‘The health sector is overcrowded’

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The Ministry of Health has previously stated that if the daily number of new COVID-19 cases exceeds 3,000, local hospitals would be “overwhelmed” and put at risk of failure. However, the third wave of the pandemic, which began in late August, is seeing over 3,000 cases daily. Head of Medical Care Policy and Implementation Coordination Department of the Ministry of Health B.Buyantogtokh clarified how the high COVID-19 incidence has affected the health sector and whether infected people are able to get necessary care and services quickly in the following interview.

Many people infected with the COVID-19 have complained that hospitals aren’t admitting them. Can you comment on this?

In addition to treating sick people, detecting COVID-19 infections is a big job for medical staff. Mongolia is trying to identify infected people and hospitalize those at high risk of complications. The third wave of the pandemic has hit, and the spread of the infection peaked this month. This is causing a huge burden on the health sector, especially in the care and services area. Mongolia has 27,000 hospital beds. At present, more than 21,500 of them are being used for COVID-19 treatment. The main problem is that every infected person wants to get hospitalized. This has increased the workload of the health sector. People are constantly writing on social media, “I can’t get the hospital to take me in” and “I can’t find a hospital at all”. This is a key sign indicating that the sector is overloaded and unable to cope with the workload. It signals overcrowding.

A person with mild or no symptoms does not need to be hospitalized. Does everyone with COVID-19, especially those infected with the Delta variant, need to be hospitalized?

Currently, about 300,000 people in the country are infected with COVID-19. We are testing them, examining their health condition and treating some of them at hospitals now. based on symptoms, doctors decide who is admitted to the hospital and who can be treated at home. Symptoms of the Delta version appear quicker than those of the Alpha version. However, as soon as the symptoms appear, people are rushing to the hospital. When doctors tell them they don’t have to get hospitalized and get treated at home, people are contacting the hospital’s management or doctors they know to get hospitalized. Some even tried to commit suicide to be admitted to the hospital.

When there are no available beds, the hospital will lock the door and let no one in. Family clinics do not sit in their rooms or avoid seeing patients. However, the workload of the health sector is too high to cope with right now. Colds are cured in seven to 10 days. COVID-19 is no different. In case of mild symptoms, you can be treated at home with a family doctor’s prescriptions and instructions without having to be hospitalized, and you can recover in seven to 10 days.

People are criticizing that hospitals aren’t setting up more beds when thousands of people are getting COVID-19 each day. Is it possible to increase the number of beds?

We can make more beds but we don’t have sufficient human resources to work. Human resources are not something that is replenished in a short period of time and becomes available as soon as more beds are provided. Even if we give out more beds, who will work there? As mentioned earlier, there are 27,000 hospital beds in the country. Eighty percent of it is being used to treat people with COVID-19.

There are more than 56,000 doctors and medical staff nationwide. How many of them have been mobilized to fight against COVID-19? What percentage of services of hospitals are directed to treating COVID-19?

It depends on the level of hospitals. Tertiary hospitals have directed more than 30 percent of their capacity to treat people with COVID-19. For example, the First State Central Hospital is using 200 beds for COVID-19 treatment, and the remaining 300 beds for basic care. Secondary care providers, including provincial and district health centers, are using more than 40 percent of their resources to fight against COVID-19.

At the local level, especially in soums, 60 percent and in some cases 70 to 80 percent of healthcare services are focused on treating only patients infected with the novel virus. Despite the limited human resources and capacity of health facilities in the soums, it is necessary to focus on COVID-19 when the spread of the infection is high. Most doctors and staff have been assigned to the COVID-19 unit while the rest provide basic care. In most cases, they take turns working in the unit. Everyone is working hard.

Did other medical services fail due to COVID-19? There have also been a number of international reports of doctors and medical staff being overwhelmed by the pandemic, suffering from depression and leaving their jobs. Did Mongolian doctors face such problems?

Even though the situation has worsened, we have not given up on basic care and services. In addition to COVID-19, we’re providing care and services in obstetrics, trauma, cancer, internal medicine, and neurology, as well as performing emergency and planned surgeries. It is not uncommon for people in our industry to be discouraged by workloads, but it is often due to the negative and aggressive attitudes of some patients.

