post crisis

 

We were like a burnt child dreads the fire since then, we took rapid test for every patient entering our ED. The reason was simple, the local county government had kept sending patient relevant with the event for PCR test on daily basis; which indicated that the local community was not safe. Thence we started to treat patient outside the ED. For patient who needed to enter the hospital building for examination, they would need to clear rapid test for covid. The practice was adopted for almost 2 weeks when boss came to ask us about the situation. An inquiry was made to the local health authority and we were told that all related persons were cleared and the screening would be stopped in a few more days.

Despite of their promises; residents were still brought to our screening station by police. We felt uncomfortable with it but yet were unable to raise any question to the local authority. Our ‘clear to enter’ policy had gone for another one weeks before most of us loosen our grip.

There were no more active cases since then. Most of the cases diagnosed were residing in the north; some of them had traces down south but did not lead to any local infection.

The Hypoman visited us 2 months later and noted with hypoglycemia again. The Taximan suffered from shortness of breath and numbess over limbs from time to time and I had seen him lately in ED. The Mangoman’s wife had unfortunately passed away during her stay in the ward.

The Delta crisis had drawn an end after 1+ months of struggle. 2 months later the country daily Covid cases had hit zero again. Happiness did not last very long; another Delta cluster was noted in a kindergarten days after the zero emerged.

The rest of the story...

 

The event had led to an intensive contact tracing and isolation. After one week of effort, the local county health authority had found that the Hypoman had been a passenger of the Taximan. The Hypoman had chartered the service of Taximan three times before the Taximan was diagnosed. Meanwhile, the Hypoman’s wife was also confirmed as a Covid victim. The Hypoman’s house was just beside the Peru grandma’s house and his wife was relative to the Peru grandma. All of them was confirmed as Delta variant carrier;the link was apparent at that moment. The Peru grandma was the source, the Hypoman and his wife; although denied of any direct contact with the Peru grandma; had contracted the disease.

A few more positive cases were noted from the quarantine group; the Hypoman’s wife who was working at a 7-11 as shop manager, a few farmer who had a chat with the Hypoman and….

The Hypoman’s PCR came back positive after 8 days from the day I saw the Hypoman. I was lucky enough to escape from the quarantine list as they only backdate 7 days for possible contact.

It was almost 2 weeks from the first case when the final rock hit us.

While driving to my ward shift, I had gotten a call from my colleague telling me that there was a positive case from OPD who had passed by the ED. The ED will be shutting down for few hours for sanitization. The case was an elderly male (Mangoman) who was scheduled for a knee replacement surgery. He had undergone a PCR test as pre surgery evaluation and it had come back positive. He had walked pass by the ED before the swab test.

He was isolated and a wild goose chase of origin had begun. Few days later, his was proved as a Delta variant victim. His wife was also confirmed having similar infection.

After few days of contact tracing, the local authority had announced that the Mangoman had contracted the disease from the Hypoman’s wife.

It was noted that the Hypoman’s wife had presented to our OPD while the Hypoman was receiving treatment in our ED. Both the Mangoman and the Hypoman’s wife were in the same OPD waiting area on that specific day. According to their investigation, this was the only overlap trace and it was the only explanation that would explained the infection route. Our hospital was designated as the infection source and thence we would need to shut down for precaution.

Based on the above speculation the local authority had however decided to shut us down even though the southern command center of Covid prevention had against their decision.

The ED and OPD was closed down under and those patients admitted in the ward was barred from discharge. The hospital was still functioning without its OPD and ED thence no admission was noted. All the hospital staffs were put under self monitoring status and some of the closed contacts from the OPD were quarantined.

We were in a mist as the local authority did not state clearly the duration of shut down. According to internal source, the local authority had decided that we could only re-open when all of our staffs were fully vaccinated with the last vaccine taken at least 14 days ago. That was deemed impossible as we had only 1/3 of staff meeting the above requirement and it would be impossible for us to comply as the vaccine shortage was still haunting the country.

It was an agony while waiting for the re-opening announcement. Most of us had commitment and the management is not going to pay us as we were not working at that time. We were the designated primary PCI center and neurosurgical referral center of the southern tip of the island. Without our present, those relevant cases would have to refer further up north for management.

