A COVID-19 Birds Eye View by Dr Peter Haug (part 2)
Posted on 16 July 2020
Birds Eye View
In the end all went well. My COVID manifestations can in retrospect be classified as only moderate, I expect to make a full recovery. Still, this good outcome was only made possible by the concerted effort of many individuals, organisations, and society as a whole. In a different environment the outcome of my simple viral infection could have been different. How a society manages its healthcare resources has a direct impact on hard fatality rates, as comparing statistics from the United States, Latin America, various European countries and conflict areas indicate.
I praise the measured actions of South Africa’s government. The immediate hard lockdown helped buying time to continuously improve testing strategies and treatment algorithms. I felt that the government tried to listen and implement scientific advice, avoiding populistic self-promoting statements for political gain which are so prevalent in other countries on this globe. I feel that the government communicated very well concerning public awareness about the impact of COVID disease, and implemented well measured instructions concerning protocols to return to work, including how and when to seek help.
I feel that South Africa is truly blessed by its high standards of academic institutions, including the training of doctors and nurses. I have contacts across the globe, enabling me to compare. The standard and tradition of medical training at South African universities, with the trickle-down effect to the private-sector, compares well with the best standards of the developed world. Continuous financial constraints enhance the creativity of South African society to seek efficient and cost-effective solutions. The last weeks were showing an increasing collaboration between public and private healthcare sectors in South Africa, which will likely benefit society as a whole.
Government and corporate institutions have shown the ability to swiftly adapt to challenges. This has happened through appointing task teams, facilitating lively discussion forums and swift implementation of resolutions. My first-hand experience is with the Mediclinic Group, but parallel processes appeared to have occurred across all hospital carriers, private and public. There is an almost endless list of drastic changes of bed and personnel allocation, structural changes, procurement of medication and personal protective equipment in the attempt to keep both patients and healthcare providers save. Having financial constraints, in addition to competing with other countries across the globe in the face of limited supply chains is challenging. It needs clear and decisive heads to decide when to pounce in reaction to emerging medical knowledge, and when to hold back. One pertinent recent example was whether it was imperative to procure dexamethasone, as opposed to the previous hype about Hydroxychloroquine.
The crisis is still unfolding and deepening. Public healthcare facilities in the Western Cape are presently overflowing, part of the reason being that many patients need to be kept quarantined due to an inability to safely self-isolate at home. The private sector only shortly trails behind. On my arrival my hospital had almost been filled to capacity with confirmed SARS-CoV 2 positive patients, in spite of the hospital having already drastically reduced avoidable and elective surgical admissions, with all implications on the income of other specialists. The allocation of intensive-care beds and ventilator usage needed to be judiciously monitored. Still, there was no impression of hysteria. Staff members appeared well-trained and disciplined, performing their allocated duties. This culture of discipline, adhering to agreed protocols at the same time of constantly striving to fine-tune and adapt more effective solutions for the benefit of individual patients and society as a whole will undoubtedly go great lengths of mitigating the devastating effects of this crisis, across all spheres of society. It is my perception that South Africa has so far managed extremely well compared to other countries of the world, and in this spirit will continue to do so.
Take home message
- When self-monitoring at home with severe COVID symptoms if possible consider obtaining a finger pulse oximeter and thermometer.
- Monitor your heart rate and fluid intake and seek additional medical input timeously. Receiving intravenous fluids or medication can improve your COVID-19 outcome and prevent complications.
- Be vigilant of the development of shortness of breath, particularly within the first week of having become symptomatic, if in doubt seek urgent medical advice, sooner rather than later.
- In patients requiring oxygen, medications suppressing inflammation and/or inhibiting the formation of clots can potentially prevent serious complications.
- Be aware of the potentially traumatic effects of isolation and anxiety.
- We will prevail.
Dr Peter Haug, Neurologist, Cape Town
21 June 2020