SA hospitals will struggle to cope with a likely exponential infection rate

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In just over a week, the number of South Africans who have contracted the COVID-19 coronavirus has gone from one to 16, to 116. If the infection rate continues to increase at the current global rate of 13% per day, hospitals will struggle to cope.

The Mail & Guardian reports that the current average infection growth rate is 13% globally – the number of people being infected is growing by 13% each day.

The report says if you use the 13% rate for South Africa, from the 17 people who have already tested positive for COVID-19, the probability is that 665 people could be infected in the next 30 days. On average, 12% of those people will end up critically ill and needing to go to hospital, with between 2 and 8% dying. If you use South Africa’s current growth rate of coronavirus, which is on average 57%, and if this rate continues, 100,000 people will be in need of hospital care in less than a month.

Dr Leaza Jernberg, from the University of Witwatersrand, said in the report that the trend in the rest of the world is of exponential increase, where the infection rate is doubling in some countries. “The cases are doubling up every six or so days. If that is the case even the best health care system will take strain. What is more concerning is whether we have enough beds, ICU ventilators and oxygen. We might have enough to cope when it is 50 people but will we have enough resources when it is 150 people?” she asked.

According to the data collected by the Health Systems Trust, as of March 2019 there are about 157,470 beds available in public hospitals. This includes regional, provincial and specialised hospitals across the country. So far, the government has identified 11 hospitals where people should go.

Professor Maia Lesosky, the head of the Epidemiology and Biostatistics School of Public Health and Family Medicine at the University of Cape Town, said that the speed at which cases increase depends on factors both related to the infectiousness of the disease, the mixing of the population as people move, and other factors, such as the case definition and availability of confirmatory testing. “It is highly likely that we will see a significant increase in cases over the coming weeks, given what we have seen in other settings, and this should be expected,” said Lesosky

Jernberg added that another concern which has not been addressed by the state yet is what the strategy is when the infection hits areas such as Tembisa, Khayelitsha and other densely populated areas.

In the event of a large-scale COVID-19 outbreak, a complicating factor would be that people diagnosed with COVID-19 need to be isolated quickly in hospitals before the virus can spread to hospital workers, other patients or family members. The isolation requirements are clearly at odds with the overburdened nature of many of South Africa’s public hospitals.

Daily Maverick reports that this is where South Africa’s private medical facilities could play an important role. In 2016, the Gauteng Health Department estimated that there was a roughly 50:50 split of hospital beds between private and public facilities in the province. The problem? Only around 16-17% of South Africans are covered by medical aid which would support treatment in private facilities.

But, the report quotes experts as saying it is untenable for private medical facilities to reserve their resources for those who can pay at a time like this. “If we are to contain COVID-19 in South Africa, the private health sector – providers, hospitals, pharmacies, emergency services etc – will have no choice but to come to the party and share their resources,” University of the Western Cape public health professor Helen Schneider is quoted in the report as saying.

UCT School of Public Health Professor Lucy Gilson agrees. “As human beings and as a community we have a responsibility to assist each other, and particularly those most vulnerable, in every way we can if the epidemic progresses at scale and speed, as elsewhere,” Gilson said. “That might well need to include the sharing of resources between private and public sectors – recognising that this resource sharing would be in all our interests. Extraordinary times demand extraordinary responses.”

The report says the Health Department is currently remaining tight-lipped on factors relating to the logistics of treating a potential Covid-19 epidemic in South Africa. Manzi said that she could not comment on whether talks are currently underway between the government and the private health sector to make resource-sharing arrangements.

In the UK, system leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients, reports HSJ. Senior sources said NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity. Trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life-saving” procedures such as cancer treatment.

An announcement is expected soon, with patients affected given at least 48-hours-notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But, the report said, it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations.

The move is part of range of measures system leaders are set to roll out, which also include tightening up admission thresholds, in a bid to free up as much capacity as possible. The last time there was a major national moratorium on non-emergency electives was in January 2018. It lasted around eight weeks. At the time system leaders estimated around 50,000 operations would be cancelled per month, although the final figure was not that high.

Leading waiting list expert Rob Findlay is quoted in the report as saying the overall elective waiting list, which at present is around 4.6m, would likely further deteriorate, but the hardest impact would be felt by the longest waiters. He said: “It will certainly accelerate the already deteriorating position on 18-week waits, but the effect may be most striking in the rise in 52-week waiters. This is because these patients tend to be in the heaviest case mix, like the more serious end of orthopaedics, plastic surgery, or neurosurgery, which require in-patient procedures, rather than day cases. This means those patients who are already suffering the most extreme long waits are likely to be most impacted by any suspensions.”

NHSE’s coronavirus incident director told senior figures that hospitals should plan for a massive increase in critical care capacity – potentially up to seven-fold, according to those present. He later insisted he said “several fold”, not “seven-fold”. NHS Providers CEO Chris Hopson said trusts were already preparing to make cancellations.

Hopson said the system could double intensive care capacity “relatively easily”, but “we are now talking actually about could you increase it four-fold, five-fold, six-fold to be able to cope with the increase (in) level of cases coming in”.

An NHSE spokesperson said: ”As the chief medical officer has warned, NHS services will come under pressure as the outbreak spreads more widely and so it is only right we are preparing a number of practical solutions to respond. Last week, guidance was sent out across the NHS to help local services to prepare so patients can get the care they need which remains the priority for hardworking staff and advice will continue to be updated.”

The report says Department for Health and Social Care did not want to comment.

Hospersa, a union organising in both the public and private healthcare sector, is becoming increasingly concerned over the rate of infections of COVID-19 in South Africa. It has called on government to increase efforts of empowering health workers, especially front-line workers in clinics and hospitals, with the necessary knowledge, skills and resources to battle this virus. The union has also supported its federation’s call (Fedusa) to the Employment and Labour Minister to urgently consider intervention measures that will mitigate the impact of the potential effects of the coronavirus in the South African World of Work.

Hospersa has called on its members in both the public and the private health sector to take the necessary precautions in preventing the spread of the virus. The union has also called on the Health Department to provide the protective clothing and training to health workers as they will be at the coal face of this virus when attending to suspected and confirmed cases.
“Hospersa will continue supporting its members in communicating preventative measures through its communication platforms. The Union will also escalate all concerns and shortcomings brought forward by its members to the relevant DoH structures at provincial and national level to ensure health workers do not end up as unnecessary casualties during the fight of this deadly outbreak,” Hospersa public relations officer Kevin Halama said.

Full Mail & Guardian report

Full Daily Maverick report

HSJ material

Full Hospersa statement on the Polity site

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