According to the national health insurance bureau, lost of income of a medical facility due to shutdown in the event of Covid will be compensated. The bureau would pay the similar amount of claim to the facility according to the figure submitted last year during the same month.

That period was definitely an anxiety period for me, everyone was waiting for the reopening order but yet everyday it ended in disappointment.

We did not believe with the contact tracing report. If the Hypoman’s wife had infected the Mangoman, why the other in the OPD area was not infected?

A massive screening was done during that period. Few thousand of people had undergone PCR test and none of them was found positive from this massive screening. All the persons who presented to the OPD at that day were summoned and screened and yet none of the result was positive. There were a few rumors later spreading around the community stating that the Mangoman had actually in contact with the Hypoman elsewhere. Those rumors were unable to be confirmed. The hospital had given up appealing early in the struggle as fighting the local health authority would lead us nowhere in the future. The local authority had contracted the part of the massive screening to us and we had received a great grant of material including two negative pressure chambers for further isolation.

The order for restarting service was finally signed 15 days later after our shut down. We were able to start our operation and everything went smooth.

The management had offered us to fill up our shift deficit by doing ward calls. Not a bad offer as it cut our wages loss to the least. The nursing staffs were offered a compensation scheme by deducting some of their outstanding working hours. Only a handful of peoples were left with a salary cut.

I had a long rest without a sense of insecurity; the mental stress noted was beyond imagine as I had to worry about the wages and also the afraid of contracting the disease even though I was fully vaccinated.

The Delta crisis drawn a red line since then and no cases of was noted.

The county government had been propagandizing their prompt action of management the Delta crisis during the period; however for me, it was a violent move of acting against advice of professional medical expert. They had stepped over our sweat and dignity by stigmatizing us as source of infection. The order of ceasing operation was the final blow and yet all the credit had gone to those bureaucrats.

The first 4....

During mid of June, we had received a call from the county health office informing us about a quarantine case would be sent over to us for treatment..

A senior lady who was undergoing home quarantine after returning from Peru had developed diarrhea and fever. I was doing day shift with my colleague G at that time. The ambulance came hours later with the ambulance team in full gear. Two patients came instead of one, the lady had brought her 10 years old asymptomatic grandson who was undergoing home quarantine with her as no one is looking after him.

G took the case and taken proper precaution while doing the consultation. A PCR swab test was done and xray was taken. The xray had revealed bilateral lung infiltration and we agreed that she was probably a covid victim judging from her xray and history. A swab test was also taken for the child even though he was asymptomatic. After 2hours of waiting, both the test result came back positive and a second confirmation test was done. We had informed the local health authority and as we had only one negative isolation ward and we had to referred both the case to another hospital.

The process was a smooth despite of the late transferring process. The case was placed all the time in our isolation room outside the hospital premises. The patients were transferred out after 6 hours of retention in the isolation room.  

The lady with her daughter in law and grandson had migrated to Peru a year before. Due to uprising of Covid cases in Peru and lack of vaccine; she and her grandson had returned for vaccination. They had travelled from Peru to Panama and later transit via Turkey, Hongkong and arrived in Taiwan. A long journey and they had caught the disease during transit.

The first rubble hit us 1 week later after our first Covid case.

About 10 days later , while I was on leave, the ED line chat group had announced our ED will be closing for 8 hours for sanitization as a positive case Covid case had entered our ED early in the morning.

A middle-aged male had presented to our ED at 5am for fever. He claimed that he was a delivery man and no significant travel nor contact history was noted. As no active case was noted around our county, the attending emergency physician had allowed him to enter our ER and he was put on a drip and antipyretics. A Covid PCR swab test was later done and patient was discharged without waiting the result.

By 7am, a positive result came back and our ED was shut down for sanitization. The patient was admitted to another hospital for care. Our colleague had apparently broken the rule and allow febrile patient to enter our ED. A swab was done without any proper precaution measure. The event had led to quarantine of 1 physician, 1 radiographer, 2 nurses, 1 attendant and 1 counter clerk.

