Coronavirus pandemic threatens to engulf South Africa’s hospitals

South Africa is bracing for the worst of the coronavirus pandemic, with infections mounting at a rapid pace, doctors and nurses being worked to the bone and ICUs at risk of running out of beds.

The government imposed a strict lockdown in late March, just weeks after the first case was detected, which helped slow local transmission. But the shuttering of most businesses proved unsustainable in a country already contending with a recession and rampant unemployment, and curbs were eased last month to enable millions of people to return to work.

The rate of new infections has surged since, especially in relatively poor urban areas, increasing by more than 8,000 for each of the past nine days to reach 238,339 on Thursday, with about 113,000 of those already recovered.

“The storm that we have consistently warned South Africans about is now arriving,” health minister Zweli Mkhize told legislators on Wednesday.

While SA has the most confirmed cases in Africa, it’s also tested more than 2-million people and screened about a third of the population of nearly 60-million. Fewer people were infected in May and June than was previously predicted under optimistic scenarios, Mkhize said, and the peak of the outbreak, expected by mid-August, may be at a lower level than initially feared.

Despite the government’s preparations, “bed capacity is still expected to be breached or overwhelmed in all provinces”, Mkhize said.

Some public hospitals are already struggling with an increased patient load and the loss of staff who have contracted Covid-19. Nationwide, 377 doctors and 2,473 nurses have been infected, latest data from the department of health shows.

Health workers are “burnt out, they are stressed, they see their colleagues getting sick and are worried that there are not enough personnel helping them”, said Dr Angelique Coetzee, who chairs the SA Medical Association. Numerous panels have been set up to deal with the crisis, but more attention should be given to providing care to those who fall ill, she said.

Keeping staff safe has proved “a real challenge”, and the pressure on them has been immense, according to Adam Pyle, who heads the SA unit of Life Healthcare Group Holdings, the country’s second-largest private hospital owner.

“We have doctors who are actually doing nursing,” he said. “There is no play book on how you deal with this. So despite all the planning you put in, there are real challenges at a hospital level.”

While the disease was initially concentrated in Cape Town, it has since taken off in Johannesburg, the economic hub and biggest city, and in Pretoria, the capital. Infections have also spiked in towns in the Eastern Cape, which have inferior resources to the main cities.

“There are signs that the healthcare system is collapsing both in the public and private sector,” said Zwelake Tywala, a National Health and Allied Workers’ Union official in the Eastern Cape. “There isn’t any management or leadership from the side of the hospitals. We’re very worried.”

The government is taking steps to address the shortcomings in state hospitals, including contracting in more beds from private hospitals, recalling nurses from study leave, and rehiring some who had retired, said Sandile Buthelezi, the director-general of the department of health. It’s also trying to entice health practitioners who have been working abroad to return, and to hire more from Cuba and other countries, he said.

Some officials suggest that stringent lockdown rules should be re-imposed. President Cyril Ramaphosa has ruled out that option, saying people need to earn a living and take responsibility for their own health by wearing masks, washing their hands and exercising social-distancing as much as possible.

That’s not happening in many areas, with people congregating at church services and funerals. Commuters who rely on public transport aren’t able to maintain physical-distancing as many drivers defy rules to restrict passenger loads to 70% of normal capacity.

A number of hospitals were already struggling to meet patients’ needs and were badly run before the virus struck, and have now reached a tipping point, Coetzee said. “Covid-19 is exposing all these problems that were already in the healthcare system. It’s not a new thing.”  (Bloomberg via BD SA)