With a key hospital shuttered and others crippled by recurrent water shortages, Gauteng is struggling to handle its largest wave of COVID-19 yet, reports MedicalBrief. Private hospitals in the province are under “severe strain” and Parliament’s health oversight committee chair warns that it will be “practically impossible” to manage the new wave with Charlotte Maxeke Johannesburg Academic Hospital closed.
However, Gauteng Health says that while the closure of Charlotte Maxeke had “affected available functional bed capacity” and “even with the decommissioning of the NSAREC facility, the province at present has more Covid-19 beds than it did in the first and second waves. Spokesperson Kwara Kekana said the department had added 750 permanent new beds at three hospitals and, despite union claims to the contrary, there was adequate PPE available to healthcare workers.
Gauteng Health said on Monday (14 June 2021) that more than 3,500 patients had been admitted to its hospitals, of which more than 1,000 were in ICU and high care. Just over 2,400 were admitted in general wards.
Spokesperson Thabo Masebe said that the province was monitoring the rapidly increasing numbers, which had reached 60% occupancy in the public sector. “ The private sector is the one that is feeling more pressure, because most of the ICU beds are actually in the private sector.
“A lot of them are running at around 90% occupation now. Most of the people, especially those who can afford it and are on medical aid, first go to the private sector and only when the private sector is full, they go to the public sector”
Dr Mathabo Mathebula, CEO of Pretoria’s Steve Biko Academic Hospital, told The Sowetan it was “coping” but not “confidently” as hospital admissions continue to rise “at a rapid rate”. “We don’t know what can happen at any point in time, because we might find ourselves overwhelmed. The difficulty is that Covid-19 doesn’t only affect the elderly but the younger people too.”
Private sector under “severe strain”
The South African Medical Association (SAMA) told Eyewitness News that the demand for beds in Gauteng hospitals had hit crisis levels. The province is currently the epicentre of the COVID-19 third wave and was dealing with over 7,000 active cases. Gauteng's case rate has already exceeded that observed during the first and second waves and showed no sign of slowing down.
With the Charlotte Maxeke Academic Hospital still closed and with no immediate plans to re-open the Nasrec field hospital, medical staff are not coping. This has placed private hospitals in the province under severe strain, SAMA's Dr Angelique Coetzee said.
Coetzee said that Gauteng’s private hospitals were under “severe strain”. “You will not get a bed for Covid-19. It is extremely difficult. People are also lying in the casualty wards in the private sectors,” Coetzee said.
“This whole weekend I sat with patients who could not be admitted and whose oxygen levels were low. So you know how stressful that is? Do you know how it feels that the patient can die and there is no bed and you have to treat that patient out of hospital?
“There is no increase in beds, there is no increase in doctors and there is no increase in nurses — and it is not going to change,” said Coetzee.
Dr Marlin McKay, a GP in Roodepoort, told TimesLIVE that it was become more challenging to get patients admitted at private hospitals in Gauteng, especially over weekends.
“There are no beds available, or very few beds. Over weekends when a patient crashes at home, they call me and I call the emergency services. They come out but when the patient needs to be admitted, the ambulance personnel tell us the hospitals are all on divert [not accepting patients from ambulances].
“That is a crisis and we are in trouble.”.
Parliamentary concern over Gauteng wave
Following an oversight visit of Gauteng’s facilities, Parliament’s Health Portfolio Committee chairperson, Dr Sibongiseni Dhlomo, said that it would be “practically impossible to manage the third wave” without the more than 1,000 beds at the Charlotte Maxeke Hospital. “This matter needs urgent attention and we have committed as the portfolio committee to engage national ministers to see how they can assist to ensure that the facility is ready and available to assist in the management of the third wave,” Dhlomo said.
“The importance of the facility stretches beyond the management of Covid-19, with the hospital having speciality services that are of benefit to other provinces as well. The continued unavailability of these services is untenable, hence the need for urgent action,” Dhlomo emphasised.
Ripple effect has become a “humanitarian crisis”
In a statement, the dean of the Wits Faculty of Health Sciences, Prof Shabir Madhi described the ripple effect of the April closure of Charlotte Maxeke as a “humanitarian crisis” and appealed for the undamaged parts to be reopened “as a matter of urgency”.
