‘New wave’ Covid-19 curbs loom as hospitals fill up, oxygen is rationed
Tougher restrictions could be imposed nationwide when the National Coronavirus Command Council meets this week to discuss a Covid-19 resurgence, partly driven by a highly transmissible mutation of the virus.
The Sunday Times understands that President Cyril Ramaphosa will recall ministers and top officials from their festive break to discuss the response to an exponential rise in infections which has left private and public hospitals running out of intensive care beds and oxygen in the four major provinces.
"I can confidently say that the meeting will be on Tuesday," said a government insider. It followed Wednesday's comment by health minister Zweli Mkhize that "we will need to review the current restrictions and consider further measures to ensure that we curb this alarming rate of spread". New measures could include tighter limits on numbers at indoor and outdoor gatherings, strict control of movement, borders being closed and curbs on the sale of alcohol. It is not clear if the lockdown will be upgraded from level 1.
Doctors and scientists pleaded with South Africans to change their behaviour to contain the massive second wave of Covid-19 which has hit sooner than expected and is spreading rapidly, driven partly by the 501Y.V2 mutation of the virus. Holiday travel and festivities will cause a surge on top of a resurgence that has already pushed hospitals, nurses and doctors to breaking point, they warned. Younger people are being infected in the second wave, and even private hospitals, which had spare ICU beds in the first wave, are becoming overloaded, transferring patients or putting them on waiting lists.
Dr Irene Boeddinghaus, an oncologist at Life Vincent Pallotti Hospital in Cape Town, said patients were far sicker than in the first wave. ICU bed availability was dire and doctors and nurses were burnt out and sick with Covid, she said. Netcare CEO Richard Friedland said the company's hospitals were close to full because the simultaneous escalation of Covid cases across the Eastern Cape, Western Cape and KwaZulu-Natal has been almost twice as fast as during the first wave.
"As a result of high patient volumes there will unfortunately be some delays when seeking treatment at certain of our emergency departments," he said. Netcare hospitals are seeing a higher demand for oxygenation of sick patients compared with the first wave, and there is rising alarm about potential oxygen shortages that have led to rationing at some public hospitals. Eleanor Roberts, Western Cape chair of the Democratic Nursing Organisation of SA, said nurses in the public and private sectors were under siege as they faced the dual pressure of sicker patients and oxygen shortages.
"Instead of having one person with oxygen for hours, hospitals now use oxygen sparingly. In some cases, patients are given oxygen for a short while, just to get them stable before it is taken away and given to more needy patients," she said. The South African Medical Association confirmed the lack of oxygen was among the issues putting doctors under stress.
Dr Andrea Mendelsohn, a senior Western Cape medical officer, wrote in an open letter to Cape Town this week: "Once the beds are full and oxygen used up - we are rapidly approaching that point - then my hospital and so many others will not be able to help. They will be clearing stations for corpses. This is my nightmare and yours.
"If hypoxic patients - where there's a lack of oxygen in the blood - are put on a waiting list for high-flow nasal oxygen, they are in all likelihood waiting to die, she wrote, appealing to people to wear masks, practise social distancing and socialise outdoors.
Dr Katrin Stüve, a senior internal medicine specialist at Helderberg Hospital in Somerset West, said people were "a lot sicker this time, with patients between 30 and 50, with no comorbidities, more critical and succumbing to the disease". She added: "In our hospital we have a small oxygen tank that used to be filled once a week, but now it gets filled every day."
Stüve faces daily choices about who to put on high-flow oxygen or transfer to Tygerberg Hospital for an ICU bed. "It is one of the most heartbreaking decisions . I have to make," she said.
"Sometimes it's easy … if, for instance, you have a young patient who is very sick and has no comorbidities versus an elderly person who has multiple comorbidities. The young person has better chances of surviving when put on a ventilator, but it becomes difficult when they score the same."
Oxygen supply is a "major issue coming towards us", said Ian Sanne, a member of the Covid-19 ministerial advisory committee. Afrox, which supplies public hospitals, has increased its production eightfold and Air Liquide, which supplies private hospitals, has taken similar steps.
But it will not be enough without bulk oxygen in hospitals, said Sanne, and there were shortages of cylinders and drivers and vehicles to distribute oxygen.
"We have recommended infrastructure enhancements for bulk oxygen and reticulation but the pace this is being undertaken is too slow," Sanne said. In Gauteng alone, 28 hospitals are waiting for such upgrades.
Sanne suggested, in his personal capacity, that the departments of public works and health and the National Treasury streamline decision-making to accelerate installations. Public and private hospital admissions have risen substantially in the Western Cape, KwaZulu-Natal and Eastern Cape. Gauteng will be next, he said. "The big four provinces are in the most trouble."
Limpopo is also in its second wave while the Free State, Mpumalanga, North West and the Northern Cape are heading the same way, the South African Covid-19 Modelling Consortium reported.
"They are all in what we call a 'sustained increase' [an increase in the caseload every day for five days with no decreases], a pattern that we found to predict the start of second waves," consortium members said. One said: "Everybody thought that holiday travel would start the fire, but the fire started earlier than expected with superspreader events. The new variant is adding fuel to the fire and now travel will add more fuel."
The UK closed its borders to SA on Wednesday because of the 501Y.V2 variant. It seems to be more transmissible, possibly because of its higher viral load and better binding mechanism, scientists said. It is the dominant virus in 90% of the samples tested at 48 sites in the Eastern and Western Cape and KwaZulu-Natal, Sanne said.
South African Medical Research Council president Glenda Gray said: "What is most important is to curb the transmission … virus escape [mutation] will drive the next wave. We need to understand that when this wave is over, there is going to be a third and a fourth wave."
South African Medical Association chair Angelique Coetzee said: "The skeleton staff on duty during the festive season now bear the brunt of the second wave. The private hospitals are suffering from the same staff shortages, lack of properly trained nursing staff and fatigue, which is emotional as well as physical." A doctor at Groote Schuur Hospital in Cape Town said holiday staff rosters had been thrown into disarray. "We do not have the same degree of support as in the first wave and we can't 3D-print nurses," he said.
Speaking confidentially, one nurse said: "Our hospital is full, but we keep admitting new patients as we can't turn people away … the patients are much sicker this time and the death rate is on the rise. "We all feel tired. It has been a long nine months and we are experiencing burnout."
PathCare clinical microbiologist Dr Marthinus Senekal said: "The resurgence has stretched our human and laboratory resources to the utmost . [and] we are seeing younger patients test positive." Lancet and other laboratories are reporting similar increases in positive test results.
Stüve said: "Inside the hospital, it has become like a war zone, but I go out and see people doing their Christmas shopping, sometimes without masks. None of them seem to think that they could be next. "The rate of new infections will soon surpass the peak of the first wave, said Mkhize.
Tourism minister Mmamoloko Kubayi-Ngubane said large gatherings, where people did not observe health protocols, were to blame for the new wave. "People are just not listening."
She said most tourist attractions, including beaches that were still open, were safe. She said restaurants and other indoor venues would face new restrictions if they did not comply with regulations. South Africans wanting to travel locally can check the Epidemic Explorer dashboard, built by the modelling consortium, to assess the risk in every district.
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