/ 11 June 2020

Call in the medics: Beds don’t cure people

Graphic Covidwave Twitter
As positive Covid-19 cases climb rapidly, health facilities will need more doctors and nurses. (Graphic: John McCann)

Nearly one million Covid-19 tests conducted, millions screened and tens of thousands testing positive. The pandemic in South Africa, after an initial slowdown in its spread, is finally taking on its natural progression and spreading rapidly. In the past week, on average more than 2 200 people tested positive from about 28 000 tests every day. The number of people testing positive has doubled in the past two weeks, to 55 000.  

On this trajectory, using a rough calculation on its current growth rate, the cumulative number of positive cases will surpass that of China, which is now at about 83 000 cases, by the end of June. Government’s estimates are that the peak will hit in August or September, although the formula for how it has reached this conclusion has been questioned because it has not been shared.

Hubei province in China, which was the epicentre of the global virus from December last year until it took hold in Italy and then elsewhere, was under intense lockdown for about two months. Restrictions were only lifted in the main city of Wuhan in April.

Professor of vaccinology at the University of the Witwatersrand, Shabir Madhi, said though the numbers are increasing, comparisons with other countries should be done within context.

“China was able to contain the virus by extensively testing and tracing right from the start. They were aggressive with their contact tracing and isolating the contacts. This was always going to be a difficult goal for South Africa. A lockdown on its own was not going to contain the virus it needed to be coupled with extensive testing and contact tracing. But, unfortunately, that was not the case in South Africa,” said Madhi.

Nchimunya Hamukoma, an economist and policy strategist, says this is one of the areas where the government has fallen behind. According to the weekly reports compiled by the National Institute for Communicable Diseases, the majority of people tested is through passive case finding. This means that more people are noting their symptoms and are getting tested rather than waiting for the government to trace them or through community screening. 

Levels 4 and 5 of the lockdown slowed community transmission. But the lockdown hit the economy hard. Level 3 has seen the government sending most workers back, with the warning that it is now in the hands of people to keep themselves safe. 

(John McCznn/M&G)

“The increase in infections shows that we are finally interacting with the baseline nature of the virus. What the other countries that have been able to manage the disease, which we have not been able to do very well, is the contact tracing and increasing screening everywhere. We need extensive contact tracing which will allow you to see the containment of the virus,” said Hamukoma.

Professor Keymanthri Moodley from Stellenbosch University’s faculty of health sciences said that if the country surpasses other epicentres globally in the numbers of infections, we could lose many lives. This would include healthcare workers — who are exposed to Covid-19 and can be affected by a shortage of protective equipment and other resources. 

In such an unequal society, with vastly different access to healthcare and the ability to self-isolate, this will be a real problem, she said: “South Africa has significant inequities where healthcare is concerned. The public health system has struggled to cope pre-Covid-19. The coronavirus outbreak has placed additional stress on a public health system that was already fragile.”

She added: “Lockdown was necessary to improve the preparedness of hospitals for the anticipated wave of Covid-19 cases … We cannot scale up healthcare capacity in the same way China did at record speed, with hyperefficiency. Many healthcare workers are infected and some have died. So, while we may have additional hospital beds and ventilators and additional field hospitals, we may not have sufficient medical and nursing staff to cope.” 

Last week the Western Cape noted that it needed an additional 5 000 nurses to assist with the pandemic as new health centres are open. The province has more than 37 000 people who have tested positive for virus with the majority of them in the poorest and most densely populated areas in and around Cape Town.

The Eastern Cape provincial coronavirus command council’s report published this week notes that the province does not have enough capability, especially since it has been projected that about 6 000 people will die from Covid-19.

“The province will experience demand exceeding supply. It would appear from the data that the lockdown did not produce the required increase in capacity in the Eastern Cape to deal with future demand,” reads the report. 

Madhi said it was important to capacitate hospitals with equipment, “beds do not cure people”.

“It’s about healthcare workers because they take care of the patients. Even in the absence of an outbreak South Africa does not have enough healthcare workers in the public sector. The number of healthcare workers that will be needed will also depend on how quickly the virus spreads. This will also depend on the bottom line, the behaviour of South Africans,” said Madhi. 

Meanwhile, irresponsible drinking is wreaking havoc in provinces as more alcohol-related incidents flood hospitals. This has driven the Premier of the Eastern Cape, Oscar Mabuyane to push for a ban on the sale of alcohol in the province. His counterpart in the Western Cape, Alan Winde said that a number of hospitals have seen a significant spike in trauma cases linked to alcohol use since the sale of it was unbanned.

“This is extremely concerning to us as the healthcare system is already under pressure as a result of Covid-19. I want to be very clear with the people of the Western Cape: alcohol abuse is taking away hospital beds and care from people who need them during this very serious pandemic. Your grandmother, brother or sister could become ill with Covid-19 and require a hospital bed,” he said in a statement this week.