COVID-19 surges put us all at risk
Posted on 2 July 2021
Surges of COVID-19 cases in South Africa put Mediclinic hospitals, resources and staff under severe strain. Our nurses and doctors have one heartfelt plea: let’s all work together to limit the impact of this third wave of cases on our hospitals, nurses and doctors.
“People out there don’t see what we see. They haven’t seen the full effects of COVID-19, how it attacks the body, young people, parents. They haven’t seen all these people, lying in their beds, struggling to breathe.”
Felicity Zuke is a senior professional nurse in a COVID-19 isolation unit at Mediclinic Midstream. Since the first outbreak, more than a year ago, she has lost five of her own family, including her mother, to this disease.
“I had to tune in very quickly with what was happening in the unit. I didn’t have time to think, time to grieve. Dealing with the families of patients helped – the people who didn’t have a chance to hold a patient’s hand while they were dying. I didn’t have time to be in denial. I just had to get on with it.”
The COVID-19 pandemic challenges all of us. It also challenges you.
The initial rise in COVID-positive patients, in March 2020, was expected and steady. The second surge of cases, in the first few months of 2021, came far more suddenly, putting hospital systems under sharp and unanticipated strain. We are now facing the increasing impact of the third surge, which has been dramatic and far more significant in volume in Gauteng than the previous waves.
Waves of COVID-19 have tested Mediclinic’s operational capacity and taught us about our fundamental responsibility to offer expert care. While nurses and doctors grow exhausted and overwhelmed, hospitals have learned to optimise their stocks of personal protective equipment, medication, ventilators, oxygen, and other potentially life-saving equipment.
Surges put us all at risk, but they are also avoidable. Just over a year after our first exposure to the SARS-COV-2 virus, safety measures put in place to prevent and reduce the spread of the novel coronavirus are more crucial than ever, even now as we see the numbers increasing.
Ashley Mashasha, an enrolled nurse at Mediclinic Midstream, knows this only too well. Having tested COVID-positive during the first surge, she shares Felicity’s concerns. “We work 12-hour shifts, we look severe illness and death in the face every day. Then we go home and we hear about how some people are going to parties, leaving their masks at home, infecting innocent people without knowing it. Often others in the family – uncles and grandmothers – are more cautious. But their relatives are endangering them. Some don’t even make it to hospital in time. It’s reckless. It hurts.”
“With the first wave, there was this incremental increase,” says Dr Gerrit de Villiers, Chief Clinical Officer: Mediclinic Southern Africa. “We could plan, we could move equipment and PPE and medicines around, move people around, to manage those patients within our existing systems.”
Whereas Mediclinic hospitals housed an average of 20-30 positive patients each at the height of the initial peak in July 2020, those numbers rose suddenly to over a hundred over the January to March 2021 period in many hospitals.
That second surge severely challenged the hospitals’ best-laid plans. Now, we are experiencing a third surge, which is anticipated to be even more significant and our best laid out plans might result in a situation where our clinical staff will not be able to provide the highest level of care as we seek to care for the most people.
“The sheer volume of new patients, with huge numbers of patients arriving at many different hospitals, all at once. The incredible speed at which the numbers are increasing – this is really putting severe pressure on the whole system,” says Dr De Villiers. “There comes a point when the resources reach capacity.”
Should a hospital be overwhelmed by the number of patients requiring care and transfers are not possible, patients may have to be prioritised for treatment, based on recognised triage treatment guidelines. In practice, this may mean that certain levels of treatment (e.g. ICU or High Care), or certain equipment (e.g. ventilators or certain oxygen treatments) will not be available to all patients. “Our doctors and treatment teams will use their clinical judgment to allocate available resources (such as available beds, equipment etc.) to patients”, says Dr De Villiers, “These are not easy decisions for anyone to make. All effort is taken to discuss the options for dignified palliative care with the patient and their family if this is necessary.”
Caring for COVID-19 patients is a resource-intensive process. Many of the patients on ventilators, for example, will need to be turned onto their stomachs while sedated, in order to distribute oxygen more evenly throughout the lungs and improve overall oxygenation. That may sound like a simple enough procedure, but it takes six or seven healthcare workers, and it needs to happen multiple times a day, per patient.
The current third surge could be unpredictable, in both its nature and scope. But the prospect of more positive patients exhausts overloaded frontline staff, for whom a sudden spike in volumes means more manpower, and longer hours. All of that takes a toll.
“When a patient is gasping for air, they’re anxious and scared. They can feel their life being pulled out of them. We have to try to help. It is very hard when we can see someone still has a lot of life ahead of them – and then we watch them die.”
This third surge of COVID-19 cases promises to place similar pressure on hospital systems across the country. The good news: there is a lot we can do to mitigate this strain, if we work together.
COVID-19 challenges doctors to find new ways to treat a new disease. It challenges nurses, who must find the strength and resolve to fight, while exhausted, to ensure patients are given every opportunity to recover. It challenges the private sector of South Africa’s healthcare industry to work together with our colleagues in state health departments, and it challenges us all to find new solutions to unpredictable ethical problems with honesty and integrity.
