Andrea Mendelsohn says she is exhausted. She says her mind has somersaulted through every stage of grief 100 times over.
Dear Cape Town,
Yesterday my community health centre reached capacity. All five oxygen tanks were in use, five men and women saved from the strangulating effects of Covid-19. Then a sixth patient arrived, chest heaving with an oxygen saturation of 74% in dire need of help, and I thought, "who will I take off the oxygen?" He was fortunate: we could make a plan, scrounging a spare tank from another clinic. But what happens next week, and the week after?
Yesterday we saw 107 people for possible Covid-19; 48 were probably positive. We transferred six on oxygen to the hospital. One waited 21 hours for an ambulance, his family phoning again and again to find out what was happening. Three bodies were brought from home to be certified dead. That was one 8-hour shift. Next week the numbers are likely to be worse. A tidal wave is enveloping Cape Town.
Tomorrow will be more of the same; hopefully not too much more. Oxygen usage across the Western Cape is running at more than 52% of available daily capacity, the highest daily oxygen use since March. The field hospital at Brackengate is full. ICUs at Groote Schuur and Tygerberg are full. We have been issued guidelines for how to triage: who among our hypoxic patients should be given high-flow nasal oxygen, and who should be put on a "waiting list". Hypoxic patients cannot wait; to wait is in all likelihood to die.
This is the nightmare. In June, we had a huge Covid-19 epidemic, but we were ready. Level 3 regulations were in place. People were minimising social contacts. The CTICC was repurposed as a field hospital. It worked. Hospitalisations were high, but we pulled through. "Jerusalema" we cheered! Now we're all fatigued. Healthcare workers are tired; many are sick. We all just want a break. I just want a break.
I'm exhausted. My mind has somersaulted through every stage of grief 100 times over. Denial. "I'll be on leave soon. Just make it to January." Anger. I just want to scream, "Wear your f*cking mask!" (Yes, you too Minister Cele, who berates beachgoers while wearing a mask that leaves his nose exposed).
Bargaining. "Please wear your mask. Over your mouth and nose. It's warm and beautiful, meet your friends outside. Please."
Depression. "Wow. Nobody cares. Everyone is going to have their huge indoor holiday parties and show up at my doorstep five days later with no oxygen, no hospital beds, and nowhere to go."
Acceptance. So this is 2020. Yeah, it sucks. But we have a choice. Preventing Covid-19 is not rocket science. It mainly spreads through the air. If you have Covid-19, you spread it when you talk, sing, cough, speak or just breathe around other people. You are more likely to catch Covid-19 indoors, especially in crowded places where people are not wearing masks. Covid-19 loves restaurants, bars, and indoor social gatherings.
Most people will have mild symptoms. However, a small but significant percentage will get very sick and need oxygen. Older people and those with chronic diseases such as diabetes are more likely to get sick. If all of your loved ones get ill at the same time, we cannot save them. That’s it. To help patients with Covid-19 pneumonia, we need oxygen and hospital beds. 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. I do not want to spend New Year’s Eve caring for Covid-19 patients with morphine and prayer. Please, Cape Town, help us help you. It's not that hard:
1. Always wear your mask when in public places, over your mouth and your nose.
2. Socialise outdoors with your friends and family. Have a braai and sit two arms lengths apart while you eat and drink. If you must sit indoors, open the windows to increase ventilation.
3. Spread out and keep your distance from other people. Avoid crowds.
4. Wash your hands.
5. Avoid indoor gatherings. If you do see family, keep it as small as possible, fewer than 10 people.
6. Keep the music volume down so you don't have to shout and stand close to each other to hear the conversation.
7. If you are sick, stay home and arrange a Covid-19 test. Call 080-928-4102 if you have a question. If you feel short of breath or very ill, go to the hospital.
Covid-19 is preventable. Covid-19 deaths are preventable. We must mask up, space out, and socialise outside to protect our uMakhulu, uTa'mkhulu, Granny, Grandpa, Ouma, Oupa, Mama, Tata, Mom, Dad, Ma and Pa. To protect us.
Together we can make this a Healthy New Years (please?).
- Andrea Mendelsohn is a Senior Medical Officer in the Western Cape Department of Health. She writes in her personal capacity.
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