The number of Covid-19 patients at Groote Schuur Hospital in Cape Town is doubling every five days and the hospital will not be able to cope unless something is done, GroundUp reported.
"I expect there will be an excess of patients needing care even if all existing beds are opened," said a doctor who did not want to be named.
The hospital was currently running seven wards with more than 120 Covid-19 patients, and four intensive care units with 19 patients, one of several doctors at the hospital told GroundUp.
Three of these wards are for confirmed Covid-19 cases, others are for suspected cases – in other words people with respiratory illnesses. A doctor said the proportion of these patients testing positive was increasing rapidly.
"I would estimate around 60% at this point."
These are not additional beds. They were created by shutting down other services. The Department of Medicine, which currently runs the Covid-19 services in the hospital, has added the 120 Covid-19 (or suspected Covid-19) beds to its existing beds (approximately 100). In other words, the department has doubled its workload.
"Additional capacity to absorb the expected number of Covid-19 patients will need to be created by collapsing other services to allocate beds and redeploy staff from surgical and other disciplines," a doctor told GroundUp.
Doubling every five days
Another doctor told the publication the number of Covid-19 patients was doubling about every five days. He said a "surge of cases" was expected in the next few weeks and "a transparent and feasible plan" to develop more capacity in the healthcare system was urgent.
"This requires beds, oxygen, and importantly, staff, plus a triage system that can identify patients requiring hospital versus lower levels of care. The public could volunteer and be trained to support lower care Covid-19 facilities."
Some doctors and nurses working hard, but others are not showing up
One doctor said nurses and doctors were working 12-hour shifts. Several doctors have tested positive, all with mild symptoms so far, and a larger number of other staff, including nurses and porters. Burnout is "starting to creep in" but there are a number of support services in place.
But some doctors and nurses are apparently not showing up for work or reluctant to work with Covid-19 patients. In a message to doctors, a senior hospital manager pleaded with them to make themselves available.
"My reason for writing to you tonight is to make a plea for your assistance and to request you to dig deep in asking yourselves why you became doctors in the first place. Each and every one of us now need to be truthful to our oath and to our profession.
"Some staff have volunteered to work in these wards; some have been told to work without any choice and then there are many who have not come to the fore as yet."
What about non-Covid-19 patients?
When we asked a doctor if the number of non-Covid-19 patients had declined, he said it was difficult to estimate because for some patients with respiratory illnesses, which increase at this time of the year, it was not known if they have Covid-19 until their tests came back, which could take days.
"There are still between 15 to 20 direct non-Covid medical admissions a day, which is maybe slightly lower than the usual numbers," the doctor added.
"We have seen data from the province showing that HIV and TB services have been affected with fewer antiretroviral treatment initiations and TB diagnoses in April compared to previous months.
"As primary care is diverted to dealing with Covid-19, there will be fewer referrals to hospitals for other conditions, although on the other hand, there may be a higher risk for underlying chronic conditions to deteriorate and more patients will require hospital care."
Oxygen is key
While there are no approved drugs in South Africa to treat Covid-19 yet, one factor makes a difference: getting oxygen to sick people.
One doctor explained the majority of patients would either be on no oxygen or on low-flow oxygen via nasal prongs or a face mask.
"A sub-group of patients with respiratory failure require much higher concentrations of oxygen that can only be achieved by specialised high-flow nasal cannula devices or mechanical ventilation.
"Because the outcomes with invasive mechanical ventilation [intubation] are so poor, we are supporting patients with non-invasive methods for as long as we can, and only intubate when these strategies fail.
"All patients admitted to intensive care will be intubated and mechanically ventilated. We have a very limited number of 'high care' beds and high-flow oxygen devices, and this is rapidly becoming a limited resource in itself as we see many more patients with severe Covid."
The hospital currently has enough oxygen for non-ventilated patients. But ultimately this too is a limited resource. Oxygen is supplied to the hospital via a liquid oxygen tank. And the limiting factor is its flow rate.
Meanwhile, Mitchells Plain Hospital has reached its capacity. And News24 reported that Tygerberg Hospital's intensive care unit for Covid-19 patients is full. Groote Schuur is expected to start receiving many more patients from Mitchells Plain over the weekend, and one of the doctors told GroundUp the hospital would struggle to cope.
'One integrated response'
In a statement on Thursday, however Premier Alan Winde said the province's capacity should be looked at as one integrated single response system, taking into account all available beds.
He said there were 1 428 additional intermediate care beds will be provided by temporary "field hospitals" in the Western Cape, which includes: - 850 additional beds provided for at the CTICC temporary hospital facility; 330 beds at the Brackengate temporary hospital facility; 68 beds at the Khayelitsha Thusong Centre; 150 beds at the Cape Winelands Sonstraal Hospital; 30 additional beds at the Tygerberg Hospital.
Also, 2162 acute beds will be provided by existing public sector capacity including 658 additional beds through expansion.
"We are also looking to make 550 critical care (ICU and High Care) beds available at the peak, including 150 beds that already exist in public health facilities, 100 additional beds to be added in the public sector (but additional resources are needed for these), and the purchase of 300 beds from the private sector for patients from the public sector.
"This means that we have a potential total of 850 ICU beds available in the Western Cape."
'Will still fall short of ICU beds at peak'
He confirmed however that even in the best case scenario, the province will still fall short of ICU beds at its peak.
"I must also make clear - while we have sufficient capacity at this time to meet our current critical care needs, as we have indicated before, even in the best-case scenario, we will still fall short of ICU beds.
"This is why it is so vitally important that we focus on protecting the most vulnerable," he said, adding that about 90% of people will not require hospitalisation.
The province therefore will be streamlining its testing and contact tracing to focus on high risk groups such as health workers and vulnerable people.
They would also be re-purposing community screening and testing programme to focus on high risk groups - those at risk of becoming seriously ill, the elderly and those with underlying conditions.
He said citizens could help by changing behaviour.
"We need the help of every single person. We simply can't do this alone. You need to keep yourself safe. When you do this, you interrupt the chain of transmission and slow the virus."
*This story has been updated to include comment from Premier Alan Winde.