3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Update 2nd November 2020
On October 28th the Scientific Director of the Reference Hospital urgently requested additional staff (doctors and nurses), because of the increasing number in Covid-19 patient admissions (https://in-cyprus.philenews.com/urgent-call-for-additional-staff-at-famagusta-general-tough-night-yesterday-director-says/). On the the same day, the administrative head of the State Health Services Organisation (SHSO), has called on the MoH to designate a second reference hospital, as staff at the already designated reference hospital; the Famagusta General was on the verge of exhaustion (https://in-cyprus.philenews.com/Covid-patients-up-to-28-at-referral-hospital/).
Update 18th October 2020
On October 2nd the MoH announced that the European Medicines Agency (EMA) has started the first “rolling review” of the first batch of data on the Covid-19 vaccine, which is being developed by AstraZeneca in collaboration with the University of Oxford and on October 6th on the vaccine known as BNT162b2, which is being developed by BioNTech in collaboration with Pfizer (https://www.pio.gov.cy/coronavirus/press/02102020_2.pdf, https://www.pio.gov.cy/coronavirus/press/06102020_5.pdf). The Cyprus government has already submitted a request through the European Commission, to secure enough vaccines for covering the population against Covid-19.
The SHSO is constantly filling all the vacancies of health professionals in the public hospitals. Moreover, in order to strengthen the work of the Surveillance Unit, the MoH invites students and/or graduates of health professions interested in providing their services within the framework of public contract (https://www.pio.gov.cy/coronavirus/uploads/16102020_1.pdf).
Update 17th August 2020
On August 5th the ΜοΗ announced new stricter measures to be taken in all hospitals and clinics by the patients, visitors and the personnel, (temperature measurement, keeping visitors / escorts registry, visits only by appointment, use of personal protective masks, strict hand hygiene) and all precautionary measures that deriving from the applicable Decrees and protocols (https://www.pio.gov.cy/coronavirus/en/press/06082020_2.pdf and https://www.pio.gov.cy/coronavirus/press/05082020_3.pdf).
The Ministry also updated the guidelines and measures for precautions against the spread of SARS-C0V-2 for Elderly’ Homes, Public Child’ Institutions/Adolescent Protection and Care Structures for the Disabled (https://www.pio.gov.cy/coronavirus/press/31072020_7.pdf).
Update 27th July 2020
On July 16th the ΜοΗ announced that Cyprus is participating in the joint procurement of seasonal influenza vaccines for 50,000 doses, due to the special circumstances caused by the coronavirus pandemic, the warnings by the scientific community about the possibility of a new outbreak in the autumn and given that so far there is no vaccine for COVID-19. The quantities of influenza vaccines for 2020 are increased compared to 2018 and 2019 (https://www.pio.gov.cy/%CE%B1%CE%BD%CE%B1%CE%BA%CE%BF%CE%B9%CE%BD%CF%89%CE%B8%CE%AD%CE%BD%CF%84%CE%B1-%CE%AC%CF%81%CE%B8%CF%81%CE%BF.html?id=14795#flat).
Update June 24th 2020
On June 19th the Minister of Health held a Press conference evaluating the activities that addressed the coronavirus pandemic and among others he stated that in case of a second wave the MoH is ready and will follow the same plan as it has already done so far, (https://www.pio.gov.cy/coronavirus/press/19062020_2.pdf).
Update 14th June 2020
On June 5th the MoH issued new guidelines for the visits to all hospitals. More specifically visits will be arranged by appointment, there will be checks for possible respiratory infection symptoms, checks for temperature, and the use of personal protective masks will be mandatory and only one visitor will be allowed per patient (https://www.pio.gov.cy/coronavirus/press/5062020_9.pdf).
Update 6th June 2020
According to the Decree issued by the Minister of Health on June 5th, visits are allowed to all public and private hospitals, homes for the elderly and disabled and in providers of 24 hour care for persons with disabilities, only by appointment and following approval by the management (https://www.pio.gov.cy/coronavirus/diat/43.pdf).
Update 24th May 2020
According to the new guidelines by the Surveillance and Control of Communicable Diseases Unit at the MoH and the recommendations of the Scientific Advisory Committee on May 19th, 20% of hospital beds should remain reserved for COVID-19 patients, while the necessary provisions should be made by the remaining, so that there are enough beds for any other emergencies. The MoH, will be reviewing the development of the pandemic and the epidemiological data as they emerge, and proceed to any necessary adjustments to the guidelines and the maximum bed occupancy limit, in order to comply with the measures to minimise the risk of virus spread (https://www.pio.gov.cy/coronavirus/press/19052020_4.pdf).
Update 14th May 2020
Public hospitals continue to deal with suspected cases at short-stay care clinics, and confirmed COVID-19 cases at the designated reference hospital (Ammochostos General) and in ICU units of the two biggest general hospitals (Nicosia and Limassol) which have sufficient infrastructure, adequate workforce, equipment and consumables (https://www.pio.gov.cy/coronavirus/en/press/30042020_20.pdf).
Due to the easing of restrictive measures, the government has decided on a new set of measures, in order to protect and prevent health care professionals and other vulnerable groups from the risk of further spread of the virus to the general population. These new measures include mandatory instructions for cleaning all the hospital premises, avoiding congestion, ban of visits and implementing self-protection measures at all public and private hospitals (https://www.pio.gov.cy/coronavirus/pdf/erg13.pdf).
