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
Early inventories of the availability and distribution of physical resources needed to manage the COVID-19 outbreak were undertaken. These inventories alerted the authorities that action would be needed to mitigate the risk of shortages.
Regarding testing facilities, on March 10 the Ministry of Health announced that there were only 7 centres in the whole country with 1,200 tests that would be sufficient for one week. However, they also stated that supplementary tests were being procured and these would cover the testing needs for one month. One week later, the government reported an increase in the number of tests performed daily from 475 on March 2 to 3,205 tests on March 15. On March 18, the National Institute of Public Health was commissioned to monitor all national testing activities: tests inventory, identification of procurement sources, coordination of sample collection, centralization and reporting results. On March 22, the Ministry of Health announced the acquisition of 2 million tests (Real-Time PCR). The total number of tests performed by September 24 was 2,302,828 and the number of testing centres has increased to 134 (public and private).
Romania is ranked as a country with a high number of hospital beds, but the real concern is how many ICU beds are equipped with ventilators. The authorities have reported that out of around 4,000 ICU beds only about half are equipped with ventilators. Measures have been taken to increase the number of ventilators by both international procurement and national production. Of the 350 million (approximately 74.5 million euros) that the Government has released to manage the COVID-19 outbreak, 209 million lei (approximately 44.5 million euros) has been allocated to ICU departments. The Ministry of Health has issued an Order regarding the re-deployment of beds and personnel, specific COVID-19 patient flows, daily reporting of bed occupancy in the electronic centralized operational coordinating centre of the Ministry of Health and other measures regarding hospital preparedness for treating COVID-19 patients. In preparation for managing any spike in the number of cases, the army has deployed a mobile hospital near Bucharest, and a second one bought from the Netherlands was located near Constanta. Subsequently, many other modular hospitals were built and 5 IC mobile units were bought with the support of local authorities, NGOs and other donors. Hospitals have also been advised to organize a triage section to detect the COVID-19 cases among the patients referred for admission, in line with WHO recommendations.
The most challenging shortage is a lack of personal protective equipment (PPE). Proper equipment (coveralls, gowns, goggles, FFP3 masks, etc.) existed in short supply only in infectious diseases hospitals, and other medical settings either had only small quantities of surgical masks and gloves, or did not have any equipment at all. Despite the rapid allocation of governmental funds, supplemented by different donations, procurement of PPE was as difficult as anywhere. The Centre for Surveillance and Control of Communicable Diseases has issued a set of minimal criteria for rational use of PPE, based on WHO recommendation “Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages”. In the end, 45 tons of PPE were delivered with the help of the NATO Strategic Airlift Capability programme. Transport assistance of PPE supplies was also provided by the army and by the national airline, when the Ministry of Health purchased higher quantities of PPE from China, South Korea, and Turkey through the National Centralized Procurement Office. Local production of PPE is also being encouraged and supported. The initial shortages have been met through intensified procurement efforts by the central and local authorities and donations by various nongovernmental organizations. Further, PPE was also provided through the European Commission’s centralized procurement for all member states. Thus, on 12 May 2020, 158,000 KN95 GB2626-2006 masks were delivered to Romania and deposited as stock to be later distributed according to the needs.
To avoid a shortage of pharmaceuticals and medical devices, the Ministry of Health has issued an Order that bans the export of drugs and diagnostic and treatment devices over six months. For the duration of the epidemic, exemption from the usual procedures of obtaining market authorization has been granted for drugs or devices used in COVID-19 treatment, allowing a simplified process. This facilitates access to investigational treatments, such as the use of blood plasma collected from individuals who have recovered from COVID-19.
Romania will receive 25,157 vials of Veklury (Remdesivir), in three tranches, within the contract signed by the European Commission with the pharmaceutical company Gilead. This will ensure treatment for over 5000 patients. The first and second tranches were received in early August and September and the last one is scheduled for October.
With the State of Alert announced on 15 May (see Transition measures: Governance), new measures were introduced to ensure rapid and appropriate response to potential needs. These measures cover: procurement of goods and services related to the cause of the State of Alert, re-distribution of equipment and medical devices, re-deployment of health personnel.