Nasal oxygen treatment instead of ventilators sees Covid-19 recoveries at hospital in Cape Town

The Western Cape has shifted to using high-flow nasal oxygen treatment on Covid-19 patients after the first six patients placed on ventilators died at Tygerberg hospital in Cape Town.

Head of the provincial department of health Dr Keith Cloete explained the shift in strategy during a virtual press briefing on Thursday.

Ventilators were used as one of the main treatments for critical care Covid-19 patients during the initial phases of the global pandemic, but the experience from Tygerberg hospital prompted a rethink.

Cloete said 114 high care patients at Tygerberg, representing about 70% of high care patients at the hospital, were placed on high-flow nasal oxygen after meeting certain criteria for the treatment. He said that 70% of these people recovered from the disease.

“The experience of our team at Tygerberg was right at the beginning our first six Covid-19 patients that were admitted to critical care, all six were admitted for what is called early ventilation because at the time that was the recommended mode of treatment,” he said.

“What happened is all six of those patients died. At that time there was the first emerging studies of critical care success by using high flow nasal oxygen,” he said.

“So, the team at Tygerberg decided that the next seven patients that came in for critical care were placed on high-flow nasal oxygen. Six out of the seven recovered. That was a huge turnaround for the team at Tygerberg,” said Cloete.

The province has the highest number of infections in the country and had 601 Covid-19 related deaths and 10,267 active cases by Wednesday.

Cloete said that since liquor stores were reopened on Monday there had been an increase in alcohol-related trauma cases at hospitals. These cases were now competing for ICU beds with Covid-19 patients.

Premier Alan Winde pleaded with the public to use alcohol responsibly to lower the burden on hospitals.

Winde said a decision to ration testing in the province to people older than 55 and who suffered from chronic illnesses was made due to the shortage of testing kits and the 28,000 test results backlog in the province.

He said the high-flow nasal oxygen treatment was so successful that they were considering moving patients from critical care and ICU wards to normal wards.

He said national health minister Zweli Mkhize visited some of the new Covid-19 field hospitals that will be opened next week, including a massive 1,429 bed paperless field hospital at the Cape Town International Convention Centre (CTICC).

Cloete said a model created in conjunction with the University of Cape Town predicted that the Western Cape would need 7,800 hospital beds at the peak of the pandemic, but he said they had to adjust this figure to include 2,200 acute beds.

He said the first cases would be admitted to the CTICC field hospital on Monday.

Several other facilities are expected to come online in June and July.

Cloete said the current critical care capacity at public health facilities was 135 but the department was using fewer than 100 of these beds.

During a parliamentary health portfolio committee visit to Tygerberg hospital, health officials attributed this shortfall to the lack of experienced staff available to work in these wards.

He said the province was working with the national health department to secure 300 beds from private hospitals at a fixed contract tariff.  

This would make up for some of the more than 800 ICU bed shortfall in the province.