Singapore Health Ministry: Adding Covid-19 ICU beds takes time, healthcare manpower constraints 'most important' bottleneck

Manpower constraints is the most significant limitation in the push to increase the number of ICU beds. — iStock pic
Manpower constraints is the most significant limitation in the push to increase the number of ICU beds. — iStock pic

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SINGAPORE, Nov 2 — Singapore may have all the equipment needed to keep increasing the number of beds for Covid-19 patients needing intensive care, but it does not have enough people to staff these beds.

Dr Janil Puthucheary, Senior Minister of State for Health, told Parliament yesterdaythat this was the “most important limit” standing in the way of stepping up intensive care unit (ICU) capacity to cope with a surge in Covid-19 cases.

“As a result, if we keep increasing our beds, we stretch and stretch our healthcare workers,” he said.

“We will come to the point that they will no longer be able to provide that continuous excellent care. Our nurse-to-patient ratio will be lower, which means each nurse will have to take care of more patients than they do today.”

Singapore’s healthcare system, he said, will also reach a point when even as health workers try their very best, more patients — both those infected with the coronavirus and others — will die, owing to lower nurse-to-patient ratios.

 “As more healthcare resources are diverted to support Covid-19 services, our hospitals’ ability to sustain regular non-Covid-19 services will also be reduced.”

Adding to the manpower constraints are a surge in resignations, with 1,500 health workers quitting in the first half of this year alone, compared with about 2,000 yearly before the pandemic.

More foreign health workers have also resigned.

“Logistically, we can keep stepping up our ICU beds. We have ventilators, equipment, consumables — all the things that are needed — but not enough people,” said Dr Janil.

He said that while Singapore’s healthcare system has been stressed by the present coronavirus surge driven by the highly infectious Delta variant, it has not been overwhelmed.

This is unlike many countries last year, where patients had to be turned away and doctors had to choose among many patients whom to save.

Dr Janil said again that Singapore would further expand its ICU capacity, in preparation for a potential rise in severe cases.

Right now, hospitals are working to ramp up the number of ICU beds for Covid-19 patients from 219 to 280 and these can be ready this week, he said.

Around 60 per cent of the 219 beds are occupied now.

“If needed, our next expansion will be to 350 beds,” he added.

Existing hospital wards, such as single and isolation rooms, are being repurposed to hold more ICU beds.

Supplementing hospital beds are close to 2,000 beds at Covid-19 treatment facilities, with occupancy now standing at half or less.

The aim is to have about 4,000 such beds by this month.

The authorities have also been boosting manpower by deploying previously trained ICU staff members to help with patient care.

Non-ICU staff supervised by ICU-trained workers have also been brought in.

Private hospitals are also putting aside ICU beds to help manage Covid-19 and other patients who are critically ill.

Even so, Dr Janil said that increasing ICU beds takes time and affects regular hospital operations.

“Converting non-Covid-19 ICU beds for use by Covid-19 patients who need intensive care has a limit, as it diverts resources from (other) patients who also need care.”

Patients in ICU need trained staff members who must be able to provide individualised attention, including round-the-clock monitoring and continuous care.

Increases in ICU capacity must therefore be supported by more health workers, who have to be diverted from non-coronavirus ICU duties.

Redeployed employees and new hires must also go through training to work in ICUs.

Ultimately, while there are plans to increase ICU spaces to a certain number, the situation on the ground and the operational considerations are not straightforward, Dr Janil cautioned.

The authorities earlier said that up to 1,000 ICU beds can be made available for critically ill Covid-19 patients.

“We do not want to go anywhere near this theoretical limit. If we do, the situation can easily get out of hand. It will affect the unvaccinated disproportionately, but it will also affect the rest of us.”

Leader of the Opposition Pritam Singh asked if the 1,000-bed limit for critically ill coronavirus patients was still the Government’s operating parametre.

In response, Health Minister Ong Ye Kung said: “Can (health workers) handle 1,000 ICUs? I think not without a major degradation of care.” 

Dr Janil, nevertheless, gave the assurance that the health ministry has strategies to restrict the number of cases, including those that shield health workers and hospitals from large surges.

He noted that attention must also be given to other medical conditions and emergencies: “We will continue to need care for heart disease, diabetes and cancer. We will have accidents and broken bones, and all of the patients will need care, comfort and healing.”

Although health workers in ICUs have been stretched to their limit in the last fortnight, Dr Janil noted that the situation has begun to ease from the peak of 171 cases to 130.

Under close watch are unvaccinated seniors who get infected — numbering 60 daily, with six likely to end up in an ICU.

“We need to keep this group as small as possible to ensure everyone who needs care can receive it.” — TODAY

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