In the event of a major outbreak of COVID-19 in the country, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) has mapped out its plan to upscale its capacity to admit and care for a large number of patients, as Thimphu Thromde has a large population. In addition, other serious patients from the dzongkhags nearby will also be referred to JDWNRH.
The main hospital at JDWNRH will not take any COVID-19 patients as the chances of spreading the disease to other patients and staff is high. Therefore, JDWNRH has identified other infrastructure for admission of COVID-19 patients, such as the eye hospital, old Community Health Department (CHD), old Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), Royal Institute of Health Sciences (RIHS), old OPD physiotherapy, and Changzamtog Middle Secondary School, if the number increases to more than 100 patients.
Medical Superintendent of JDWNRH, Dr Gosar Pemba, said JDWNRH has identified a total of 100 beds for COVID-19 patients. The old Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) building is being used by the staff looking after the positive case admitted to the eye hospital. The staff is to be shifted to another location so that the building can be converted into a temporary hospital.
The old KGUMSB building can be converted into ward to admit COVID-19 patients who are not seriously ill. The building can be easily accommodate more than 50 patients if the need arise. This will enable the hospital management to provide care easily as all the patients are placed under one roof. The building can be cordoned off so that the public does not have access to it, and there is only one entrance to the building making it easier to be monitor.
More staff will be required if the infrastructure is scattered over many areas. Converting service facilities into temporary hospital has a huge impact on the delivery. It is not known how long the outbreak will last as the disease is still evolving and the spread is likely to spread from one country to another, which will prolong the duration.
The hospital has ordered 50 beds and there are 10 beds being used by the staff. The number of beds in the hospital in the wards can be reduced and the beds transferred to the KGUMSB building if the need arises. The utilities, like electricity and water supply, is checked and made available 24/7.
JDWNRH is preparing for such worst-case scenario.
First case scenario: 20 or less COVID-19 patients requiring admission
The patients are to be admitted to the eye hospital with a capacity to admit 24 patients. The eye hospital has 12 beds for mild cases with 10 bedded ICU and 2 bedded PICU. The hospital also has a delivery room and an operation theatre (OT) if in case a pregnant woman in her due date gets COVID-19. Similarly, if a COVID-19 patient has appendicitis and needs operation, OT in eye hospital can be used.
If the eye hospital is full then the patients will be admitted to the CHD building which has the capacity to admit 30 patients. The staff working in the physiotherapy room can use the facility in the old MCH for donning and doffing of PPE as the buildings are nearby and access is convenient. This facility already has 20 beds and with another 10 additional beds to be secured. The physiotherapy room has toilets for patients as well as for the staff and also two rooms for staff that can be used as nurse station.
Second case scenario: 100 more patients with COVID-19 need admission to JDWNRH
In the event of an outbreak in Thimphu Thromde, the likelihood of a large number of patients requiring admission to JDWNRH may occur.
In such a situation, the hospital must have a surge capacity to deal with the situation. The best infrastructure available in JDWNRH is the old KGUMSB building, which can accommodate about 50 patients. This ward is be used to admit only COVID-19 patients who are not very serious and do not require ICU care.
The COVID-19 patients who are serious and may need ventilator support should be admitted to the eye hospital. Therefore, taking the case scenario as 100 or more COVID-19 patients, and assuming that a team of doctors, nurses, allied health staff and support staff work for a period of 2 weeks continuously, before handing the shift to the next team.
Out of 100 COVID-19 patients admitted, 10 to 12 patients may present conditions, like severe pneumonia requiring ICU care, and a few patients may also need ventilator support. The serious patients will be admitted to the eye hospital and those having mild symptoms will be admitted to the general ward (KGUMSB) and old CHD.
Assuming that out of 20 patients admitted, 5 to 6 could be seriously ill and need to be admitted to the ICU and isolation ward for intensive care. A team of doctors, nurses, allied health staff and support staff are required to manage the case and they will work for period of two weeks before another team takes over. If the number of patients is less than 20, all patients will be admitted to the isolation ward.
A total of 80 staff will be required, including medical specialist, resident, GDMO, pediatrician, pediatrician resident, general nurse, laboratory staff, X-ray staff, USG staff, support staff ward boy/girl, wet sweeper, biomedical engineer, plumber, and electrician in the general wa rd hospital (KGUMSB) which is 70 bedded.
The main hospital providing other services will have only adequate beds and other facilities for functioning. If JDWNRH is overwhelmed with the patients, and the present identified infrastructure is not adequate to accommodate the patients then the community health department can admit 50 patients, the old Royal Institute of Health Sciences (RIHS) building can accommodate 50 patients, old OPD physiotherapy has the capacity to admit 10 patients and Changzamtog school can accommodate 100 patients as a temporary hospital.
In such an event, the buildings will be emptied of all the furniture and converted to makeshift including basic OPD services for other patients. Hospital equipment, like beds and other medical equipment will be shifted to these buildings to provide services for COVID-19 patients.