Contact tracing was done and it had revealed that he did not give the whole story. He claimed that he was a delivery man but he only delivered human; he was actually a “taxi sapu” driver (illegal taxi operator). The contact tracing had led to a dozen of patient being isolated and checked. One of them was an elderly male who was seen by me few days ago. The elderly male  had presented to our ED for hypoglycemia and was discharged 3 hours later after his sugar stabilized. I had asked if he wanted any admission but he denied even though he was still feeling giddiness on his discharge.

The elderly male (Hypoman) was tested positive few days later. Now we had 4 cases, the granny (Peru grandma), the grandson (Peru grandson) and the taxi driver(Taximan)

So the connection between them was still unclear at that point…The common part was all of them lived around the same area……

Pre-impact

 

The local county had been celebrating +0 for a couple of weeks since the start of recent outbreak. A few possible clusters was noted but however did not expand into an uncontrollable state.

The outbreak started in late April where a few pilots from the local airlines were tested positive. The incident was preceded by a relaxation of quarantine rule for airline pilot by the local health authority. The initial rule was 5+9 where a pilot had to be quarantine for 5 days followed by 9 days of self monitoring period. Later the restriction was adjusted to 3+11 by mid of April.

The discovery of positive cases among pilot was later follow by case from the community. Cases by cases were noted among the resident of WH area(old town of T-city). Suddenly it had become out of control with hundred of cases were reported in a single day. Major hospital’s ICU was packed with patient, negative pressure rooms were filled up quickly and patients were referred a few hundred km down south for critical care.

Most of the virus strains noted was of the alpha strain, originated from the pilot cluster. The medium of transmission was believed to be the N- hotel which manned by the government own C- airline. The hotel had mixed its patron with the quarantined pilot at the same floor. More and more cases were noted despite contact tracing and isolation effort. An active lion club leader had spread the disease to its member after attending a few gathering. The spreader was known as the ‘Lion Ling’. A grape dealer had also formed a cluster transmitting to his relative and friends. The final hit was noted after cases emerging from Tea lounge with female GRO(guest relation officer) at the WH area.

The whole island had fallen since then. Cases with foot step tracing back to the WH area was noted. Luckily the southern part of the island had managed to stop the chain of transmission by proper contact tracing and isolation. Within 4 weeks, the southern part had managed to achieve zero case while the north was continually haunted by cases of ? origin.

We had stood at our principle of no travel, no contact history is considered safe rule.

We had wanted to purchase PCR machine however no stock was available and we had to send our sample out for testing initially. The whole process was tedious. Patient was admitted to isolation ward pending negative test result. The ED was considered as hot zone in many hospitals however we had treated our ED as grey area; not contaminated nor clean. Some of our staff had started to loosen their grip and various restricted wrong doing (swab test in the ED without proper precaution) was noted.

PCR machine had arrived later and rapid test kit was approved for after the initial hazardous weeks we been through. The arsenal was built up slowly and the line of defense had been stronger ever after.

Level 3 alert state around the island had been a suffering stage for everyone. Dine in was not allow, food joint had turned their focus to take away. Meal box was selling like hot cake from some top notch restaurant. The only place allow to eat is your own premise. Face mask was required everywhere except your house. All entertainment joint had been shut down.

The local people had confined themselves in the house and the southern part had been noted with zero case weeks after the outbreak. We were looking forward to the relaxation of critical state at the end of June but the falling boulder hit us one by one until we were knocked out…

The rise...

Although we had a small surge of cases during the January of 2021 which involved a hospital up north; the flame was controlled by the local authority quickly. The situation was quiet for a couple of months until the lower half of April. A few airline pilots were tested positive followed by their family. When the local authority rammed up the testing, more cases were revealed. The situation had lost control and the government had elevated the situation to level 3.

Peoples were requested to don mask all the time when they leave their home; restaurants were ordered to shut down dine-in. The worst part was the vaccine amount delivered.

I received my vaccination at the end of March. The only choice available was AstraZeneca vaccine. Frankly said, I had doubt to receive the vaccination but as a front-liner, I had no choice but to risk my life for it.

I remembered the day of the jab. It was my off day and I registered for my vaccination at PTC hospital 20km away from my house as my own hospital was not authorized to give any vaccination at that time. I arrived early at 9:15am and reported to the clinic after initial registration. I had gotten my jab 30minutes later and after observation for 30minutes. I left the clinic. Ving had accompanied me to the clinic and we had stopped by a local restaurant for our brunch at 11am. We finished our meal later and proceeded to the BNQ mall for some home repairing staff. When we left the shop by 1pm, I was so tired then and Ving took over the wheel and driven us home. I slept throughout the journey and continued my nap the whole afternoon.

