Staff and oxygen shortages in second wave tremor, front-line workers fear Covid-19 tsunami
As South Africans battle to breathe and flood emergency wards, scenes reminiscent of the first wave of the pandemic that caused hospitals in Italy and New York to flat line, are starting to play out in SA.
SA experienced two spikes this week — a daily death count of 497 on Tuesday and more than 17,000 positive infections within 24 hours on Wednesday. The records confirmed what experts predicted about the damage and devastation of the second wave on the country and its embattled health-care system.
On Saturday, SA recorded 288 more Covid-19 related deaths bringing the total to 29,175. There were 15,002 new positive cases bringing the total number to 1,088,889. The Eastern Cape had 92 more deaths, the Free State 9, Gauteng 39, KwaZulu-Natal 29, Mpumalanga 6, Northern Cape 2 and the Western Cape 111.
Now authorities are bracing themselves for surges in numbers as holidaymakers return home and take the virus with them.
Private and state facilities were scrambling last week to recruit thousands of nurses and doctors and at least one province has already reached out to the army for medical staff to be made available as front-line health-care workers battle infection, deal with irate patients and families over shortages of beds and oxygen, packed mortuaries and being stretched to the limit as colleagues go into quarantine.
National health minister Zweli Mkhize said on Tuesday that government would welcome 2,367 medical interns and 1,693 medical community service practitioners to “provide relief” to the 7,895 community service workforce.
KwaZulu-Natal premier Sihle Zikalala said on Sunday that a total of 8,723 health-care workers (HCWs) had been infected with Covid-19 in the public sector since the beginning of the pandemic.
“Of the total infected, 98 (or 1%) have sadly succumbed to the disease. The majority of the infected health-care workers (IHCWs) are nurses (56%).”
In the past week, some health-care workers in KwaZulu-Natal, which has been identified as the epicentre of the pandemic with spiralling infections, bid an emotional farewell to four state nurses — Vanessa Govender, Sheron Govender, Sandra Reddy and Prissy Moodley — who succumbed to Covid-19 complications.
At the height of the first wave, hospitals in New York and Italy collapsed under spiralling infections, a dire shortage of resources and health-care workers who contracted the virus. According to the Italian National Institute of Health (ISS) 16,991 health-care workers tested positive and 182 died. According a report by Kaiser Health News and The Guardian, more than 2,900 US HCWs have died in the pandemic since March, with about 680 from New York and New Jersey.
Vanessa Govender’s brother, Charles Somiah, said his sister was given a special send-off at the hospital, where workers formed a guard of honour and released balloons as the hearse carrying her body drove by and neighbours lit candles and sang.
“She and the other nurses who also died at the hospital were heroines in our eyes. Their deaths leave a void in our health-care system — if our workers die, who is going to take care of the sick?” he said.
Two weeks ago, KwaZulu-Natal health MEC Nomagugu Simelane Zulu confirmed that 38 staff members have tested positive at Addington hospital — including five doctors, 11 nursing staff, one allied worker, and 21 support staff members. A further 23 staff tested positive at RK Khan Hospital, including seven nurses, 10 doctors, two radiologists, three clerks and one general orderly.
A health-care worker who lost colleagues at RK Khan last week, said staff at the hospital were reeling from the deaths.
“Most of the staff are very emotional here. It is so heartbreaking to know that we have lost our staff. People who we see everyday in our lives are no longer with us. PPE (personal protective equipment) is a challenge. In our dept we use it sparingly. There's many days when I get ready for work and just don’t feel like going. And once you get there, there's really not much to think about, just work.
“This second wave is without a doubt far worse than the first. We are seeing far more infections. Though much effort is made to separate these patients, the influx of trauma patients makes it impossible. Though I have seen many ill patients in my lifetime, these patients just present so ill and no family can be with them.”
She said their greatest fear is taking the virus to their families and that many were separated from their young children or elderly parents.
“To see these patients is just scary. The mortuary is packed to capacity. There is a shortage of beds and oxygen. We are trying our best to make do with what we have but it's becoming emotionally and physically draining. It makes me very very angry seeing people not adhering to social distancing and wearing of masks. Like very angry.”
Durban orthopaedic and spinal surgeon Dr Rinesh Chetty, who runs SA Doctors United, said the second surge of infections has “broken the back of our efforts to keep the pandemic at bay”.
“All health-care workers are working around the clock, the numbers are overwhelming, all units have been plagued by staff shortages, burnout and illness. Both public and private sectors are struggling to meet adequate numbers to man the required beds to service the massive surge of ill patients that require hospital support. The is no end in sight, no chance to breathe or rest at the moment. Your phone is ringing till it is flat and you are drenched in sweat from PPE, too scared to eat or drink and when you get home you face the biggest fear of bringing the virus home to your loved ones.”
