Rafik Hariri University Hospital (RHUH) Experience during COVID-19 Pandemic
Being the first governmental hospital to respond to COVID cases, although the economic problems we are struggling in, was a real fight. Our response was rapid. We have done a significant adaptation in 24 hours to meet the very specific needs of our population during the pandemic and since then we keep integrating new knowledge day after day.
Sharing our clinical experience and our staff engagement and suffering in managing cases of Coronavirus disease, is a salute to our heroes, a success story and a lesson to be learned by healthcare policy makers in the context of dramatic pandemics.
On the 21 of February 2020, Lebanon disclosed the onset of the first positive COVID-19 patient, transferred directly from Rafik Hariri International Airport and admitted to RHUH isolation unit. The patient was coming back to Lebanon through a direct flight from Iran (Koum area).
RHUH being the referral governmental hospital called by the Lebanese Ministry of Public Health for the management of very contagious cases was immediately engaged to carry out rapid response actions and to track all needed arrangements and provisions.
This was an unprecedented challenge to all RHUH staff. It perfectly affected the physical and mental wellbeing of our Health Care Workers especially frontlines.
From February till October 2020, 49744 persons have been tested positive for COVID-19 in Lebanon. We have traced 21625 recoveries, 439 deaths during this 8 months period (Figures are subject to increase by time).
Among these 782 patients infected with COVID-19 were admitted to RHUH dedicated Corona Wards, 59 patients infected with COVID-19 died in RHUH, 482 patients infected with COVID-19 were cured and discharged. Some other patients presented to RHUH Emergency Room for testing and assessment, and have been found well enough to be discharged and advised to self-isolate themselves, take prescribed medications and instructions and monitor their symptoms at home.
The hospital had in place one dedicated isolation unit of 4 intensive care beds fully equipped and some of our staff were already trained on the management of contagious disease but there was an imminent need to tackle expected increased workload in an ever-evolving situation.
At the very beginning of the pandemic, in order to minimize the spread of the disease, and in addition to the Ground Floor isolation unit, we converted conventional wards to isolation areas without suspending any essential clinical services: 4 wings at third floor of the main hospital building were capable of providing 24/24 care to 128 patients. A triage system with a separate pathways for suspected cases was developed with a fully equipped emergency room for COVID patients’ assessment and admission. By the evolution of the disease and the increase in demand, later additional units were prepared:
ICU 1with a total of 11 beds (after transferring non COVID cases to CCU unit),
ICU 3 with total of 8 beds,
6 ICU beds for in-patients staying in COVID ER (due to lack of places in COVID ICU beds),
8 ICU beds (inside the operating theater which was restructured in collaboration with UNHCR),
4 COVID NICU beds.
Working stress, daily influx of patients to hospital, low hospital capacity and the insufficient ratio of nurses to patients have made the care more difficult.
By the time the pressure was increasing on RHUH frontlines, and the fear of contacting the virus among healthcare workers was also increasing, the first staff exposure was declared.
One of our leaders a nurse supervisor, 30 years old presented a symptomatic table in favor of COVID-19. While she was on duty in June 12 she felt tired, and noted a mild cough with rhinorrhea. She was advised by the infectious disease physician to do the PCR test. The second day, her test comes up positive. Her symptoms were aggravating and she needed admission.
She was suffering from a severe pneumonia that required O2 administration along with the Antibiotics and the standard COVID treatment. She was only discharged after 9 days of hospitalization, in June 21.
Although she has been very careful since the beginning of the pandemic, wearing all needed PPEs at work and quarantining herself and her family at home, she always had in mind that it could be her one day who might be positive.
The day when she noticed the signs was memorable:
“It started with chills, body ache, severe headache, dry cough and fever of 39 degrees. I called the infectious disease physician who told me that I need to be closely observed and admitted”.
“At this moment my first reaction was to concentrate on whom I could have transmit it”.
“My only thoughts were regarding my three children, my husband, my parents and the people I was obliged to see”.
“The first hours were awfully difficult”.
After tracking all people who were in contact with her, the physician believed our supervisor contracted the virus from her little girl who had a doctor visit to one of the hospitals.
Loneliness, fear, anxiety were embracing her during all her stay although she was monitored and supported by all colleagues:
“It was really a nightmare, I felt helplessness and loneliness. I was on my own, I didn’t know whether I will survive or no”.
“Now that I am recovered, I thanks my family and friends who continued to follow on my case throughout my whole recovery period and I urge all people to respect guidelines diffused by the Lebanese Ministry of Public Health protecting their lives and the life of others”.
After this first staff contagion, many other staff were tested positive, but without the need for long hospitalization. Out of 124 nurses working with COVID-19 patients, 9 nurses have been exposed and managed individually according to their degree of exposure.
Hope that sharing this experience will enhance preparedness for future possible pandemics and will highlight the many bottlenecks when drawing crisis plans. In addition, this could be a call for all healthcare stakeholders that nurses are the critical line of defense, countries must identify the need for nurses and consider how to find ways to support them to ensure we can respond to any crisis confidently, and increase nurses and hospital resilience in response to such crisis.