Medical scientists have warned that moves to tighten restrictions as Covid-19 cases threaten to overwhelm Gauteng hospitals are too late to be of use, reports, MedicalBrief. Their stark advice is that people should simply stay at home, whenever possible.
On Sunday, Gauteng recorded 8 640 new cases, the highest number yet. For the country as a whole, the National Institute for Communicable Diseases recorded 11,093 new cases for the previous 24 hours. Gauteng had 7,471, or 67%, of the total. No other province breached 1,000, with the Western Cape second on 847 cases. Over the past two weeks, Covid cases in SA’s economic heartland, which accounts for 34% of the country’s GDP, have risen by more than 83,000, with 7,000 people in hospital and 1,098 in ICUs.
Also by Sunday, the country had vaccinated only 2,141,624 people, of which a substantial portion had received only the first of two Pfizer vaccines.
Gauteng is struggling with a shortage of beds and staff, with the premier predicting full capacity within seven days. The provincial administration said it had contracted 5,000 additional health-care workers and 1,100 more beds. With one of the government’s flagship public hospitals, Charlotte Maxeke Johannesburg Academic Hospital, still closed after a fire in April, Chris Hani Baragwanath will take on 500 ICU beds.
Government says maybe…
Both President Cyril Ramaphosa and Gauteng Premier David Makhura have publicly stated that they are contemplating tighter restrictions, as the province moves towards an expected third wave peak in two weeks.
EFF leader Julius Malema told Newzroom Afrika on Tuesday that he had it on good authority that the government intended to impose a Level 5 lockdown on Gauteng for 21 days. Malema has on several occasions correctly predicted the government’s tightened measures in response to Covid-19, writes TimesLIVE.
Speaking at a weekend ceremony to mark the deployment of 60 medics from the SA National Defence Force's Military Health Services to Chris Hani Baragwanath Academic Hospital, Makhura raised the possibility of stricter restrictions. “The pandemic is completely out of control, and if we have to do extraordinary things to ask for further restrictions above level three in Gauteng… it's something we must explore.
“We are studying the numbers very carefully. Indeed the situation is grave in that we have a larger number of active numbers than the second wave. We seem to be two weeks away from the peak and once that happens cases will start going down. Unless we see a new spike like the one we saw two weeks ago, it's not clear that a lockdown is necessary.”
President Cyril Ramaphosa has said that he was “deeply worried”. “We are seeing infection rates that seem to be much higher than what we have seen before … The deployment of more medical personnel is obviously one of the things we need and more hospital beds. They are opening up as many hospital beds as they possibly can. There is also a challenge around oxygen availability and ventilators.
“We are involved in a very, very serious situation in relation to the pandemic in Gauteng. We are also seeing cases rising in other parts of the world and here in the Western Cape. I was talking to premier Alan Winde earlier and we are seeing signs of that.”
… Experts say no
However, Professor Bruce Mellado, a senior scientist at iThemba LABS and head of the Gauteng government's Covid-19 medical advisory committee, said the group had not recommended the province impose a harder lockdown from the Level 3 restrictions imposed a week ago. “We can discuss right now what should have been done, but we have to deal with reality. Finger-pointing and blame shaming isn't going to help. What we have to do now is socially distance.”
Dr Angelique Coetzee, the South African Medical Association (SAMA) head, said that It was too late for further restrictions. “We should have done this when SAMA started asking three weeks ago. Now we have to go through this; it’s too late now. We are going to see quite a huge number of people infected.”
Professor Clare Cutland, a scientific coordinator at the Wits African Leadership in vaccinology expertise consortium, said a restriction that might help would be imposing a ban on interprovincial travel. “A lot of the infections have already occurred, and the peak is predicted in two weeks. Provincial restrictions might help reduce transmissions to other areas.”
Lack of capacity
News24 quotes Makhura as saying that the biggest challenge facing the province was the number of healthcare workers and bed capacity. There are 5,218 people hospitalised in the province. Of these, 1,105 are in intensive care units, and 538 are ventilated. The closure of Charlotte Maxeke continues to place pressure on the provincial health system. It had close to 500 Covid-19 beds.