Chetty said the new lockdown will help, and while the country was reeling, the country needed to work together.
“There is an active need as South Africans to retrain, re-educate and reinforce behaviour, so that everyone follows the instituted protocols and maintains focus. The number one major hurdle across the board is with a shortage of health-care staff: due to illness, burn out and historical frozen posts. We need emergency laws, funding and policies to assist us in getting staff and manpower right now.”
Dr Kams Govender, who works in the upper Highway area, west of Durban, said: “What we are experiencing now is just the tremor, the tsunami is yet to come in mid January. It’s hit us hard and it’s going to hit us even harder then. We are physically and emotionally exhausted, and worse, losing our health-care colleagues every single day. But still we push on and show up and pray for better days where there is more light than darkness.
“As a community based practitioner I’m still seeing an increased number of patients requesting treatment and testing. In addition, our number of positive patients per day is still on the increase mainly as a result of positive contacts. The recovery rate among my patients has been pleasing with the bulk recovering within the prescribed isolation period with no serious complications.”
According to the Healthcare Workers Heroes memorial — an online tribute to fallen medical staff — at least a dozen medical workers have died in the past two weeks around the country after testing positive.
Private health-care group Netcare CEO Dr Richard Friedland said they had recalled all front-line staff from leave and were increasing oxygen capacity to deal with the resurgence. He said that they were deploying additional doctors, nurses and health-care workers to areas of need. He said the group was particularly concerned about Gauteng as holidaymakers returned to the province.
Western Cape premier Alan Winde said the province was in the process of recruiting over 1,300 health-care workers as one of the measures to counter the resurgence of the pandemic which was more devastating than the first wave.
“We have received over 500 applications as part of this recruitment drive and a dedicated team have been working throughout this festive period, contacting applicants to determine their availability and channelling information to the appropriate regions and districts for immediate placement,” he said.
He added that they had also approached the military for medical staff to be made available.
Bhaviysha Chendriah, who runs a private nursing agency, said that they have been inundated with requests for high care staff to nurse critically ill patients.
“Most of our hospitals were at max with Covid admissions and so many staff were turning positive and infecting their families. Other staff are experiencing burnout due to lack of staff and resources as they are working 5/6 days straight 12-hour shifts without full PPE.
“My staff tell me they are under pressure. Some nurses are nursing four ventilated patients on their own when it’s supposed to be one on one. We are losing staff on a weekly basis now, so much so that nurses are afraid to even work and are choosing to stay home.”
Meanwhile funeral homes and crematoriums are stretched to the limit as the Covid-19 casualties add up.
At Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi — south of Durban, hospital CEO Gabriel Khawula asked staff to inform families who had lost loved ones to Covid-19 that the hospital mortuary has reached full capacity.
He said unfortunately all bodies had to be removed from the hospital mortuary to private funeral parlours within 48 hours.
Speaking on condition of anonymity, a nurse from PMMH said the hospital was struggling to cope.
“The hospital is full, the Covid wards are full, the normal wards are full. There are no beds for our outpatients, they lie in the passage on stretchers waiting for beds. The Covid patients will be placed with one another in a consultation room. We try to separate them but it's not a proper place for patients to be in because there are no beds, just the stretchers. We are running out of oxygen points because there are so many patients that need oxygen. We tend to prioritise who needs it more, but right now everyone needs it.”
Mluleki Madlala, 43, the owner of Madlala Funeral Services in Umlazi, said they was a shortage of coffins as manufacturers had closed for the festive period.
“We are running out of coffins. We have to phone places in Hillcrest and Newcastle. It's getting to a stage now where we are getting desperate.”
Madlala said the body count had tripled compared to previous Decembers. “We're dealing with at least five Covid-19 cases per day and we still have other bodies to deal with as well. People need to start waking up now, I am pleading with people to take this seriously.”
Thegraj Kassi, secretary of the Clare Estate Umgeni Hindu Crematorium, said they were dealing with an average of 12-15 Covid-19 related cremations per day.
“The number of bodies are increasing on a daily basis. We are booked up until Saturday with Sunday's bookings already half full. Over and above the Covid-19 cremations, we are still dealing with 10 non Covid-19 related cremations.”
Kassi said this was an increase of close to 10 more bodies per day in comparison to previous festive periods.
“The undertakers could not cope and that's why we extended our working hours to 11pm at night.”