/ 14 January 2021

Admissions soar as second wave tightens its hold

Safrica Health Virus
Unions representing healthcare workers advise members to get vaccinated despite AstraZeneca postponement. (Phill Magakoe/AFP)

The last week saw the second-highest number of hospital admissions since the pandemic hit our shores. It was also one of the deadliest weeks, with more than 3 649 people succumbing to Covid-19. 

These escalations have put pressure on the health system amid the second wave of Covid-19 infections. Dr Lungi Nyathi, managing executive for clinical risk and advisory at medical aid society Medscheme, said according to the National Institute for Communicable Diseases (NICD) numbers “the public sector is experiencing more deaths than the private sector.” 

According to the NICD’s data, the last two weeks of July saw the highest number of patients put on ventilators — more than 700 per week. The past two weeks have seen South Africa return to those levels. Last week more than 650 patients needed ventilators. 

Nyathi said that Medscheme had seen an increased number of admissions of its members in private hospitals in the second wave compared to the first.

In the week of 4 January 2021, there were 4 000 admissions, while in the week of 12 July 2020, which was the worst week of the first wave of Covid-19, it only recorded 3 188. 

Private sector capacity 

Nyathi said that the admissions recorded in early January were the highest number Medscheme had seen since the beginning of the lockdown last year. 

In terms of provinces, Medscheme’s data showed that KwaZulu-Natal had the highest number of admissions per week, at 1 100, Gauteng had more than 820 and the Western Cape stood at 620 per week. 

Medscheme’s data also showed that 25% of people with no comorbidities have died due to Covid-19, while people who have two to four comorbidities accounted for 60% of deaths. 

Dr Angelique Coetzee, chair of the South African Medical Association, said that she would not be “surprised” about a high number of deaths at public hospitals as most were struggling with beds, staff, and infrastructure. 

She added that in certain instances, both public and private hospitals could be struggling to control their fatality rate depending on the burden of disease in the hospital’s area. 

Dr Ronald Whelan, the chief commercial officer at Discovery Health, told the Mail & Guardian its data shows Discovery’s highest fatality rate was during the first wave at 2.7%. Its case fatality rate currently stands at 1.9%.  

“However, there are some lags on reporting deaths, and this number is, unfortunately, likely to increase over the coming weeks,” he said. 

Whelan added that at the beginning of November on average per week, the number of admissions was 50. But by the first week of December, the average number of admissions for Discovery members increased ninefold to more than 460. 

“This is 49% higher than the average weekly admissions for our members in the first wave, which was 308,” said Whelan. 

The fund said it recorded the highest number of admissions in Gauteng, with the average number of admissions per day over the last week at 177, followed by KwaZulu-Natal at 118 and the Western Cape at 99. 

Gauteng takes strain 

Tembisa Provincial Hospital’s chief executive, Dr Lekopane Mogaladi, told the M&G that the facility experiences some challenges but is working with its resources. 

Mogaladi explained that in the first peak, the hospital had 577 positive cases and recorded 68 deaths. In December 2020 it recorded 227 cases and 25 deaths.  

Since the beginning of the pandemic, 315 staff members had tested positive, that currently there were 22 active cases and that there had been four deaths among staff. 

However, the hospital had managed to create additional bed capacity. The hospital has 159 beds, eight of which are in intensive care units and 28 are in high care. 

Mogaladi said that though the hospital experienced infrastructural challenges, staff had managed to secure tents and also converted some wards to accommodate Covid-19-positive patients and those under investigation.

In terms of the staff to assist with patient care, Mogaladi said that they have additional workers who help reduce stress and fatigue. 

However, oxygen is becoming a scarce resource.

“We are currently out [of stock] of the permanent ports. We are using the oxygen cylinders and we are still fortunate up to this point that we don’t have a patient who needed oxygen but wasn’t given oxygen. We don’t know how long we are going to be able to hold on that,” he said.

The Charlotte Maxeke Johannesburg Academic Hospital saw 1 437 admissions between June and December last year. 

This year, more than 700 people have already been admitted. This means that the number of admissions has already surpassed that of the preceding six months in a mere month. In the same period last year, the number of deaths stood at 241, of which 169 were of patients who were older than 60 years. This year, 36 deaths have been recorded, of which 15 were people under the age of 60.

“The deaths are giving an impression of being higher [this time because of] the Covid-19 mutation”, said Gauteng health spokesperson Kwara Kekana. She added that they are seeing younger patients with more severe disease.

Kekana said the hospital was able to increase its ICU capacity with 49 additional beds. 

Meanwhile, Helen Joseph Hospital has reached capacity. Kekana said the hospital had opened two new medical wards, which was about 70 to 100 beds, to cope with the extra admissions. 

“The medical wards are over 100 % capacity. We are sitting with between 40 outliers in the surgical and orthopaedic wards at the moment. This is after having taken over a couple of wards already, so we are beyond our capacity, we are now outlying patients in non-medical disciplines.”

Although oxygen is not a problem at the hospital, Kekana said that there are staff shortages due to exposure to the virus.  

(Graphic:Francois Smit)

KwaZulu-Natal hits daily high 

While speaking at a public awareness campaign in KwaMashu in Durban this week, health  MEC Nomagugu Simelane-Zulu said that the province had 6 700 new infections last week — its highest daily increase. 

She said private hospitals had bed capacity challenges and were permitted to erect temporary structures outside of their facilities. Speaking on the province’s plans for ramping up capacity, the MEC said: “We have created a temporary structure at Clairwood Hospital.” 

The structure only had 95 patients while it has a 228-bed capacity.

“We have created beds in what we are calling an EMS [emergency medical services] base. We have repurposed it and put oxygen in that base. We have not utilised that particular facility as yet, as we have not run out of beds in our different hospitals,” she said.

She added that two TB hospitals in the province would be used to house Covid-19 patients when needed.

Sharp increase in Western Cape 

This past Sunday, the Western Cape recorded more than 100 Covid-19 deaths and more than 3 100 infections. Mark van der Heever, the health department spokesperson in the Western Cape, told the M&G that all the province’s hospitals experienced a sharp increase in admissions. 

However, van der Heever said looking at the seven-day moving average, used as an indicator of whether or not cases are increasing, stabilising or declining, all indicators so far show “stabilisation”. 

He added the province would watch the data closely to be in a better position to confirm if the province’s peak is starting to stabilise. 

The department planned for 685 intermediate Covid‑19 care beds across the province, including 72 acute beds that have been added to rural hospitals since March.

Tshegofatso Mathe is an Adamela Trust business reporter at the Mail & Guardian