I woke up in by 7pm with soreness over my body and eaten my dinner. By 9pm, I sunk into my bed and woke up at 6am the next morning preparing for my shift.

The next 5 days, I had experienced most of the side effect listed on the list except for fever. I had fever though and had to take medication for it. I was lucky as I did not suffer from any fatal complication.

By the time the outbreak surged up late April, only part of the medical staff was vaccination as the AZ vaccine was treated as notorious by the local people. However as cases built up, the limited AZ vaccine had become hot cake over a few weeks and the government was out of vaccine in a short period.

Cases had increased from single digit to few hundred per day. Most of the cases were noted in the northern part of the island. The south was calm and even though some infected person had placed their foot step around the area but yet no prominent cluster was noted.

The atmosphere was tensed up north, but the south was still a land of peace in 5/2021. We still practice the ‘negative TOCC’ means no risk of infection principle. The screening rate was still low as sending PCR test means the patient need to be quarantined in his house for 1D1N before the result could be obtained.

However we hit the rock one month later…..

new year new wave

The new wave finally strikes my homeland and northern part of the island since few days ago 

Homeland had been well controlled even though it had been noted with 2-3 daily figures of new cases. The loosening of the control order had brought hope to economy recovery; however it did not last long. Non compliance to the control order had eventually fueled up the gas tank leading to a blast after the state election in the Borneo. The blast’s shock wave had however expanded and over crumbled the medical system. Daily ICU case raised and mortality had increased steadily since 1+ months ago. I am not concerned about the daily cases but had been tracing the ICU cases and ventilated cases rise during that period. These two figures reflected the final burden of the medical care. The expo center neared the agricultural university was transformed into a hospital for low risk group with bed of 600 initially. Each bed had cubicle with cupboard, bed, table, chair and a spacious personal space. Recent 2 weeks, it had been expanded into 10000 beds where it had been more crowded than a Bangla workers dorm…And even with such facility, it was not enough, the ministry had planned to build more facility and allowed low risk patient to be treated in their own HOME!!! The decision might lead to a further worsening of the condition as peoples have not and will not comply to the order....

Finally, the boleh land had reached it breaking point. Darurat was announced and government had the power to mobilize everything including private hospitals. Political struggles was still going on despite of the Darurat. The DG was playing his part well but without a full mandate and authority to run the situation all he could do was plead everyone to stay home. The leaders of the country had been breaching the SOP like don't know what; solid evidence? Look at the amount of positive test result among the ministers; if they had complied to the order, they would not get infected….if the head cannot be straight, don't hope the body to do so...

The northern part is currently at the verge of outbreak after a nosocomial infection originated from a resident physician treating a covid 19 patient.

The contact tracing of such event had led to a massive screening event and currently it had spread beyond the boundary of the relevant hospital. One of the patients was a husband infected by his wife and he worked in a fast food joint at one of the airport express station. The command center had extended it screening and isolated the in patient service initially. Tension had built up as more and more positive cases were noted and further closing down the service was done by stage. Some local authorities up north had ordered postponing of some events.

Since earlier this month, the authority had demanded us to upgrade of screening. We were given a quota to performed screen on patient with diagnosis of pneumonia. Few months ago, we were encouraged to screen patient with severe acute respiratory illness case and especially hinted us to screen those with diagnosis of pneumonia. We had however known that it would be an index later on and started to refrain ourselves from coding pneumonia in our diagnosis. Most of the hospital except one did similarly except one. Their quota was 30 as they had coded pneumonia for 150+ cases for the last few months.

I had a referral case down south for pneumonia which favor pulmonary tuberculosis reactivation yesterday. I had decided to screen it as he will be staying in the negative pressure isolation room anyway. So after months of easiness, I had donned the PPE again…Smooth process and it was a good drill for me to revise the procedure.

I had called my dad on regular basis to check on them every few days. Life definitely is bored and the only things they could do is to walk along the jalan for exercise. Both of us shared the same feeling: accept the faith and coup with it....