“Our provincial healthcare system is under severe strain. The protracted closure of [the hospital], the water crisis across several hospitals in Gauteng, and the increase in Covid-19 admissions as we enter the third wave of the pandemic, threaten to collapse an already unstable system.
“The loss of critical bed space at [Charlotte Maxeke Hospital] has put undue pressure on other hospitals which are currently functioning at capacity. Helen Joseph Hospital, Rahima Moosa Mother and Child Hospital and Chris Hani Baragwanath Academic Hospital have experienced crippling water shortages in the past few weeks and as a result have not been able to deliver adequate healthcare services to their patients.
“Notwithstanding the impact this has had on our healthcare system, the closure of [Charlotte Maxeke Hospital] has also had significant consequences for the Faculty of Health Sciencesʼ clinical training programmes. Although students allocated to [the hospital] were distributed among the other teaching hospitals, this only served to add to the burden and stress of clinicians trying to manage the service delivery crisis. Student numbers across the other clinical platforms have reached a level that prevents proper clinical exposure and training. Inadequate clinical training of undergraduate students has a knock-on effect on the capabilities of this group as future interns and doctors.
“What we face is no longer just a healthcare crisis — it is a humanitarian crisis.”
The facultyʼs statement called for the undamaged parts of the hospital — blocks one, two and five — to be reopened as a matter of urgency to prevent further collapse of the system.
Uncertainty over the repeatedly delayed opening of Charlotte Maxeke
However, the Gauteng government says the re-opening is being delayed by the installation of fire doors in line with building regulations.The oncology building, it had been announced, would reopen this month, but safety concerns prevented this. A provincial spokesperson said this week that he could not say at this stage when the hospital would reopen.
Last week, Gauteng Premier David Makhura said that that the provincial government wanted to declare a local state of disaster. "It will enable us, as an emergency, to swiftly open the hospital. We can't go through the entire June without Charlotte Maxeke.
"I can't throw a rulebook when people are dying, and there are lives that should be saved. We are looking at other legal instruments to open parts of the hospital. Charlotte Maxeke Hospital occupies the apex of Gauteng health. It offers specialised services. The province can't afford to have the hospital closed in the middle of a raging pandemic.
"The sooner the hospital opens, the better. It is the top of the class in providing oncology services. We are discussing declaring a localised disaster at the hospital. It should open urgently," Makhura said.
Daily Maverick reports that the Charlotte Maxeke closure, has had a ripple effect, with surrounding hospitals taking massive strain. Patients who need lifesaving treatment are forced to seek help elsewhere and often face a long wait. Medical students worry about how the closure of the teaching hospital will affect their training.
With a third wave of Covid-19 sweeping through Gauteng, hospital the size of Charlotte Maxeke is desperately needed, “but details of plans to reopen it remain sketchy”.
Zodwa Sithole, head of advocacy at the Cancer Association of South Africa, said they had been inundated with calls from desperate people whose families can no longer access the care they need. “Patients are anxious as they experience delays in their treatment… many need assistance with pain management, stoma and wound care.”
HospiceWits CEO Jacqui Kaye said many patients had been left in the lurch. “Most are non-malignant cases looking for help and support and even medication. These are not really hospice cases. The families become desperate and are in need of medical support.”
Brenda Bisschoff, the administration manager at Hospice East Rand, said the closure of Charlotte Maxeke Hospital was having a “dreadful impact” on cancer patients. “The physical and emotional effect of not being able to access their treatment is taking a toll on their already weakened immune systems. Patients are also not able to fill their prescriptions and pain control becomes a major issue.
“We are struggling to get medical reports completed by Charlotte Maxeke Hospital doctors for patients requesting palliative care from our organisation and this is severely hampering their access to our care. It is a dire situation and compounds the negative effect of patients already trying to cope with a potentially life-threatening illness,” she explained.
Ewa Skowronska, the CEO of the Hospice Palliative Care Association, said if there were more support for palliative care, more people would get the care they need. “The current situation in Gauteng is unacceptable. Human lives are at risk and human suffering is not receiving the attention it deserves.”
Full Sowetan report (Open access)
Full Sowetan report (Open access)
Full TimesLive report (Open access)/a>
See also from the MedicalBrief archives:
DA: Health MEC's reply highlights dire situation at Charlotte Maxeke cancer unit
What really happened in the Charlotte Maxeke Hospital fire?
Gauteng Health denies safety failures in Charlotte Maxeke's R40m fire