Amid Staff Outbreaks, SGH And Sibu Hospital Struggle Keeping Non-Covid Services

Sarawak General Hospital and Sibu Hospital are facing at least 5% reduction of their health care workforce over Covid quarantine, straining capacity to maintain elective care.

KUALA LUMPUR, March 11 – Sarawak General Hospital (SGH) and Sibu Hospital administrators highlight manpower shortages, as more health care workers are taken off work for quarantine after contracting Covid-19.

Unlike the wave of the Delta variant mid last year that disrupted non-Covid services across the country, such as elective operations, the two public hospitals in Sarawak now are struggling to maintain health care services for non-Covid patients.

Although Omicron is milder than Delta, the highly contagious variant ripping through the community has also infected health care workers in rising numbers, posing challenges to hospital administrators to maintain both Covid and non-Covid services with a reduced health care workforce that needs to cover for quarantined staff.

SGH, Sarawak’s main tertiary hospital located in the state capital of Kuching, is preparing to cut and temporarily suspend elective surgeries and elective admissions should staffing drop below a certain level. SGH’s non-Covid services slowed down “a bit” during the peak of the Covid-19 epidemic last year, according to the hospital administrator.

“It will be quite tough this month, we admit,” said SGH director Dr Ngian Hie Ung.

Sibu Hospital, a secondary referral centre for eight district hospitals located in the central region of Sarawak, has already temporarily reduced non-Covid services like palliative care home visits, the wound clinic, specialist clinic, and some elective cases, after previously resuming all services last November.

However, administrators of both Ministry of Health (MOH) facilities maintain that there are still sufficient beds for Covid-19 patients, even as Sibu Hospital is in the midst of opening a second Covid ICU ward.

Increasingly, these Sarawak facilities are seeing patients with concomitant or concurrent Covid, which means that they sought treatment for other conditions, but tested positive for the virus during screenings upon admission or during subsequent screenings before a procedure.

In frank interviews with CodeBlue, SGH director Dr Ngian and Sibu Hospital director Dr T. Nanthakumar talked about their challenges facing Malaysia’s Omicron wave that has yet to peak.

Both hospital administrators spoke to CodeBlue to clarify issues that were raised to CodeBlue by two anonymous health care workers from SGH and one from Sibu Hospital.

SGH: 5% To 10% Staff Currently On Quarantine

Sarawak General Hospital. Picture by Boo Su-Lyn.

At SGH, with about 5,000 staff, Dr Ngian estimates more than 300 health care workers to be off by the end of this week due to Covid-19 quarantine.

The number of staff increasingly lost to seven-day self-isolation has been growing every week during the Omicron wave, from 20 to 40, 100, 200 and now possibly more than 300.

So Dr Ngian estimates that about 5 per cent to 10 per cent of health care staff are off due to quarantine at the time being (not all the time).

“We’re prepared in case the number of staff is really too low, then we have to cut services,” she said.

“Various departments have been informed that in the event we really reach that point – we can always cater until a certain point – but beyond a certain point, we can’t, then we will stop certain services for a short period of time.”

Most of the health care workers with Covid-19, she believes, got infected from the community, not their workplace. So the coronavirus outbreak among SGH staff is a proxy for the Covid-19 situation in the state capital, more so as Dr Ngian suspects that some people in the community do not inform MOH via MySejahtera of their positive test result.

“Our numbers are not slowing down yet. We expect Kuching to increase until the end of the month.”

An SGH health care worker, speaking to CodeBlue on condition of anonymity, said duty rosters were being changed almost every day due to home surveillance orders (HSOs) amid outbreaks among health care workers.

“At the rate we are going, there will soon be a crisis if we don’t cut services. However, with the shorter quarantine period, we still might be able to sustain for now.”

Staff Pulling Double Shifts Almost Every Day

A health care worker sitting in an ambulance at a public hospital in Sabah. Picture credit anonymous.

