VietNamNet would like to introduce an article by Assoc Prof Dr Vu Minh Phuc, a respected doctor, on the issue. The article shows the viewpoint of the author.

As of the morning of July 31, Vietnam had reported 1,161 deaths because of Covid-19, including 900 in HCM City.

I need figures to analyze the situation and suggest solutions. However, I could not find necessary figures in the statistics released by HCM City. Therefore, I would assume some possible situations. Each situation would need a specific method of intervention.

The figures I need include:

Frequency of death at home

Frequency of death before getting to hospital or medical facilities

Frequency of death within 24 hours after hospitalization

The average time from the moment patients or hospitals contact to the moment patients cmare carried to the places they want.

Bottlenecks need prompt settlement

If the frequency of death at home is high, the responsibility is blamed on the healthcare systems in wards and districts (Layer 1).

I receive a lot of calls these days from my regular patients who are F0s now and ask for advice. They said local medical units told them to return home, anf they did not give any advice, prescribe or give any medicine, did not tell them where to buy medicine, and did not give phone numbers to contact. They just told them to call 115 in case of emergency.

To make intervention in this layer (Layer 1), it’s necessary to establish a network of consulting doctors who give advice via phones in every ward, district, and drugstore in the areas. However, the lists of doctors needs to be made public. Medical workers in the ward’s medical units must know the lists. It’s necessary to show people how to use the consulting network and choose doctors, because many workers cannot use the internet.

Ward medical workers seem to be overloaded and cannot examine all patients who have demand. And they seem to be afraid of meeting patients.

In principle, when discovering that a patient turns severe, it’s necessary to carry patients to hospitals. However, consulting doctors like us don’t know any hotline to contact to ask for support. We can only tell patients’ relatives to call 115. But the line is always stuck. There is no means of transport for patients to come to the nearest healthcare units. If they go to hospitals, they may be refused because the hospitals don’t specialize in treating Covid-19.

In principle, when discovering that a patient turns severe, it’s necessary to carry patients to hospitals. However, consulting doctors like us don’t know any hotline to contact to ask for support. We can only tell patients’ relatives to call 115.

This is the biggest problem of Layer 1 which needs to be solved immediately.

Increasing Layer 3 hospitals

The death rate is highest in Layer 5, which gathers the most severe patients. And this is understandable. The other reasons are the lack of ventilators, ECMO (extracorporeal membrane oxygenation), and the lack of human resources. However, I found that the Ministry of Health has poured big human and material resources into the layer already, but the death rate is still high. So, it’s necessary to consider other reasons.

If the death rate before hospitalization and within 24 hours after hospitalization is high (I feel that the deaths are mostly in this group), this could be attributed to the following reasons:

Slow hospitalization because of objective and subjective reasons (no ambulance because of overloading, long distance, no bed at hospitals).

Unsafe hospitalization because of the lack of support and equipment on vehicles that transport patients.

Critically ill patients cannot be discovered in a timely way because of the lack of human resources and equipment, and medical workers’ lack of experience.

As far as I know, HCM City has decided to build 2-3 more intensive care hospitals for Covid-19 patients in Layer 5 and call on medical workers from other provinces to work at the hospitals. However, I believe that in order to reduce the death rate, it’d be better to focus on Layers 2, 3 and 4.

I think that the weakest links lie in the hospitalization and the transfer among the layers.

Local healthcare departments need to publicize the situation of equipment and human resources and clearly state how many machines and what kinds of materials they need. Benefactors are willing to donate equipment.

I think it’d be better to increase the number of hospitals for Layer 3, so that each district has 1-2 hospitals in this layer. This allows the patients who turn severe to reach the nearest hospitals (the field hospitals of Layer 2 are too far from their homes).

As for the hospitals in Layer 4, I know that some hospitals have to divide into two parts to treat severe Covid-19 patients and other patients. I think that the hospitals of this kind need to be equipped well, not inferior to Layer 5, except for ECMO.

If possible, I would increase the number of hospitals in this layer by selecting more hospitals to operate under the two-part regime. There should be 1-2 hospitals in this layer to receive patients who turn severe.

Ambulances and transportation vehicles

I have big worries about hospital transfer.

Taxis have been mobilized to support the 115 emergency center, but I think this is still not enough in quantity and quality.

To improve the network of transportation, ambulances and transportation vehicles need to be present at a station in every district. There should be a specific contact number in every district to avoid congestion. Only 200 taxis for all districts in a city of a population of 10 million is too little.

Ambulances of hospitals in Layers 2, 3 and 4 need to be equipped with equipment to support breathing inside, in addition to oxygen tanks. 

Associate Prof Dr Vu Minh Phuc

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