At the height of the COVID-19 outbreak in the Western Cape, a project was implemented that saved lives and has the potential to save many more, writes Neal David, a family physician in the public sector in Daily Maverick.
David writes: “As the epidemic escalated, it became clear that the disease was hitting people with diabetes especially hard. A study looking at over 15,000 COVID-19 infections showed that of every 100 deaths in the Western Cape, 52 were in patients with diabetes.
“Diabetes was a more significant risk factor than all other comorbidities combined. Within the diabetic population, elderly diabetics and those with kidney disease had the poorest outcomes of all. The mortality rate in this sub-group was almost 30%.
“This was why the provincial health department decided to try a novel approach. The department has access to a central database that captures the medical history of all patients who are treated within the public sector, as well as all positive COVID-19 laboratory tests performed in any Western Cape facility, both public and private. This made it possible to see from day-to-day whether there were patients who had been diagnosed with COVID-19 who fell into this extremely high-risk cohort and had not yet been hospitalised. Since we knew one in three of these patients was likely to die, we decided to take action to improve their outcomes.
“We set up a team called VECTOR (Virtual Emergency Care Tactical Operation) on 17 July 2020. Six doctors were recruited. Their job was to perform telemedicine consultations with patients diagnosed with COVID-19 in the highest risk groups. In effect, the highest risk patients were called by the VECTOR team and offered admission to an Intermediate Care facility even if they were not clinically ill. If they declined admission initially, they were followed up on daily.”
David writes that the results have been very promising.
“Prior to this intervention, out of 2,558 patients meeting the high-risk criteria, 718 died (28%). After the intervention was introduced, looking at data up to 14 August 2020 (one month of activity), out of 379 patients who have been allocated to the VECTOR team, only 17 died. That’s a mortality rate of 4.5%.
“The project has subsequently been extended into rural areas. The team is also supporting the provincial call centre so that diabetics can be screened for any evidence of deterioration.”
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