Acting Health DG Dr Anban Pillay

The two-week extension of the national lockdown in South Africa announced last week has given government two more months to prepare the health system for the expected peak in coronavirus cases in the country. According to a presentation delivered virtually to Parliament’s Portfolio Committee on Health by acting director general of health Dr Anban Pillay shortly after the announcement of the extended lockdown, South Africa will now reach its peak in September instead of July as initially predicted, giving government time to address the current dire shortages of hospital beds, ventilators and personal protective equipment and allow for intensive training of health workers in the management and treatment of patients.

The presentation titled COVID-19 Public Health Response is available on: https://sacoronavirus.co.za/2020/04/11/covid-19-public-health-response/

Based on statistics prepared by Prof Tulio de Oliveira of the KwaZulu-Natal Research Innovation & Sequencing Platform (KRISP), the presentation gives an indication of the country’s current readiness and what will be needed in the event of a worst-case scenario, which could see more than 50% of the population contracting the virus.

It includes projections on the number of cases that can be expected in the worst-case scenario, the total number of general and ICU beds and ventilators that will be needed compared to the number of beds and ventilators currently available in the private and public sector in all nine provinces. It also details the number of healthcare professionals including doctors and nurses available in the public health sector and gives estimates on the personal protective equipment (PPE) that is currently available to healthcare workers and how much will be needed and available when the number of infection peaks in the country.

Some of the projections in the presentation include:

  • Gauteng could see over 1.5 million infections by the end of the winter followed by KwaZulu-Natal in the worst-case scenario.
  • There is currently a total of 3216 ventilators available in the public and private sector. In the worst-case scenario 7000 will be needed.
  • A total of 4900 critical care hospital beds is available in the country which is enough for a best-case scenario in September but many more will be needed to reach the 14 700 that will be required should the highest estimated level of infections be reached. In addition, more than 78 000 general hospital beds would be needed in the event of a worst-case scenario.
  • The total number of healthcare workers including doctors and nurses available in the public sector now stands at around 197 000.
  • Only “severe to critical COVID-19 patients” will be treated at hospitals, while “mild to moderately infected patients” will be accommodated at field hospitals. Field hospitals will incorporate five essential functions:

  1. Isolation of COVID-19 patients from the community;
  2. Triage of patients into three prioritized
    categories to enable severe to critical COVID-19 patients to be separated and
    sent immediately to hospitals with intensive care units (ICU) and to isolate
    the mild to moderately infected patients into the field hospital;
  3. Provision of basic medical care including
    antiviral, antipyretic and antibiotic medication; oxygen supplementation and
    intravenous fluids; and mental health counselling;
  4. Frequent monitoring and rapid referral;
  5. Essential living and social engagement
    which includes shelter, accommodation, food, sanitation, and hygiene as well as
    spaces to eat together and socialise.