Hospitals in Gauteng are stagnating due to a “massive increase” in Covid-19 cases and health workers warn that there could be an acute shortage of beds equipped to provide high-pressure oxygen to the sickest patients within the next week.
Doctors, nurses and paramedics tell Rapport they already have to “choose” whose life to save and there is great confusion about where beds are available.
By Saturday, Gauteng had 57,995 active Covid-19 cases, including 1,000 health workers tested positive over the past week. New cases double every ten days.
The 87,033 Covid-19 cases recorded in Gauteng since March – including 29,038 people who have already recovered from the virus – are slightly less than the 115,000 cases reported according to projections from the National Institute of Communicable Diseases (Nios ) would have occurred in Gauteng by 13 July.
So far, 554 people in Gauteng have died from Covid-19.
On Saturday, a little over 3,100 hospital beds in the province were occupied by Covid-19 patients. Although the number of beds suitable for Covid-19 treatment – 1 496 in state hospitals and 6 805 in private hospitals – seems spacious, the increase in cases means that these beds will not last long. In addition, not all beds are properly equipped.
“The entire health system is now experiencing a crisis,” says Dr. Francesca Conradie, Deputy Director of the University of the Witwatersrand (Wits) HIV Research Unit. “Patients are not admitted because no one knows where beds are available. The information should be made available online so that people can know where to go.
“We are starting to get too little oxygen in public hospitals and clinics and doctors and nurses now have to decide who gets oxygen to keep patients alive and who does not.”
The crisis has been exacerbated as more than 1,000 health workers and other hospital workers tested positive last week, Conradie said.
Dr. Angelique Coetzee, chair of the South African Medical Association (Sama), says many hospitals do not have the infrastructure to deliver high pressure oxygen to enough beds. “Doctors now have to decide whether to give a young man with HIV or an 80-year-old aunt with high blood pressure oxygen.”
A doctor at Kalafong and Steve Biko Hospital in Tshwane says the sudden increase in Covid-19 cases is “frightening”.
“There are no more beds in the intensive care units. It is literally a case where you have to wait for someone to die so that a bed can be opened for you. ”
According to her, the problem is often the shortage of beds with high-pressure oxygen.
“The sicker you get, the more oxygen you need. So, initially you get free flowing oxygen through tubes in your nose. You breathe on your own. But when you get sick, you need high-pressure oxygen that goes deeper into your nose and lungs as you begin to struggle to breathe on your own. The next step is ventilation, where a machine helps you breathe. The problem with patients on ventilators is that they also need a dedicated health worker to monitor the treatment, and that’s a big problem with our current staff shortages, ”she says.
An Eastern Rand paramedic says Covid-19 patients who are seriously ill are not yet dismissed, but there is “no guarantee” that a ventilator will be available if you have a chronic illness such as diabetes or a have no heart problem. This reduces patients’ chances of survival.
A doctor at a private hospital on the West Rand says health workers’ morale is low because not all patients can be helped.
“If you need a bed in the intensive care unit, there is a great chance that you will not be able to find one and die. It’s as simple as that. And I’m not just talking about Covid-19 cases here, I’m also talking about people who suffer serious injuries in accidents or get things like heart attacks. ”
A Pretoria specialist says the hospital where he works is “full” and he has received instructions from management to point out even serious cases referred from outside Gauteng. “So, if you are in a major accident right now and your back is broken or you have brain injuries and need to be transferred, I will have to say no, we have no place. That’s the reality and there is no more distinction between private and public hospitals. We work closely in Gauteng and you have to go wherever there is room for you, ”he warns.
In addition, due to delays in test results, nursing staff must treat all patients as if they are positive while waiting for results. Mzi Gcukumana, spokesperson for the National Health Laboratory Service (NHLS), confirmed that backlogs in Gauteng are the largest in the country.
Prof. Alex van den Heever, health economist at Wits, says if the pandemic is not controlled, a shortage of beds will arise in public and private hospitals.
“What we are seeing now is a massive increase in new cases. In about ten days, we will see a huge increase in the need for beds, and for death. At present there are not enough services to deal with the pandemic. ”
While the Western Cape early on set up field hospitals with oxygen points at beds that could accommodate high-care patients when ordinary hospitals were under pressure, Gauteng’s field hospitals, according to Van den Heever, are without this infrastructure.
“There is no oxygen supply there and clinical staff are struggling to come up with a plan to get doctors, nurses and oxygen to the beds. This is a failure in the prevention strategy as well as the treatment strategy. The government has prepared for nothing. “
The government said on Friday that field hospitals were being set up at Nasrec (1,000 patients), Diepsloot (500), Soshanguve (500), Midrand (500), Daveyton (720) and the Tshwane showground (700). Construction on the latter has yet to begin.
A doctor at a private hospital told Rapport that many private hospitals’ emergency units are already full and beds in regular halls are now provided with ventilators.
On Friday, the Mediclinic Morningside in Sandton had only two beds left. Richard Brett, hospital manager, confirmed they had oxygen for two weeks.
Netcare spokeswoman Martina Nicholson says some of their hospitals are under pressure due to a sharp increase in Covid-19 admissions, but in general “we are not struggling” and there is enough oxygen.
Dr. Charl van Loggerenberg, head of emergency medicine at Life Healthcare, says by Friday they had treated 656 positive cases in their hospitals in Gauteng. The sharpest increase in cases was on the East and West Rand. “All our facilities still have capacity. The management at each hospital is constantly in contact with each other and with other hospital groups to ensure that extra beds are available. ”
Dr. Bandile Masuku, Gauteng MEC for health, said on Friday that the province had “enough hospital beds for the foreseeable future” thanks to cooperation with the private sector and that 64% of the province’s high care beds were full on Thursday.
However, Masuku told News24 provincial hospitals could “reach their capacity” within the next week.
He expects a peak in infections by early August and that the province will only be out of the “danger zone” by September.
He has meanwhile withdrawn his earlier remark to eNCA that 1.5 million graves will be dug in Gauteng and also confirmed that no tenders for digging graves have been promised.
Dr. Health Minister Zweli Mkhize said on Friday that an “emergency decision” had been made to “make extra beds in literally every hospital in Gauteng”.
“We have also been informed about the shortage of staff and are working on it. So far we have been able to mobilize almost 680 staff members to come from private nursing agencies. “