Dr Alias said.
Surging demand for oxygen has put the resource at a critical level, forcing Ampang Hospital to run its oxygen storage tank at full capacity. Under normal circumstances, the tank gets refilled every week. Now, refills have to be done twice a day.
Supply from the oxygen tank is accessible through the hospital’s oxygen ports. A standard hospital ward has between 28 and 32 oxygen ports, and in Ampang Hospital, priority is given to severe Covid-19 patients who require high-flow oxygen therapy.
Patients on face masks or nasal prongs are usually connected to oxygen cylinders that range from 0.7 litres, which can last about one to two hours, 1.4 litres (lasts about four to six hours), and to 7 litres that can last up to 12 hours and are shared between five people, depending on the usage rate.
Amid the high-level usage, it is worrying to note that all of the hospital’s oxygen supply comes from a single contractor: Gas Pantai Timur Sdn Bhd. While the company has so far been able to meet the spike in demand, the solo deal unquestionably threatens the already fragile situation.
It is understood that Ampang Hospital has submitted a request to the Health Ministry (MOH) to add another oxygen vendor to its supply chain for the purpose of mitigating risks.
CodeBlue sought comments from Health Minister Dr Adham Baba and Ampang Hospital director Dr Kasuadi Hussin on the hospital’s condition, but they did not immediately respond. Greater Klang Valley Task Force chief Dr Chong Chee Kheong could not verify the situation instantly.
Ampang Hospital is the country’s second fully designated Covid-19 hospital after Sungai Buloh Hospital. It accepts mainly Categories Four to Five patients with severe disease requiring oxygen supplementation, though the hospital also provides care for Category Three patients as well as those with severe acute respiratory infection (SARI).
Ampang Hospital usually takes in about 20 to 40 critically ill Covid-19 patients a day, mainly referrals from the Malaysia Agro Exposition Park (MAEPS) Integrated Quarantine and Treatment Centre (PKRC) 2.0 in Serdang, Selangor. Daily admissions also include walk-in Covid-19 patients and those referred to from Covid-19 Assessment Centres (CAC).
Apart from oxygen therapy, treatment for Covid-19 patients includes the use of steroids, anticoagulants and antivirals, Dr Alias said.
“That’s the standard treatment that we give, but again, we hope the body has enough strength to fight off the infection,” he told CodeBlue.
“We can provide oxygen therapy and monitoring, but in the end, we can just hope that the person is able to climb the hill to the top. But more often now, they don’t.”Dr Alias (not his real name), doctor at Ampang Hospital
Meanwhile, Dr Anne said all wards at Ampang Hospital have reached full capacity, with the hospital treating 500 to over 600 Covid-19 patients each day. “Sometimes, we have over 100 patients stranded in our emergency department for up to two to three days.”
Full Covid hospitals like Sungai Buloh Hospital, Ampang Hospital, and recently appointed Selayang Hospital have no choice but to admit critically ill Covid-19 patients who are forced to wait for days at MAEPS PKRC 2.0 — where oxygen treatment facilities are limited — before they are transferred to hospitals.
To exemplify, MAEPS PKRC 2.0 on Monday had 336 Category Four coronavirus patients waiting to be sent to hospitals.
Dr Alias described as “misleading” the disease classification of the country’s daily Covid-19 cases — announced regularly by Health director-general Dr Noor Hisham Abdullah as predominantly asymptomatic and mild infections — as it did not reflect the realities on the ground.
“How can there only be 42 Stage Four cases (on July 19) and 45 Stage Four cases (on July 18) when every public hospital in the Klang Valley is dealing with Stage Four patients? Clearly, there are a lot more uncounted for,” he said.
Dr Noor Hisham did not immediately respond to CodeBlue’s request for comment on the allegation of misleading data. MOH’s daily graphics claiming that more than 95 per cent of new Covid-19 cases are in Categories One and Two do not specify how many eventually deteriorate to severe disease. MOH also does not provide updates on the severity of active cases numbering at 142,051 as of yesterday.
Status Quo In Workforce
Despite being swamped by a record number of patients, Ampang Hospital continues to operate at a handicap as its workforce count remains relatively unchanged.
“We have received a few new nurses but they’re not adding to the workforce, they are merely replacing those that have been transferred. So it’s status quo for us,” Dr Alias said.
The MOH earlier this month announced that health workers from select states will be mobilised to support government hospitals and university teaching hospitals in the Klang Valley in need of additional manpower in treating Covid-19 patients.
Final-year nursing students under the ministry’s trainee institutes undergoing practical training at Covid-19 vaccination centres (PPVs) will also be optimised to allow experienced nurses previously assigned to PPVs to be reassigned to support hospitals under the ministry, Dr Adham said.
Ampang Hospital is also handling non-Covid patients and gets two to five non-Covid critically ill patients per day as they are allegedly turned away by other hospitals.
“We hope everyone — public, private, university and military hospitals — will work together and absorb more patients accordingly so that all of us can provide adequate, if not the best, service to patients in critical need of care,” Dr Alias said.
Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh told Free Malaysia Today recently that more than 800 non-Covid-19 patients will be moved out of government hospitals into private medical centres in the next two days to free up space for Covid-19 patients in public health care.
He said more than 38 private hospitals in Kuala Lumpur, Selangor, and Negeri Sembilan will take part in the programme.
“There are now thousands of Covid-19 patients in emergency rooms and at MAEPS PKRC 2.0 who need care, and the best solution is for them to get treatment in government hospitals while we clear government hospitals (patients sent to private hospitals),” he was quoted as saying.