Gauteng Health MEC Dr Nomathemba Mokgethi said that 40% of the people admitted at hospitals in Gauteng were Covid-19 patients. A further 32% of those admitted were potential Covid-19 cases, “patients under investigation”, as the department calls them.
“I don't want to send a message that we have lots of beds because to send that message may be to say, ‘Oh it's okay.” Every two days, there are beds that are filling up in our hospitals. If we have 100 beds today, there is no guarantee that we will have those beds at the end of 48 hours.”
Makhura said that given the rate of increase in infections over just five days and the seven-day lag, he viewed all Gauteng hospital beds as already taken, even although they are not, at the moment, occupied. He said that the private sector was also experiencing capacity issues.
The puzzle of the missing hospitals
Makhura said that if it were up to him, he would open Charlotte Maxeke immediately. “We have looked at everything, we have taken legal advice and everything else. Standing here, I feel like walking into Charlotte Maxeke and opening it, even if there are areas that the city of Johannesburg has pointed out as needing attention.”
Business Day writes in an editorial: “More than two months after a fire broke out at Charlotte Maxeke Johannesburg Academic Hospital, one of the province’s most important facilities remains closed. Even the fire itself can probably be placed at the door of the Gauteng government, as an investigation, once completed, is likely to show neglect as a key factor, if reports of faulty smoke-detection systems, fire alarms and fire hydrants are anything to go by.”
Financial Mail writes in its editorial that, as experts have warned, a “worst-case scenario” has already materialised. “It underscores the stories you hear from weary doctors, of ambulances carrying sick patients circling outside hospitals waiting for a bed, of oxygen suppliers with growing waiting lists; all while the shortage of nursing staff, evident even before the pandemic, is now crippling.
“Last week it emerged that the state-of-the-art field hospital with 1,000 beds at the Nasrec showgrounds in the south of Joburg — set up at a cost of R350m — remains empty. Gauteng’s health officials say the field hospital, which was used during the first and second waves, has been ‘decommissioned’ and the equipment ‘moved out’. And provincial health department spokesperson Kwara Kekana says the facility isn’t going to be reopened.
“Equally mystifying is that a hospital on the West Rand, donated by AngloGold Ashanti and refurbished at a cost of R460m, has a budget to staff only 40 of the 175 beds …Critically, the Charlotte Maxeke hospital, which has an outstanding ICU and can cater for 300 Covid patients, is still closed two months after a large section of it was gutted by fire.
“This week, Gift of the Givers founder Imtiaz Sooliman said those parts of the hospital that are safe must be reopened. "The public needs a rational explanation, as a matter of urgency, as to why it is two months since the fire … and yet this important facility is not functional at the height of the third wave,” he said.
Dance of the absurd at Charlotte Maxeke
Daynia Ballot, head of the University of the Witwatersrand’s School of Clinical Medicine, told TimesLive that Gauteng’s healthcare system “cannot withstand the closure” of Charlotte Maxeke. The paediatrician described the results of the closure as a “catastrophe” that was “completely off the scale” in a provincial healthcare system that ordinarily operates under near-crisis conditions. At the time of publication, a petition started by Ballot to have the hospital reopened had more than 25,000 signatures.
“Some of the urgency and accountability regarding the reopening of the hospital appears to be getting lost in the bureaucratic knot that makes up the hospital’s management. While the City of Johannesburg is responsible for issuing the occupational health and safety certificates needed to reopen Charlotte Maxeke, the provincial department of infrastructure development and property management owns the hospital and the department of health employs the staff who keep it running,” writes TimesLIVE.
“The city issued non-compliance reports in May relating to fire equipment, signage, detection and alarm, along with smoke control, water pressure and emergency lighting. To date, the hospital has not been issued with the requisite fire certificate and other occupational health and safety certification.
“The infrastructure development and property management department is not in possession of an up-to-date floor plan for the hospital, which is one of the reasons for the delay in issuing the fire certificate. The installation of fire doors is another.”
Full TimesLIVE report (Open access)
Full News24 report (Restricted access)
Full Business Day editorial (Open access)
Full Financial Mail editorial (Open access)
Full TimesLIVE story (Open access)
See also from the MedicalBrief archives:
Gauteng’s 3rd Wave: Crippled public hospitals put ’severe strain’ on private facilities