Hospitals discharge patients with COVID-19

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When the coronavirus first broke out among the population in Mongolia, scientists predicted that infection would peak in March to April this year. Their expectation is coming true. At present, it is estimated that 200 or more people will be infected every day. The State Emergency Commission and the Ministry of Health are warning the public every day that the spread of infection has been increasing sharply.

Previously, they reported that they are ready to provide emergency equipment and reserved more than 4,000 beds, during the state of high alert. In addition, a few months ago, 180 medical devices were imported through the Asian Development Bank-funded “Health Development Program-5” project. The service apparatus was distributed to specialized hospitals, officials reported. At the time, 23 coronavirus treatment devices were reported to be installed at the National Center for Communicable Disease and 12 at the Military Central Hospital. However, during the peak of the spread of COVID-19, the number of hospital beds could not meet the needs and hospitals began to treat people at home.

More than 4,000 beds are said to be in reserve. But, COVID-19 patients said that the National Center for Communicable Disease has less than 10 respirators in its two intensive care units. In fact, the Ministry of Health may have prepared only 2,100 beds for the ongoing COVID-19 treatment. According to the report of the ministry on March 30, a total of 1,693 people are being treated, of which 1,416 are in mild condition, 219 in severe condition, 29 in moderate condition, and 9 in critical condition.

Currently, 375 people with COVID-19 are being treated at the home, though the government reported that 500 beds are ready for use. The treatment guidelines and methods to for COVID-19 patients being at home are still unclear. Just a few days ago, the Ministry of Health and the National Center for Communicable Disease announced that the state provides an average of 14 million MNT per infected person for COVID-19 treatment. But some infected people said that there is no support for those who are said to be receiving treatment at home. It is not clear who monitors or treats them. Officials said family clinics are monitoring those who were isolated and treated at home, but the public criticize that this was false.

Since the first case of COVID-19 was registered in Mongolia, when the infection started spreading among the population in November last year, treatment guidelines, costs of medicines, drugs and equipment have been a secret. It is still undisclosed to date.

A year ago, the Ministry of Health and the National Center for Communicable Disease made public estimates of medical and other costs per person infected with the coronavirus. They reported that this was inspected and certified by the World Health Organization (WHO). At the time, one infected person was hospitalized for an average of 27.5 days, and 6,962,164 MNT was spent on treatment of patients with mild symptoms. According to the report, 11.6 million MNT was spent on moderate patients and 12,598,630 MNT on patients in critical condition. In other words, Mongolia has spent a lot of money to treat about 400 COVID-19 people that came abroad who were diagnosed with the coronavirus, with treatment continuing for 20 to 60 days. However, health officials are not willing to disclose which drugs were used or where they were imported from.

However, since the domestic outbreak, the coronavirus treatment guidelines have been updated more than once, reducing the number of beds and the amount of money spent on hospitalization for 14 days. After examination, people with antibodies against COVID-19 were discharged from hospital and transferred for the next stage of observation. However, as the number of patients with COVID-19 increased, the Minister of Health approved Order A/105 on March 7. Accordingly, they shortened the treatment period for patients to 10 days and discharging them directly from the hospital. During this time, they were said to be provided with the necessary treatment and services, and were discharged directly to their homes without isolation at hotels. These rules and regulations are followed in accordance with Order A/101 approved by the Minister of Health issued on March 4.

In the case of a viral infection, the disease does not go away from the nose and throat for up to three months. Therefore, it was decided not to perform PCR tests on “recovered” patients who were hospitalized for 10 days. In other words, people with coronavirus who were hospitalized for 10 days are considered to have recovered. Also, antibody tests have been discontinued. It should be noted that all of this is regulated by international treatment guidelines in accordance with WHO recommendations, according to the Health Ministry.

At present, there is no shortage of personal protective equipment, antiviral drugs and injections in hospitals for treating patients with COVID-19. There are enough resources, the authorities claim.

Deputy Director for Medical Care of the National Center for Communicable Disease M.Tunsag said that the medical cost per infected person is different depending on the stage of the disease. For example, 3 million to 4 million MNT is needed for treatment and other expenses for mild and severe patients, while costs can be increase by 10-fold for critical patients. The National Center for Communicable Disease stated that a 34-day treatment for a person with coronavirus, pneumonia, and co-morbidities costs 30 million MNT. In addition to drugs and injections, the patient is treated with a lung replacement device called Ekmo. According to officials, the treatment of a person with COVID-19 may cost 3 million to over 30 million MNT.

According to the Ministry of Health, the number of people receiving home treatment is 375. But Head of the Ulaanbaatar Health Department B.Byambadorj said on March 24 that more than 600 people and about 2,900 of their close contacts were being monitored by family clinics.

 “Order A/101 of the minister of health regulate the home treatment of people with mild symptoms and pain at their request. The National Center for Communicable Disease will identify close contacts of those who have been confirmed to be infected, and the isolation will be lifted after they have been tested three times during home treatment. Family clinics currently employ an additional 733 resident physicians, providing care and services to those who are being isolated or treated at home. They communicate with customers online twice a day and monitor their health condition. A mobile laboratory has been set up to further improve medical care. These include ultrasound, electrocardiography, X-rays, and laboratory tests. In addition, eight teams of specialists are providing consulting and support services to family clinics,” he said.

The data from the central state health authorities remain inconsistent. Due to the high prevalence of infection in the capital, response teams face a hard time transporting people with the coronavirus. In addition, it is no longer possible for households, apartments and offices where the infection has been reported to comply with the rules, regulations and orders for disinfection within 24 hours. Therefore, if someone you have contact with becomes infected, you are considered an indirect contact and are advised to stay at home voluntarily. That means you don’t have to wait for professionals to review your case. In other words, the hospital, the Ministry of Health, and the National Center for Communicable Disease have “abandoned” the people because they are facing a shortage of hospital beds and human resources. After all, infected patients are hospitalized for 10 days and discharged without PCR test.

Studies have shown that infected people do not spread the disease to others if they develop antibodies. However, while the virus is still present in the nose and pharynx of patients, they were discharged from the hospital without testing. Unfortunately, many criticize the fact that those who can infect others are being discharged from hospital to enter social life in the community and spread the disease to others. The worst part is that professional health organizations allowed this to happen knowingly while the authorities scratch their heads about why COVID-19 infection rate is rising sharply.

Enkhnaranjav Tumurbaatar