With typical South African dark humour, some people have renamed Johannesburg as ‘Wuhannesburg’ as Covid-19 spreads north from the Western Cape to Gauteng.
Wuhan is the Chinese city where Covid-19 first made itself known to the world.
By 8 July, it is likely that Gauteng, a province of 15 million people, will overtake the southern tip of the country as the centre of the crisis. Numbers here are now set to breach total infections of 70,000, and the epidemic has reached the point where almost everyone knows someone who has Covid-19.
Total official deaths are still low at 403, but doctors have told Daily Maverick that classification of deaths may mean the numbers are higher, as this Medical Research Council report revealed at the end of June.
And within the province, the Covid-19 centre in Johannesburg had a total of almost 32,000 cases by 7 July, with recoveries at about one in three. Both Soweto and the inner city are chalking up big numbers of infections, showing that the coronavirus has moved from suburb to township.
Over eight in 10 Gauteng residents rely on the public health system, and their first stop for treatment is the network of 104 clinics dotted across the city.
Now those clinics are teetering on the brink of collapse as the pressures of Covid-19 push them deeper into crisis.
A note from a clinic doctor reveals the extent of the emergency.
“(It’s) getting hectic here. Patients have to spend an hour on oxygen before (I’m) allowed to pick up a phone for transfers. Makes no sense. Most (patients) are puffing away with sats (oxygen saturation levels below 80% – normal is 95%). Then, one Covid ambulance in a district (can transport) one patient at a time. I don’t think we prepared ourselves enough for this. It’s bush medicine.”
‘Bush medicine’ defines very basic treatment and oxygen innovation being used at Johannesburg clinics as stocks run dangerously low at primary and tertiary (hospital) levels of the system.
Clinics close regularly as more and more healthcare workers get infected.
There are over 100 clinics in Johannesburg and on any day, a large number are closed. This adds considerable pressure on the system, and symptomatic patients often have nowhere to go.
As the government has developed a referral system, hospitals are turning away patients whom clerks insist must first go to clinics – which are frequently closed.
In Region F, for example, doctors told Daily Maverick that all clinics were closed earlier this week due to staff infections. Region F is the inner city and one of the infection hotspots in Gauteng.
“Six of the 13 clinics were closed, but from 8 July there will be a return to operations gradually as the status of the nurses tested becomes known,” said City of Johannesburg spokesperson Mlimandlela Ndamase.
It’s absolute chaos.
“The figures change almost daily as the clinics close for decontamination when positive cases are reported, and this is normally for a period of 12 to 24 hours. So the number of clinics closed changes almost every two to three days,” says Ndamase.
Lynne Wilkinson has long worked in primary healthcare clinics across the continent to prepare them for epidemics like HIV/AIDS, TB as well as Ebola.
Now working at UCT’s Centre for Infectious Disease, Epidemiology and Research, she is in touch with Johannesburg clinics.
“The central data system (linking clinics to hospitals so patients can be referred for available beds) is inaccurate so doctors can’t use it. You’ve got clinicians calling for beds. And hospitals are not answering,” she says.
It’s a story Daily Maverick has heard repeatedly this week – doctors and nurses spending hours on the phone in search of empty hospital beds.
While only a small number of Covid-19 patients require hospitalisation and oxygen, it’s usually urgent when they do need it.
Francois Venter, deputy director of the Reproductive Health Unit at Wits University, questions whether the lockdown healthcare system planning in Gauteng has worked.
“The bottom line is we are not prepared,” says Venter. On top of the pressure on beds, oxygen has run low or run out at many facilities. At the Nasrec quarantine, isolation and field hospital facility, planning was done without oxygen beds – a basic requirement for patients with Covid-19 who need hospitalisation and oxygen for an average of one or two days.”
Venter says that “testing is still a disaster” and this means that doctors wait between four to five days to get case results, meaning that they cannot transfer patients.
“Our health facilities are under pressure and we are trying to decongest hospitals through referrals and making use of quarantine/isolation sites for persons under investigation (PUIs), and Covid-19 cases that are stable enough to stay in isolation facilities,” says Kwara Kekana, spokesperson for Gauteng Health MEC Bandile Masuku.
By 11 June, Gauteng had 8,300 hospital beds available, but these are now full, according to reports like this one. In a briefing last month, the provincial government said it was planning for 1,575 more beds by the end of July, but the numbers suggest this will be insufficient. There is always stress on public sector hospital beds in Gauteng, but Covid-19 has turned the shortage into a crisis.
Health care service under huge stress
“The healthcare service is under huge stress,” says Dr Francesca Conradie, deputy director of the Clinical HIV Research Unit of Wits University.
“The steps put in place have been sound and the lockdown gave us time, but the system was still caught unawares,” she says, adding that “the situation is probably worse at lower level clinics”.
Conradie says that understaffing and undertraining of nurses and other healthcare workers is eating away at the system, with over 1,000 staffers testing positive as of last week. And if oxygen stocks at clinics run any lower, “there is a risk of death at the primary healthcare level”, says Wilkinson.
Covid-19 is an infectious beast of a virus and if healthcare workers are not properly trained to doff and don their PPE with great care, infection among staff could be the biggest vector for the spread, says Venter.
Asked if Gauteng had used the lockdown period to plan adequately, Kekana said: “The lockdown allowed us to prepare as much as it could. Additionally, it allowed not only Gauteng but the whole country to slow down the rate of infection.
“One of the most notable things was to strengthen cluster systems that are improving daily for the coordination of Covid cases, and setting up some much-needed infrastructure in some areas,” said Kekana. DM/MC