Adriaan Basson: Can we assemble 20 000 ICU beds in three months?

Students from Kenyatta University who made a ventilator at the Chandaria Business Innovation Incubation Centre to mitigate the shortage experienced in the country.
Students from Kenyatta University who made a ventilator at the Chandaria Business Innovation Incubation Centre to mitigate the shortage experienced in the country.
Simon Maina, AFP
  • As South Africa moves to Level 3 of the Covid-19 lockdown, we should assess the success of the lockdown to improve our health system.
  • The availability of ICU beds and ventilators are crucial to prevent a spike in Covid-19 deaths.
  • In two months, the health department has added only 48 critical care beds to our national capacity.

The reason for South Africa's very hard lockdown, that has cost the economy billions and may leave up to seven million more people unemployed, was to delay the inevitable rapid infection of our population with the coronavirus.

It bought us time to upgrade our hospitals for what lies ahead.

Speaking to journalists for the first time since the outbreak of the virus in South Africa in March, President Cyril Ramaphosa confirmed this on Sunday: "Our strategy has therefore been to prevent a massive spike in infections by delaying the rate of infections, and to simultaneously prepare our health system for the anticipated surge in cases and put in place broader public health interventions."

As the economy opens up on Monday and life returns to semi-normal – you can exercise between 06:00 and 18:00, shop where you like and buy booze – we can begin to reflect on the success or not of the lockdown.

There is no doubt that the hard lockdown reduced the rate of infections. "Before lockdown, the doubling time of coronavirus cases was 2 days. During lockdown it was 15 days. During the easing of the lockdown – with the implementation of Level 4 – it has reduced to 12 days," said Ramaphosa.

In my books, the government gets a pass for the first part of the lockdown strategy. Other countries were at much higher levels of infection after a similar period than us.

Besides staying at home, our country has also taken remarkably successfully to the wearing of face masks in public spaces. Even though I still feel like I'm going to a dress-up party when I wear mine, I am proud of South Africans for doing the right thing without too much hassle (I see there is a booming business for personalised face masks with corporate insignia – we are indeed a nation of entrepreneurs).

On the second part of the strategy – the upgrading of our health system – the success rate is much less clear.

Yes, we have built field hospitals that will accommodate 13 000 patents who don't need serious hospitalisation and took delivery of millions of face masks and other personal protective gear. But we also know that Covid-19 can be extremely aggressive, particularly to older patients with comorbidities, and that thousands of South Africans will need intensive treatment to keep them alive.

They will need an ICU bed with a ventilator to survive.

Unfortunately, these numbers are not quoted as often as they should be by Ramaphosa, Health Minister Zweli Mkhize or at the health department's daily Covid-19 updates.

Could the reason for this be that we are massively behind target?

When the then acting director general of health Anban Pillay presented the department's strategy to Parliament on 10 April, he reported that the country at that point had 4 909 existing critical care beds available across the public and private sector. Depending on the severity of our peak, we would need between 4 000 and 15 000 ICU beds, he said.

Pillay further disclosed that the country had 3 216 ventilators and would need an additional 3 784 to provide for the Covid-19 outbreak.

Two weeks ago, the Covid-19 modelling consortium of scientists advising government released their projections of how many ICU beds we would need during our peak. In an optimistic scenario, we would need 25 000 beds by the end of August. If the virus spreads rapidly, we may need 35 000 ICU beds at the beginning of August.

This is two months away.

On Friday night, Pillay again provided updated slides to Mkhize as the minister briefed the public on the latest health updates. This time, almost two months after his first presentation, Pillay had the total number of critical care beds on 4 957.

Of those, 2 309 have been allocated to Covid-19 patients.

No updated numbers for ventilators were provided in the presentation, but we know from answers by Trade and Industry Minister Ebrahim Patel, who oversees the project to purchase more ventilators, that we now need an extra 15 000 of these breathing machines to cope during our peak.

Patel's advisor told the Sunday Times production of the 15 000 ventilators would only start next week. A week ago, the tenders were not yet awarded.

In May, the United States donated 1 000 extra ventilators to South Africa.

So, in a nutshell; during two months of lockdown, we added 48 ICU beds to our national capacity and 1 000 ventilators, courtesy of the United States.

When I asked him on Sunday if this meant the health department is failing South Africa, Ramaphosa said no, the department has achieved enormous successes. He listed testing and the setting-up of field hospitals.

He added that he would take a personal interest in the assembling of ICU beds and ask Mkhize to prioritise this issue.

For many countries, the availability of ICU beds has been key in managing low mortality rates. In countries like Italy, there were simply not enough beds with ventilators available for the sudden rush of very sick Covid-19 patients and doctors had to play God.

We have two to three months left to avoid a similar situation. The clock is ticking.

- Adriaan Basson is editor-in-chief of News24

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