Grim Covid-19 projections for SA: 40 000 deaths, 1 million infections and a dire shortage of ICU beds

More than 40 000 people are expected to die from the coronavirus in South Africa by November, one million people will be infected and the country is unlikely to have enough ICU beds at the peak of the pandemic. 

This according to a presentation by a group of scientists advising the government on projections and modelling to inform policy and regulations. 

Dr Sheetal Silal, who led the presentation in a virtual meeting co-ordinated by Health Minister Zweli Mkhize, said projections showed there would be 40 000 deaths by November with 475 expected deaths by the end of May.

READ | These are SA's 7 worst-hit Covid-19 districts

Based on a pessimistic projection, there might be between 45 000 and 48 000 deaths by November, she added. "Even these projections may change as interventions come into play and transitioning to different levels [of lockdown] in the future," Silal said, painting a grim picture of how the coronavirus will peak in South Africa this coming winter.

She added projections showed there would be 30 000 confirmed cases of Covid-19 in South Africa by the end of May with one million cases projected by June and July.

ICU beds 

Silal said all projections showed the threshold for ICU beds for Covid-19 cases in the country would be exceeded by the start of July in the optimistic projection and by June in the pessimistic projection. 

READ | Schools reopening: Dept ensures feeding programmes and scholar transport

"They are projected to be exceeded early on the pandemic."  South Africa has 4 000 ICU beds across the country, with “plans to add additional” beds, but the country would need between 25 000 and 40 000 ICU beds at the peak of the virus in September.

"When the ICU bed threshold is exceeded, those requiring but not getting an ICU bed will be occupying a general hospital bed," Silal said. "What we can expect is the general bed threshold will be exceeded quite a bit early on in the epidemic because we will be taking into account those who are requiring ICU beds but are not getting them." 

Projections show the threshold for ICU beds would be exceeded in early July in the best-case scenario or in June according to the worst-case scenario.

Ventilators

Dr Gesina Meyer-Rath from the University of the Witwatersrand's Health Economics and Epidemiology Research Office warned most Covid-19 patients requiring ICU beds would "end up in normal hospital beds and not be able to access ventilation". 

She said the availability of ICU beds was a central aspect in shaping policy and making recommendations to the health department. Her estimation is that ICU bed capacity in the public and private sector will be breached "regularly … we need to increase capacity by a factor of 10".

READ | Gauteng to move to Level 3 in June

Silal added all scenarios pointed out hospital and ICU capacity would be exceeded. "When you talk about capacity it is important to realise that it is not just about beds available, ventilators or oxygen available. It is also about the staff to manage those patients in each of those required services. It is important to realise that staff is the least fungible." 

Silal said provincial data showed different provinces would peak at different times. "The peak in active cases will likely be between early July [pessimistic] and early August [optimistic]. This will be affected by post-lockdown measures."

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