Another health care worker from SGH said the hospital’s occupational safety and health unit could no longer cope with formal contact tracing via Google Sheets from the surge of infections in the health care workforce. Instead, staff are just asked to self-check to determine if they are a high-risk close contact.

“Burnout rate is high among staff as they are forced to pull double shifts almost every day of the week,” the health care worker told CodeBlue.

Dr Ngian acknowledged that some health care workers in ward may feel burned out for one to two weeks, especially when staff is short when their colleagues are in quarantine, but stressed that the current situation is “not as bad as previously” in 2020 when Covid-19 was still a novel coronavirus.

Burnout among SGH staff last year was not as bad as 2020, Dr Ngian said, as health care workers were getting used to Covid-19 and faced “slightly less” mental stress.

“But I must say, quite a number of staff may be quite resilient. For short periods, they can stand it,” said Dr Ngian.

She added that hospital management would try to accommodate health care workers who are unable to cope with their work burdens temporarily.

“But if they can’t cope, we hope they’ll inform us, then we’ll have to cut services,” said Dr Ngian, adding that SGH would not turn away emergency cases, but reduce elective surgeries, elective admissions, and outpatient cases if needed.

“We hope that we don’t have to go backwards like previously.”

Dr Ngian also denied an SGH health care worker’s claims to CodeBlue that symptomatic staff who tested positive for Covid-19 with an antigen rapid test kit (RTK) were asked to come back to work. Instead, she maintained that any staff who tests positive will be sent home for self-isolation, adding that MOH policy no longer requires confirmatory diagnosis with PCR tests.

As for Covid-19 close contacts among staff, home quarantine depends on their risk categories, with Dr Ngian saying those who fall in certain categories could still go to work, while others would be required to self-isolate.

“At the end of the day, if we work together as a team, whatever problems we’ll share together, we’ll go through it together very well,” she said. “Of course certain concerns need to be addressed.”

Wards, Non-Covid ICU Full Like Pre-Covid Days

Sarawak General Hospital (SGH) director Dr Ngian Hie Ung (second from left), together with Sarawak Deputy Chief Ministers Douglas Uggah Embas (second from left) and Dr Sim Kui Hian (right), during the deputy chief ministers’ visit to SGH on January 26, 2022, as part of Omicron surge preparation. Picture from Dr Sim Kui Hian’s Facebook page.

The SGH director also clarified that although wards and the non-Covid intensive care unit (ICU) are full, it’s no different than pre-pandemic days, saying: “Even without Covid, the hospital setting is already very challenging.”

“We always have many stranded patients in the emergency and trauma department (ETD) because ward is normally full, even without Covid.”

The average waiting time for a bed in SGH last February was the same as January and almost the same as last year.

However, there are occasional days when certain patients are found in the ward to be Covid-positive in their second screening before a procedure, after initially testing negative during admission, or some caretakers turn up positive.

“That happens more frequently now,” said Dr Ngian.

Hospital management then will need to conduct a brief investigation and clean the wards, during which patients in the ETD may have to wait longer to enter the ward.

She also pointed out that SGH was admitting 100 new Covid patients a day during the Delta peak last year, but the facility is now admitting just 20 to 30 cases.

One SGH health care worker, however, said there has been a “drastic increase” in admissions from last week, including Covid-19 cases coming in with breathlessness and low oxygen levels.

“It’s starting to look a bit like the first wave,” the person told CodeBlue.

According to Dr Ngian, SGH has one Covid-designated ward for patients who get admitted specifically for Covid-19. On the other hand, patients who come in for other issues, such as for surgery, will not be placed in the Covid ward if they incidentally tested positive for Covid in hospital and are asymptomatic in Category One. Instead, they will be sent to the respective medical ward, but in isolation from other patients.

As for critical care for Covid patients, Dr Ngian explained that while previously, the ICU was used for Covid, patients are now ventilated in certain areas equipped with ICU facilities to avoid disruption of non-Covid services.

