Ventilating COVID-19 patients is not always in their best interest. The Times reports that this is according to Health Minister Dr Zweli Mkhize who said that despite the fast-growing number COVID-19 patients in South Africa, the current treatment protocol evidence supported the avoidance of invasive ventilation strategies as far as possible”.
Mkhize said that health professionals in South Africa and across the world were “constantly learning more about the behaviour of the virus when it enters the body”. “Our ability to refine our clinical management will have a significant impact on the overall burden of the disease on our health care system,” he is quoted in the report as saying.
The avoidance of ventilation was among the newer clinical management protocols. “We soon expect the ministerial advisory committee on COVID-19 to issue advisories on the use of high-flow oxygen for patients who are very ill but can be managed without intubation and ventilation.”
The minister also explained another of the new treatment protocols that was showing success: the prescription of dexamethasone. This, he said, “has shown that deaths can be reduced by a third for patients on ventilators and can also help patients who only need supplemental oxygen”.
Focusing on case management amid a “surge” in infections, Mkhize said the National Institute for Communicable Diseases (NICD) had given an indication of the specific challenges in South Africa.
He is quoted in The Times as saying the NICD looked at 10,700 COVID-19 admissions from 269 facilities across South Africa, of which 71 were in the public sector and 198 in the private sector, between 5 March and 21 June.
These were among the key findings of the study: the median age of COVID-19 admissions was 50, with 338 (3%) admissions in patients younger than 18 and 1,386 (13%) older than 70; 54% of people admitted were female; among 8,245 (77%) patients with data on comorbid conditions, 2,810 (34%) had one condition and 3,126 (37%) had two or more; of the 5,836 patients with comorbidities, the most commonly reported were hypertension (3,419 or 59%) and diabetes (2,813 or 48%); there were 1,116 (19%) patients admitted with HIV, 240 (4%) with active tuberculosis (TB) and 579 (10%) with a previous history of tuberculosis; and obesity was noted by clinicians as a risk factor in 297 (3%) patients.
[link url="https://www.timeslive.co.za/politics/2020-06-30-ventilation-not-always-the-best-bet-for-covid-19-patients-zweli-mkhize/"]Full report in The Times[/link]
[link url="https://www.nicd.ac.za/wp-content/uploads/2020/06/NICD-Weekly-Epidemiological-Brief_-Week-ending-20-June-2020.pdf"]NICD material[/link]