A shared cause
Dr Rene Sim is the head of the Emergency Centre at Mediclinic Constantiaberg. She has been on the frontline of a global public health crisis since March 2020 and plays a major role in expediting patients through the hospital system to receive the best, most appropriate level of care.
If a hospital’s ICU can accommodate 20 patients, with another 20 in high care and 80 in a general COVID-19 isolation unit, this means new patients must first wait for space to become available. This is time they often don’t have, says Dr Sim.
“At the start of the year, there was a queue outside, it looked like something you’d see at a supermarket. Included were young people, brought in by family members, who had walked to their cars, and before they even reached our Emergency Centre, they had already passed away. That was very traumatic for all of us.”
The sheer weight of sky-high patient volumes puts hospital staff like Dr Sim in an unprecedented position. During the first wave, if patients presented with signs of a severe case of COVID-19, they would be referred to high care or ICU immediately. As numbers rise in subsequent surges, those patients must be assessed by physicians with new criteria in mind.
“It’s a very difficult discussion to have with families,” she says. “Because everyone wants their family to have the best care. Everyone wants their family to end up in ICU if it’s needed. But it doesn’t matter how much money you have. It doesn’t matter what option of the medical aid you’re on. At times there is just no capacity.”
Staff in this scenario must be ready to go to war for their patients. And it’s a challenge they are ready to rise to again, together. “What we noticed right from the onset of the second wave, was there was an incredible number of patients coming into hospital in comparison to what we had seen before,” says Dr Sean Rogers, a pulmonologist at Mediclinic Constantiaberg. “So we reached maximum capacity much quicker: two weeks, compared to two months the first time.”
Dr Gerrit de Villiers also expresses his concern around capacity, “What we don’t know is how this third wave will impact us, but initial indications are that it might be more severe, as we are already experiencing in Gauteng.”
Dr Rogers himself had developed a severe case of COVID-19, during the first peak, an experience he describes as “hellish”. But while the second surge strained resources, it only strengthened the team around him, he says. “One realises, after so many years of being a doctor, how very important nursing staff are. From the lowest level – whatever you call low in this hospital, there’s no low anymore – everyone is on par. From cleaners, from kitchen, laundry staff, everyone, it’s been an incredible team effort. It’s changed my view, it’s humbled me completely.”
Experience helps the staff, says Felicity. “Passion and empathy is embedded in me. Of course the risk of transmission is there, but if you protect yourself with the proper PPE and protocols you can keep yourself safe. I knew when I signed up for this profession that nursing needs to be a calling – otherwise you would run away.”
That training can also help you. Since March 2020 we have all been on a steep learning curve, adjusting to a new normal of everyday preventative measures – that are just as important as ever, a year later. Knowing how to keep yourself and your family safe can prevent further surges from spiraling out control, and putting thousands of lives at risk.
Believe in the process
Mediclinic staff are supported by teams of colleagues. Psychiatrists and psychologists, who facilitate interpersonal counselling sessions, and surgeons and anaesthetists, who show up in their free time to help out
Management teams play a crucial role. “When I tested positive a few months ago, I was asymptomatic, but self-isolated for 10 days,” remembers Ashley. The management team at Mediclinic was incredibly supportive and checked in with me often to see if there was anything I needed. I live with my father and his partner and neither of them got infected, so it worked. I really appreciated how much the management team cared for our wellbeing.”
Mediclinic staff are working long hours in sometimes unfamiliar roles. These are dedicated professionals fighting the effects of an unpredictable disease. In the face of all that, they are committed to providing expert, compassionate patient care.
“Wearing PPE does change your relationship with patients because you are covered by a mask, visor and gown and need to maintain a safe distance,” says Felicity. “But patient care is always the focus. You can always find time to talk to a patient who is scared or lonely.”
These frontline healthcare workers are making great sacrifices in order to provide high quality care when it is needed the most. And they have a favour to ask: stay vigilant against COVID-19. Keep your distance in public spaces. Don’t gather unnecessarily. Wash your hands, properly and often.
Wearing a mask costs nothing, says Felicity. Don’t get caught up in the noise of fake news, says Ashley.
The process works. Felicity remembers an elderly patient who was discharged after weeks in ICU. “Everything was against him but he seemed to have the will to survive. We are still in touch today.” These success stories should be celebrated, agrees Ashley. “When someone’s condition improves, it’s like a victory. It’s a thrilling moment to realise we have beaten the unknown.”
You can be a part of that success. Staying vigilant is our best weapon against COVID-19. Dropping our guard will only lead to further surges, more pressure on already strained resources. Ask any nurse or doctor and they likely say the same thing, says Dr Sim: believe in the process.
“We’re not asking a lot. Wash your hands, wear your mask, avoid crowds. It’s about caring about somebody else when you do that. It’s not even about protecting yourself. It’s about believing in your social responsibility and caring about the people around you.”