ICU, short for intensive care unit, has become an often-read and heard term during the pandemic. This is especially true among the elderly and those with co-morbidities who were the hardest hit by COVID-19. As a result, ICU bed utilization rates rose to unprecedented levels, preventing them from taking in more patients. Hence, lockdowns were implemented to curb the spread of the virus, and ease the burden of the local health care system.
What are ICUs?
The United Kingdom’s National Health Service defines ICUs as “specialist hospital wards that provide treatment and monitoring for people who are very ill.” The ICUs are equipped with special monitoring equipment and health professionals specifically trained to handle critical cases. Sometimes, ICUs are called intensive therapy units (ITUs).
According the journal entitled “ABC of Intensive Care” archived in the US National Library of Medicine, intensive care is reserved for the following patients:
- Those who need advanced respiratory (breathing) support
- Those who need support for 1 or 2 organ systems
Photo by Anna Shvets from Pexels
Some common equipment that can be found in the ICU includes:
- Ventilator to help the patient breathe
- Monitoring machines that constantly measure vital signs
- Intravenous (IV) tubes to provide nutrients, fluids and medicines
- Feeding tubes
- Drains to remove blood and fluids that have built up
- Catheters to drain urine
Early admission to the ICU is critical as this increases the chance for full recovery.
The State of Hospitals in the PH
In the Philippines, health facilities are classified based on ownership. According to data from the Department of Health (DOH), there are more private hospitals (60%) than government-owned ones (40%). Majority of public hospitals are managed by the DOH, while the rest are run by local government units (LGUs) and other government agencies. More than half of Philippine hospitals are at only Level-1, which means their capacities are limited— comparable to those in infirmaries.
The World Health Organization (WHO) states the following ideal characteristics of a hospital:
- Matches the needs and values of the communities it serves, including the elderly and children
- Able to deliver and upgrade services during emergencies and disasters
- Fosters well-being of its patients and staff
- Has enough supplies, technologies, and infrastructure such as space, water, energy, etc.
- Well-coordinated staff, services and supply chains
- Constantly monitors and improves service quality
The number of hospital beds indicates the availability of health care. WHO recommends 20 hospital beds for every 10,000 people. But as of 2014, the Philippines only had 9.9 beds per10,000 population.
Sadly, the DOH reported that except for NCR, Northern Mindanao, Southern Mindanao and Cordillera Administrative Region (CAR), all the other regions do not have enough beds in relation to their populations. The Autonomous Region for Muslim Mindanao (ARMM) has the lowest bed count at .17 beds per 1,000 population.
Photo from Philippine News Agency
ICU Beds in the PH
In measuring critical care bed capacity in Asian countries, the ABC of Intensive Care study used the ICU bed definition outlined by the World Federation of Societies of Intensive and Critical Care Medicine. According to the WFSICCM, ICU beds should have at least a Level-1 capacity with the following traits:
- Has a dedicated space in the hospital
- Has a higher nurse-to-patient ratio than a regular room
- Able to thoroughly monitor the following: vital signs, oxygen levels and the heart
- Able to conduct ventilation—whether it is invasive, non-invasive, or mechanical in nature
According to the report, the Philippines is one of the only four countries in the surveyed regions that does not have an official definition of an ICU. The study, conducted from September 2017 to 2019, found that there were more ICU beds in private hospitals than public hospitals in the Philippines. Critical care beds which includes ICU and Immediate Care Unit (IMCU) beds amount to only 2,335 in the country. This is equivalent to 2.2 beds per 10,000 population.
Adding to the problem is that there is no clear distinction between ICU and IMCU in the Philippines. This study states that IMCU caters to patients that need more advanced care than in a general ward, but does not have the same high level of expertise as an ICU.
In conclusion, the medical journal on ICUs stated that critical care bed capacity is evidently lower in countries with low and lower-middle income economies.
COVID-19 and ICU Beds
The pandemic shone a light on the lack of ICU beds in the country. With the health care system unable to handle an influx of critical cases of COVID-19, many patients were not able to access vital services, leading to an increase in deaths. As of writing, more than 42,000 COVID deaths are recorded in the Philippines.
To help address this issue, the United States Embassy turned over ICU beds and vaccine cold storage units this 2021. DOH also reported that it had been steadily increasing its ICU beds, oxygen supply and isolation beds since March 2021.
Still, pandemic or not, the health care sector needs to be prioritized. In 2016, only 4.4% of the country’s GDP was spent on health according to the ABC of Intensive Care. Health remains to be a valuable human right, and we must take to heart the difficult lessons COVID-19 brings—preparedness being one of them.