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
On January 29, it was stated that strict infection prevention and control measures should be in place to prevent further spread of infection in healthcare settings (i.e., apply respiratory protective equipment to healthcare professionals (FFP2 or FFP3 respirators) during patient aerosol generating procedures).
Laboratory capacity was gradually expanded from one laboratory in Vilnius to five and then to 12 across the country, with daily testing capacity of about 200 initially, 1500 by end of March, and 3,000 by mid-April – see also section 1.5. During the time of growth in possible cases Lithuania reported shortage of testing reagents, but from 26th March the number of reagents has been sufficient, and now there are calls to expand laboratory processing capacity.
From 3rd March, the largest university hospital in Lithuania (Kaunas Klinikos) started to produce medical masks using own production capacity.(4) On 13th of March transfer of PPE (e.g. protective respirators, glasses, gloves, disposable footwear, disposable gloves) stored in the State Medical Reserve to ambulance services was arranged. However, the medical professionals community reported that measures to combat coronavirus are still inadequate. Since then, additional purchases started through national (1) and community (2) initiatives. On 26th of March Lithuania has submitted applications to participate in three joint procurements with other countries initiated by the European Commission (EC).(3)
MOH collaborates with the private sector companies to maintain some of the supplies – e.g. the production of disinfection solutions,(8) medical masks (9) and similar medical materials (10) equipment and protective aprons .(11, 15) By 3rd April, the about 30 thousand masks have been delivered to various facilities.(12) On 7th April, mobile lung ultrasound machines were donated to two major COVID-19 designated hospitals by charitable foundations. (14) From 23rd of April disposable booties made in Lithuania will be produced and delivered to medical institutions by a cluster of 8 companies.(20)
Between 28th March and 12th April, Lithuania received hundreds of tons of PPE purchased from China. These included masks and respirators, suits, hats, gloves, etc. The equipment was distributed across major hospitals, ambulance centres, mobile testing points and fever clinics. (5-7),(13),(16),(18),(19) By 12th April, 5 million gloves, 2.5 million masks, 300 thousand hats, 200 thousand respirators, 100 thousand foot covers, 100 thousand eye covers, 85 thousand robes and 30 thousand suits were distributed. All information about distribution of personal protective equipment (PPE) can be found on the dedicated MOH website https://sam.lrv.lt/lt/news/koronavirusas/asmens-apsaugos-priemoniu-paskirstymas-lietuvos-medikams.
Once wearing mask in public became an obligation on 10th April (see section 1.1) MOH allocated 120,000 protective masks for citizens (17).
Lithuania has one of the highest ratios of hospitals beds per population in the EU, which, in case of the outbreak, may help to maintain availability of hospital beds to patients with COVID-19 to a certain extent. It was planned that the suspected COVID-19 would be isolated in the six hospital settings of the five largest Lithuanian cities. In case of surge of cases general hospitals may have an option to re-allocate some of the non-COVID-19 patients to create more inpatient beds for the COVID-19 patients if needed.
In April nursing homes in the country have been undergoing safety assessment to prevent spread of infection and a preparatory work to free up beds. Nursing hospitals / department have not been taking any new nursing patients for several weeks.
In light of the worsened epidemiological situation and the increased risk of healthcare workers becoming infected, on 28th September MOH has issued recommendations to health care providers on the establishment of a reserve for PPE. (20) Specifically, it is recommended that providers have PPE stock for at least 30 calendar days. In addition, municipalities are recommended to have a stock of least 20% of the entire monthly supply of all providers operating under municipal ownership.
On 5th of November, the Parliament approved the national model of accumulation of PPE and other emergency stockpiles. It is planned that the state reserve should be sufficient for 60 days of uninterrupted use, plus there would be municipal-level and provider level stockpiles enough to continue operations for 30 days. (21) This would amount to a total national stockpile of PPE enough to last for up to 4 months.
Starting from 11th of November MOH appoints a coordinator for hospitals to organize provision of services and monitor capacity and bed occupancy.
Throughout November – early December 2020, over 75-80% of hospital beds designated for COVID-19 patients were occupied, reaching critical threshold, with doctors increasingly raising concerns regarding the availability of beds and staff. (22) (23)(24) (25)
On 8th of December it was announced that there were a total of 480 beds in Kaunas region, where people with COVID-19 can be treated. Although it was claimed that there are enough beds, some hospitals started experiencing challenges coping with patients’ flow. The lack of health workers also meant increasing pressures on non-COVID services. More hospitals started to take in COVID patients, with some preparing to re-purpose departments. Building of a temporary hospital has been considered but was not implemented at this stage as it would also lack staff. (26)
By 10th of December all regions of the country had hospitals where all COVID-19-designated beds were in use, treating more patients that planned previously. According to hospital management, in Vilnius region 85%-99% of all active beds were occupied. (28)
From December 14, LSMU Kaunas Hospital increased the number of beds for COVID-19 patients from 200-214 to 245, while beds in non-COVID units also started to be used for COVID-19 patients (27)
In addition to hospitals with designated COVID-19 beds, from 28th December, COVID-19 patients who do not require oxygen therapy can be treated in 10 medical rehabilitation facilities adding further 900 beds.
On 30th December, the government expanded the list of entities that are required to have a PPE reserve from central reserve, municipalities and health facilities to include entities where disruption would endanger national security or economic functioning.(30)