2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Since March, over 2,500 hospital beds have been allocated for the treatment of COVID-19 patients, 300 of which are ICU beds. As of 28 June, COVID-19 patients are being treated in 19 medical facilities across Armenia (7 in the regions and 12 in Yerevan). In April, only the inpatient building of the Grigor Lusavorich medical center has been actively treating patients with COVID-19. Additionally, 16 hotels with 400 beds are occupied by patients who have mild symptoms or almost no symptoms and people were in contact with them. As of 17 April, only about half the available capacity was in use. By 24 May 154 ICU beds were occupied. On 4 June it was reported that Armenia had run out of ICU beds. As of 7 July, there are no patients waiting for hospitalization at home although 20 patients waiting at non-COVID-specialized medical centres. However, ICU beds were once again nearly at capacity. By 13 July the situation appeared to stabilise.
There was a documented shortage of ventilators, ICU equipment, PPE, lab reagents and supplies. The detailed list of needs was quantified and made available on COVID-19 partners platform. [https://covid-19-response.org/] Many essential supplies were delivered on 16 April (namely more than 87,000 protective medical uniforms; 20,000 KN95 protective masks; 24,000 medical masks; 101 no-contact thermometers; medical instruments; biochemical raw materials necessary for the production of covid-19 tests).
On 8 September WHO and the EU provided the Armenian Ministry of Health 100 oxygen concentrators, 20 electrocardiography devices, and 10,000 PCR tests. The equipment and the tests will be provided to the national medical centres and laboratories. The equipment and supplies were procured by WHO, with support from the EU. USAID and the Ministry of Health have launched a new phase of cooperation to overcome the COVID-19 epidemic in Armenia. The programme will last for one year. The goal is to prevent the spread of COVID-19, to support the healthcare system with the necessary equipment and supplies, to equip the medical staff with the necessary knowledge, and to provide reliable information to the families.
Several public secondary and tertiary care multi-profile hospitals were repurposed to manage COVID-19 patients and operational plans were developed and have been implemented in these hospitals. The number of hospitals/beds will be increased as needed by repurposing additional hospitals. At the moment only the dedicated beds are occupied by COVID-19 patients. The PPE available in all health facilities of the country was quantified and repurposed for COVID-19. In addition, the government and humanitarian partners have already procured certain quantities of PPE, ventilators, and tests.
On 1 June, The Minister of Health informed that there will be an additional 100 beds made available in the upcoming month or so. The beds will be at two of the country’s largest medical centres; 50 will be at Surb Grigor Lusavorich and 50 at Erebuni Medical Center. The Director of the Lusarovich informed on 29 May that 95% of the beds in the ICU unit and about 80% of the remaining 420 beds are occupied. From 8 June, the medical centres in Spitak (100 beds) and Vedi (100 beds) will treat COVID-19 patients, and a COVID-19 department will open in the Martuni medical centre (35-40 beds) and in Dilijan medical centre and capacity at the Armenia and Surb Astvatsamayr Medical Centres have been increased. Overall, 350 additional beds were allocated for COVID-19 patients.
A new triage centre was announced on 6 June, to be based at the National Burns Centre, which currently has 64 beds, nine of which are emergency care beds. For COVID-19 triage, the Centre will have an extra 58 beds (in total 132 beds). The National Burns Centre will not offer ambulatory treatment but will receive patients brought in by ambulance.
From 7 June, any medical centres that wish to be involved in COVID-19 patients’ treatment can submit applications to the Ministry of Health if they meet the required criteria. In October / November 2020, about 26 medical centres across the country reprofiled and treat patients with COVID-19. In addition, 36 medical centres began to operate as military hospitals.
On 15 December, the Kapan Medical Centre (Syunik region) announced that with the joint efforts of the Ministry of Health, Syunik Municipality and the Kapan Medical Centre, the medical centre has been equipped with new computer tomography diagnostic equipment.
Inpatient care, particularly ICU, is back under pressure as the number of COVID patients receiving healthcare in health facilities keeps increasing as does the number of people injured in armed conflict. Number of designated COVID facilities was increased to 17. As of 19 October, only 7 vacant places in ICU and 120 vacant places in regular wards. It is planned to further increase the number of COVID hospitals. One hotel in Yerevan is dedicated to accommodate COVID positive patients not requiring medical treatment among spontaneous arrivals. As of 18 November, all the COVID-19 beds in Armenia were full, and a critical lack of oxygen was reported; 375 patients were on a waiting list for admission to hospital, 25 of whom are in a serious condition. By 24 February 2021, incidence had fallen and the coping capacity of the health system was sufficient.
A new Intensive care and Reanimation unit was opened at the Surb Grigor Lusavorich Medical Centre on 15 January. The new unit has a 40-bed capacity which brings the total number of ICU beds in this facility to 120, making it the largest reanimation service in Armenia. In 2020 this Medical Centre also got a blood bank service and updated its laboratory equipment to be able to run PCR tests. In April 2021, the EU and WHO have donated 100 oxygen concentrators to the Ministry of Health to help patients recover from the severe illness caused by COVID-19. These devices were provided as part of a broader package of assistance to prevent the spread of COVID-19 in Armenia.
As of 10 March 2021, the Ministry of Health was further expanding hospitals to treat COVID-19 cases because 808 of the 865 beds for the treatment of COVID-19 patients were occupied. From 4 March another two medical centres started providing beds for COVID-19 patients and the number of centres opening has continued to expand to meet demand. However, despite the number of beds almost doubling (to 2,171), by the end of March 2021, Armenia had almost run out of vacant beds for the treatment of COVID-19 patients. According to the Armenian Ministry of Health, about 300 people with severe COVID-19 infections are waiting for hospitalization.