The number of COVID-19 deaths has increased dramatically recently. At least 10 people are dying from the disease every day. Is it related to the workload of hospitals? Is medical care not available to everyone?

Death does not depend on a single factor. It depends on many things. Medical workload has very little effect on this. The biggest factor is the spread of infectious diseases. People in high-risk groups such as those with chronic illness, late-stage cancer, and the elderly, are at higher risk of death. This is the case for not only Mongolia but all over the world.

Are you able to hospitalize all people in the high-risk group?

People who are seriously infected will be hospitalized first. They usually show certain symptoms and conditions. Then, pregnant women and then, people over 60 years of age and those with chronic diseases. Mongolians are well immunized against the virus. Some have even got the booster dose. The vaccine does not protect you 100 percent from the infection, but it does prevent the risk of complications if you get infected. According to the current estimations and research, vaccines are 75 percent effective against infections. Even if you are infected after getting vaccinated, you will likely avoid the risk of complications and death.

How many people are being treated at home nationwide?

Currently, 30,000 people are getting treated at home in Ulaanbaatar and more than 20,000 in provinces. Family clinics are monitoring and treating them. According to global statistics, a maximum of 3.3 percent of patients is hospitalized. On average, it is about 1 to 3 percent right now. In general, only people with serious infections are treated in hospitals internationally. In Mongolia, this figure has reached 35 to 45 percent. Of course, there are advantages to hospitalizing people. For example, it prevents death. On the other hand, if hospital beds are occupied by people with minor infections, it could put those in need of emergency care at higher risk. In fact, we are restricting the hospitalization of people with mild symptoms, but we are still struggling.

Out of some 21,500 people who are currently hospitalized, more than 60 percent are showing mild symptoms. According to international standards, only 2,000 of them need to be hospitalized.

Earlier this month, the Ministry of Health announced that it would change the treatment method of COVID-19 and take measures based on its symptoms without having to be tested. How would you know that someone is infected with COVID-19 if they are not tested? What if the COVID-19  is mistaken for a cold or flu?

When the infection is widespread, it is too late to provide care and services after getting people tested and getting the results confirmed. For example, there are criticisms that the results of PCR tests are sometimes released after 72 hours. If a person with symptoms of COVID-19 is tested for PCR, confirmed by a diagnosis, and starts treatment after 24 to 72 hours, there is a risk of complications. Therefore, if the symptoms are clear, the person was in close contact with an infected person, and/ or the rapid diagnostic test comes out positive, we should respond to it quickly. Doctors and staff of family clinics and district hospitals have been instructed to provide timely medical treatment. This is a very important step. As the spread of infection has increased, this is necessary. If the prevalence decreases, treatment can be started after confirmation of the test results.

When do you think the pandemic will subside? Have professional organizations made any estimations?

There are three rules to reducing infectious diseases. It’s also called the “golden triangle”. The first is to contain the source of the infection. This means isolating and treating sick people. Mongolia is able to detect and treat infected people.

The next rule is the intervention of vulnerable people. In this context, we are intensifying immunization against COVID-19. The third or most important rule is the restriction of transit routes. This means restricting the movement of the population and preventing the spread of the virus to asymptomatic patients. In the health sector, the first two rules are well followed. However, there are no measures to prevent the passage. Since we’re not in charge of this work, do not ask the health sector when the spread of infection would decrease.

Is that why the Ministry of Health proposed to impose quarantine after 10:00 p.m.?

The Ministry of Health always proposes quarantine because the golden triangle needs to be fulfilled to fully contain the spread of the disease and end the pandemic. The pandemic is a global issue, not just a health issue. Citizens also have an important role to play in the prevention of the virus. If you really want to get on with your work and life, you need to make sure you and those around you follow the infection control regime. In reality, a quarantine of at least 28 days will reduce the spread of the infection. It is the most effective solution. However, people don’t want that. If you want to reduce the spread of COVID-19 while living and working without confinement, you need to obey the safety protocols. Even if you follow the protocol yourself, it will be of no use if your family and co-workers don’t do the same. So, demand those around you to follow the infection control regime.

Enkhnaranjav Tumurbaatar