SGH’s infectious disease wards, for example, are fully equipped with gas supply and come with individual rooms. Ventilators can also be placed there to cater for ICU patients.

“Our ICU for non-Covid is always usually very full. It’s not something new; it’s always been the case.”

Sibu Hospital Opening Second Covid ICU Ward

The new field hybrid modular intensive care unit at Sibu Hospital in Sarawak. Picture from the Ministry of Health.

Sibu Hospital director Dr Nanthakumar said his facility will be opening another Covid-19 ICU ward by next week, pending completion works by the contractor.

All 10 beds in Sibu Hospital’s current Covid-19 ICU are being occupied; the second Covid 19 ICU will have another 13 beds.

Dr Nanthakumar said the main challenges are to run both Covid and non-Covid services, therefore internal mobilisation is done to maintain both services.

“We’ve changed the way we handle Covid-19; we don’t admit every single case now – so that has helped us. Last time, we had to admit all the categories of Covid-19 patients, hence it put a huge strain on logistics,” Dr Nanthakumar told CodeBlue.

With most Covid-19 cases now on home quarantine under monitoring by the virtual Covid-19 assessment centre (CAC), Sibu Hospital’s workload is lesser despite the surge of coronavirus infections in Sarawak.

Most patients getting admitted to Sibu Hospital came for non-Covid issues like heart attacks, stroke, fracture or appendicitis, but tested positive for Covid-19 in the facility, generally they are in Categories One or Two, said Dr Nanthakumar. A minority of admissions are for moderate to severe Covid-19 in Categories Three to Five.

The Sibu Hospital director also said most patients with Covid-19 are discharged from the Covid-19 ward after seven days and transferred to non-Covid wards for treatment for the conditions they were originally admitted for.

“Definitely, Delta is much worse compared to Omicron. Delta patients will come with silent hypoxia (low oxygen in one’s tissues), anosmia (loss of taste and sense of smell). Nowadays, you don’t see these that much.

“Now for Omicron, they’re not bad, but there’s still persistent flu, cough, and sore throat for a longer period. After one week, people still complain that they’re still tired and exhausted, so we still see a bit of that.”

When asked about the average length of hospitalisation for Covid-19 cases, Dr Nanthakumar it depends on the patient’s immune system. Some stay for 10 to 12 days, such as immunocompromised patients, though others recover within a week. Those who haven’t completed Covid-19 vaccination tend to stay longer in hospital.

The average length of stay for severely ill Covid-19 patients in the ICU also varies. Most require hospitalisation for at least 7 days, but some can be discharged from the ICU after four days and be stepped down to other Covid wards.

Notably, some of Sibu Hospital’s non-Covid services, such as palliative care home visits, the wound clinics, specialist clinic, and some elective cases, have been reduced temporarily due to mobilisation of staff from Covid to non-Covid areas.

About 4 per cent to 5 per cent of health care workers in Sibu Hospital now are on home quarantine after testing positive for the coronavirus.

“It does put a significant strain on my human resource because I’m not 100 per cent full,” Dr Nanthakumar said.

As a result, hospital management has limited leave for health care staff to three days, prohibiting long leaves of one to two weeks.

He added that Sibu Hospital mandates self-isolation only for staff who test positive, regardless of whether they show symptoms or not.

Official MOH policy for the general public exempts self-isolation for boosted close contacts only if they are asymptomatic on the day of exposure to Covid-19.

In line with surging infections nationwide, Sarawak reported 1,963 new Covid-19 cases yesterday, the highest in over five months since October 2 with 2,121 cases. Kuching reported 699 new cases, the highest in the state, while Sibu reported the third-highest daily tally with 177 cases.

Health Minister Khairy Jamaluddin said Wednesday that MOH expects the country’s Covid-19 epidemic to turn by month’s end, before Malaysia reopens international borders and relaxes domestic Covid restrictions on April 1.

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