On May 7th, the MoH prepared and communicated to all healthcare facilities, a list of basic principles for controlling and preventing the spread of the virus during the treatment of suspected or confirmed cases of COVID-19. (https://www.pio.gov.cy/coronavirus/pdf/7_2_metra_elenxou_kai_prolhpshs_diasporas.pdf).
The Nicosia General Hospital, the biggest in the country, was initially designated by the MoH in the early stages of the planning for COVID-19 (end of January) as the reference hospital, but this was later changed to the smallest hospital in the district of Famagusta, with a 120 bed capacity, together with one nursing ward with negative pressure facility. One Intensive care unit in each of the remaining five public hospitals in the country were also made available. In order to free up general and acute beds, as from March 16th, it was decided that all public and private hospitals had to postpone, when medically justified, their scheduled surgeries and patient admissions as well as visitations and to deal only with emergencies and exclusively COVID-19 patients (https://www.pio.gov.cy/coronavirus/diat/3.pdf).
Further measures to reconfigure service delivery and increase treatment capacity for COVID-19 patients have been implemented. In addition, beds and ventilators in the private sector, after agreement with the MoH, will be used by public sector patients with no COVID-19. At the same time there is a centrally-managed capacity planning for the Intensive care units of the public sector, beds, personnel, ventilators and consumables to deal exclusively with COVID-19 patients. The measures to increase capacity are ongoing.
As soon as the first case of COVID-19 was traced in Cyprus, a 24-hour call centre was established to be used by citizens who had symptoms and complied with the epidemiological criteria set by the MoH. The call centre is managed by the public Ambulance Service which, with its specially trained teams called “hazardous response teams” (according to the emergency plan), is responsible for transporting suspected and confirmed cases to the reference hospital.
As the number of cases increased, citizens that experienced symptoms related to the coronavirus had to communicate with their personal doctors in order to get initial instructions (https://www.pio.gov.cy/coronavirus/diat/10.pdf). According to the Plan, personal doctors would then communicate, where necessary, with the Unit of Epidemiological Surveillance and Control of Infectious Diseases of the MoH and will jointly decide further action according to each case. If a citizen has been diagnosed positive and should therefore be confined at home, then he/she will need to be monitored by their personal doctor who will provide via telephone all the relevant instructions. Only in the case of urgent and serious incidents, at the doctor’s judgement and following a telephone assessment, can citizens be examined by personal doctors at their surgeries. In cases where the personal doctor considers that further investigation is necessary, he/she will have to apply to the Unit of Surveillance and Control of Communicable Diseases at the MoH via an electronic platform and the Unit will then contact the patient and make an appointment at one of Public Health Clinics, for testing.
Update 18th of April 2020
From April 3rd 2020 the MoH in collaboration with the Deputy Ministry of Research, Innovation and Digital Policy and the KIOS Centre of Excellence for Research and Innovation has put into operation an electronic platform informing citizens via a message if they had tested negative for the virus. For positive test results, informing continues to be done by the Epidemiological Surveillance and Control of Infectious Diseases of the MoH (https://www.pio.gov.cy/coronavirus/press/7042020_1.pdf).
In an effort to improve the operation of public hospitals in order to better respond to the increased needs arising due to the pandemic, the MoH and the association of Private Hospitals have, following negotiations, agreed that the following decisions will be in effect from the 8th April:
1. Redirection of patients to private medical centres: private hospitals shall be treating all urgent cases through their accident and emergency departments, where patients will either be transferred there by ambulances or their own transport.
2. Appointments to Outpatient Departments of public hospitals: As regards cancelled appointments in outpatient care, patients are urged to book appointments either directly with specialists who are part of the National Health System or contact their personal doctor (GP) for a referral or advise on what to do. Both GPs and specialists are obliged to serve these patients.
3. Scheduled surgery appointments at public hospitals - urgent cases: Scheduled surgery appointments concerning urgent cases will be referred to the private sector by the attending doctors of the public hospitals.
4. Scheduled surgery appointments to public hospitals - non-urgent cases: in that case the patients will be given a new date by the public hospital.
5. Scheduled surgery appointments to public hospitals - non-urgent cases, whose situation has worsened or changed: Patients are advised to contact immediately their attending doctors at public hospital or their GP for further advice.
Update 3rd May 2020
For public health reasons and in order to avoid the spread of SARS-CoV-2, especially within vulnerable groups of the population, the MoH decided to proceed with laboratory testing for the new coronavirus in vulnerable groups (elderly, people with mental illness, abused, addicted, victims of trafficking) who are residents of institutions and nursing homes. A referral by the treating physician to the Public Health Clinics is required (https://www.pio.gov.cy/coronavirus/press/30042020_14.pdf).
Update 11th May 2020
Public hospitals are required to review their protocols for bed capacity so that beds can be used more efficiently and to serve COVID-19 patients that require hospitalisation. The ΜοΗ may adjust the guidelines including the bed capacity limit (now up to 60%), depending on the progress of the pandemic (https://www.pio.gov.cy/coronavirus/pdf/erg13.pdf).
Update 18th May 2020
Public hospitals are progressively dealing with less and less suspicious cases at the short-stay care clinics, while the numbers of COVID-19 patients requiring hospitalisation and ICU care is decreasing. (https://www.pio.gov.cy/coronavirus/pdf/erg13.pdf).