With between 60-70% of South Africans expected to be infected with COVID-19, there is a dire need for the response of healthcare professionals to be coordinated and standardised to curb the chaos and panic that is threatening to overwhelm the country’s health system as thousands of people descend on health facilities and medical practices demanding to be tested. This was the message from health minister Dr Zweli Mkhize as he addressed members of the South African Medical Association last night. In a question and answer session hosted via a webinar, the Minister highlighted the direness of the global pandemic, the many uncertainties about the behaviour of the virus and the need for the medical fraternity in South Africa to cooperate to come up with solutions that will make it easier to deal with the challenges of COVID-19.
Opening the session, SAMA chair, Dr Angelique Coetzee stressed the vital importance of all doctors to work together and leave their silos behind to strengthen government’s efforts in fighting the pandemic from spreading. Pledging SAMA’s full support to government, Dr Coetzee urged doctors to stop venting and come up with workable ideas that are tailormade for the South African situation to change the course of the infection.
Likening the situation to an all-out war, Dr Mkhize said the time for talking about preparation is over.
“Whatever we were ready to do and what we were not ready to do, are not relevant anymore. We are now in a battle and we have to make do with whatever we have to fight together to ensure we win this fight,” Mkhize said. “We will only see an impact to stop the spread if we are all working together to say we do the same thing in the same way to everyone wherever we are,” he added, urging healthcare professionals to come up with solutions to address their challenges in a bid to improve their capacity to detect the infection and prevent transmission to themselves and between the patients they are caring for.
“This enemy is rapidly spreading and at the moment most cases are imported but it is now beginning to cross into the community where we are most vulnerable, so we need to mobilise forces to tackle this. We are in hard combat territory which means it is going to be hard for all of us but if we are focused and determined we are going to be able to make an impact,” he said.
Doctors inundated the minister with questions relating to the supply of personal protective gear (PPE) for health workers, what doctors should do after coming into contact with patients who need testing, screening protocols, problems at primary healthcare level to deal with the influx of people who are demanding to be tested and the need to change the HPCSA’s rules around virtual and telephonic consultations.
Here are some of the key points that came out of the discussion:
- In any community, the rate of infection is expected to be between 60% and 70% with about 20% of patients estimated to present with severe disease.
- The Department of Health is setting up an advisory committee to coordinate all efforts in testing, treating and managing patients. This will include discussions with clinicians from all disciplines, pathologists and laboratory services to draft protocols and approaches for testing, management and treatment.
- The country’s testing capabilities are to be scaled up. Since the beginning of the outbreak, more than 1200 people have been tested. According to Mkhize, government currently has the capacity to do 5000 tests per day. This will be increased to 15 000 by next week and 30 000 by the middle of next week. Government is also looking at options such as drive-by-testing to test larger numbers of people.
- The process to establish capacity in both the public and private sector is continuing with a team set up to determine the number and location of all practitioners, facilities and available beds in the country. Mkhize urged every member of the medical fraternity to share information about patients and the shortage of resources. He said in a number of cases that have tested positive in the private sector, doctors didn’t provide enough information on the patients which made it difficult to trace some of them.
- Although current guidelines only provide for testing when patients are symptomatic, there have been cases where tests on asymptomatic people who have returned from high-risk countries tested positive, while several cases who initially tested positive were found to be negative after verification.
- Every doctor in the private and public sector should be part of a network that share communication with the public through the distribution of leaflets and other information so that it can be distributed as widely as possible to the community to stop the fake news that is shared social media platforms.
- There is a shortage of supplies, particularly protective clothing because of the global need. Doctors need to come up with suggestions on how to use the available supplies judiciously and at which levels it should be used. In isolation wards, the whole PPE-kit including gowns, goggles, masks and gloves are required. In other areas, especially in crowded facilities, protocols are needed to establish how protective gear should be distributed.
- Doctors need to come up with solutions on how they can protect themselves against exposure so that they won’t have to self-isolate or be quarantined after contact.
- Government will be using NGOs to do so-called mop-up testing of people who have tested positively in the private sector and have recovered. Mkhize said some patients are reluctant to go back for testing in the private sector because of the costs involved.
- The tracing of contacts remains a challenge, but government has recruited 2000 tracers that are working on coordinating all efforts to ensure all contacts are traced.
“High-level of suspicion to frontline doctors and nurses and clinics and hospitals and the efficiency of contact tracing are imperative. If we can combine those two, we will increase the numbers of tests and we will be able follow the movement of the infection to ensure immediate intervention,” Dr Mkhize said.
For all updates and information on COVID-19 In South Africa, doctors are advised to go to: https://sacoronavirus.co.za/