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
Update 11th March 2021
On March 1st the State Health Services Organization (OKYpY) stated that it is ready to face a possible third wave, having formulated a revised plan for the deployment of more beds and the recruitment of staff needed. This plan takes into account the worst-case scenario, with a large number of cases. More specifically it provides the development of more than 300 beds in common wards and around 65 active beds in intensive care units (currently there are 54 available beds in ICUs and during the second wave, the usage of ICUs around mid-January reached 39 beds). The plan clearly states that the beds will be developed in all hospitals and defines the personnel that will staff these departments. As far as nurses are concerned, the number of other departments will be reduced to save more staff, while the plan for the doctors includes the recruitment of private doctors so that they can also help deal with the pandemic. The development of 100 additional beds to the current 200, the plan provides for the further creation of 58 beds in the General Hospital of Larnaca and 48 beds in the General Hospital of Paphos.
Update 16th November 2020
As a result of the rapid increase of hospitalised patients (on November 13th 42 patients were hospitalised in the reference hospital) it was decided that all wards at the reference hospital would be used exclusively for the treatment of COVID-19 patients (also see section 3.1). At the same time, instructions were given so that the fifth floor of the Limassol General Hospital will be available to meet any further COVID-19 needs.
In addition, in all public hospitals, special clinics have been organised to which the personal doctors can refer patients tested positive who develop intense symptoms. In these special clinics, patients will either receive supportive treatment and return home or sent by ambulance to the reference hospital for admission.
Update 2nd November 2020
Within the strategic plan prepared by the MoH for the management of cases that need hospitalisation, and following the reorganization of the wards of the reference hospital, the beds available for Covid-19 cases increased to 47. If these beds are not enough to cover demand, the remaining beds in the reference hospital will be used. Also, if necessary, the Ministry will designate a second reference hospital in the coming days (http://www.reporter.com.cy/local-news/article/740488/).
Update 28th September 2020
On September 15th the Council of Ministers approved the use of the 2nd floor of the reference hospital for COVID-19 (Famagusta General Hospital), for the treatment of coronavirus patients after the construction is completed (https://www.pio.gov.cy/coronavirus/press/15092020_5.pdf).
Update 22nd July 2020
Regarding the provision of sufficient quantities of vaccine against COVID-19 for the whole population of Cyprus, the MoH on July 21st clarified that Cyprus, together with the other Member States of the European Union, participates in the initiative of the European Commissioner for Health, through which 2.7 billion euros will be used from the Emergency Support Instrument (ESI) to invest in companies that the European Commission considers can move fast or are at a fairly advanced stage in relation to the vaccine research and clinical trial. The MoH has already submitted a request for 1.2 million vaccines (in this quantity Turkish Cypriots who live in the Turkish-occupied area are also included) (https://www.pio.gov.cy/coronavirus/press/21072020_1.pdf).
At the beginning of the epidemic there was a sufficient stock of tests to cover the needs of Cyprus. However, due to increased testing needs and the universal lack of tests, the availability is gradually decreasing.
Regarding intensive care beds, according to a statement by the MoH, at the beginning of May public hospitals will have 123 intensive care beds with mechanical ventilator support available exclusively for COVID-19 patients. In addition, 80 intensive care beds will be available for other patients. The MoH has come to an agreement with the Pancyprian Association of Private Hospitals (PASIN) and a number of patients from the public sector have been transferred to private sector beds in an attempt to relieve the pressure exerted on public hospitals. Although there are currently no major problems with intensive care beds, it is not certain that the health care system will be able to meet intensive care needs if the worst-case scenario occurs. It is a common perception that public hospitals currently have limited capabilities and strengths. However, the extent to which it will be able to meet the needs of the pandemic will depend on the growth rate of new cases, the resilience and availability of health professionals, and the overall coordination and management of the crisis by the government.
It is well known that there is a global shortage of personal protective equipment (PPE). Early in March, the MoH announced that there was a sufficient stock of PPE in Cyprus. However, the latest assessment (March 27th) found the Health System may be facing shortages of PPE soon. Efforts have been made since the beginning of February to cover these needs and in the next 10 days (April 4th-14th) two special flights are expected in Cyprus, with medical equipment, personal protective equipment and other consumables, which the government has bought from China. The MoH is also participating in the Joint Procurement initiative from the EU for PPE and other equipment. In an effort to ensure that there will not be a shortage of PPE, the MoH has set specific guidelines regarding the appropriate use of PPE, which have been distributed to all health care professionals since mid of February. Also by mid-February, the MoH had established a central management team to coordinate, monitor and control the national supply and demand of PPE. Both stock and the distribution are centrally controlled by the MoH.
Regarding medications, including antiviral drugs that are used for the treatment of hospitalised patients with COVID-19, at this moment there is sufficient stock in Cyprus. Under the instructions of the Minister of Health, sufficient quantities of Chloroquine have been reserved in collaboration with the Cypriot pharmaceutical industry to cover any short or long-term needs. The MoH has sent the relevant treatment protocol on the use of chloroquine to all hospitals, which has already been used for some COVID-19 patients.
Update 18th April 2020
Many organizations, companies and individuals are supporting the effort of the government to raise money and buy the necessary protective equipment. On 1st April the MoH announced that it had received a donation of 1320 protective medical uniforms from the People's Republic of China. On the same day, the MSC Ship management Ltd donated 106,000 surgical masks and 100,000 gloves to the Cyprus Government, to assist in the fight against the coronavirus disease outbreak.
A sports betting company, is among the major sponsors and supporters of the fight against COVID-19. On the 10th April a donation of €1,330,000 for the creation of the new Intensive Care Unit at the General Hospital of Nicosia, which is expected to be operational on May 6th, 2020, with a capacity of 20 beds was announced.
In addition, during the first week of April, 29 tons of medical protective equipment have arrived on two charted flights from China. According to the MoH these supplies will cover the needs of Cyprus for the next months.
Update 26th April 2020
On April 21st and 24th the fourth and fifth batch of medical equipment and consumables from China, arrived in Cyprus. It will contribute to the efforts made by Cyprus to tackle the pandemic. Part of the batch is a donation of 140 ICU monitors. It also includes surgical masks, swaps for sample collection and full-body protective uniforms. All those items will be immediately forwarded to health units to be used by health workers.
Update 11th May 2020
As part of the strategic plan to increase the capacity of the public sector to meet the needs of the pandemic, the construction of a new intensive care unit at the Nicosia general hospital was completed with 30 days. The new ICU with a capacity of 28 beds, will be equipped in the coming days, increasing the operational capacity of the public system in intensive care (https://www.pio.gov.cy/coronavirus/press/4052020_10.pdf).
On May 8th, the MoH issued new guidelines regarding the operation of hospitals. Hospitals will use only 60% of their total bed-capacity (hospitals that treat cancer and immunocompromised patients, may use up to 80% of their total bed capacity) (http://www.reporter.com.cy/local-news/article/676716/anatheorimenes-odiges-ga-ti-leitoyrga-ton-nosileftirion-exedose-to-ypoyrgio-ygias).
Update 18th May 2020
The Ministry of Transport, Communications and Works announced the arrival of another chartered flight from China with 36 tons of protective material, (protective clothing, shoe covers, single-use surgical uniforms and protective masks); the flight arrived in Cyprus on the night of May 13th. The material will cover the needs for personal protective equipment of Cyprus for the next few months. (https://www.pio.gov.cy/coronavirus/press/13052020_2.pdf).