Two big organisations operating in the Eastern Cape — as hospitals buckle under the weight of an increased patient load due to Covid-19 infections and an increased number of health workers falling ill or required to isolate themselves — this week highlighted the need for a rapid response to the human resources challenges brought about by the pandemic’s second wave.

While the latest outbreak of coronavirus infections in the Eastern Cape was isolated to Nelson Mandela Bay and the Sarah Baartman district (large parts of the Karoo, but also the towns of Kareedouw and popular holiday towns such as Jeffreys Bay) the latest epidemiological report for the province showed that between Wednesday 9 December and Thursday 10 December, 44% of new cases were from the Buffalo City Metro (East London), the Chris Hani district (including Komani, Cradock and Middelburg) and 17.7% from Alfred Nzo and the OR Tambo districts (in the former Transkei and Ciskei).

The provincial recovery rate stands at 89.6% and the case fatality rate at 2%. According to the epidemiological report, the number of Covid-19 related deaths has significantly increased in November and December.

The province has 9,519 active cases. Healthcare workers made up 6% of active cases; 153 healthcare workers have died since March.

“The second peak of the pandemic is more likely to exceed the first peak which occurred during the June-July period. The key risk factors are associated with the relaxation of the lockdown restrictions. These factors may include failure to use the non-pharmaceutical prevention strategies (wearing of masks, social distancing and hand washing or sanitation), mass gatherings (in funerals and memorials, parties, bashes with famous artists or DJs, etc.), and high mobility rates,” the report said.

To help the Nelson Mandela metro to cope with the projected influx of patients, Gift of the Givers is finalising a plan to pay the salaries of 26 paramedics to work at Livingstone Hospital and bolster the number of hands on deck, Dr Imtiaz Sooliman said on Thursday.

“When I asked for a list, there were only a few names,” he said. “Then I said okay. But I wanted to carry on with my plan. Then the word spread and every day there would be a phone call to say more and more paramedics are willing to come help,” Sooliman said.

He said the memorandum of understanding between the Eastern Cape Department of Health and Gift of the Givers was at an advanced stage.

“We will fund them to support current staff at Livingstone Hospital and the Nelson Mandela Bay Metro until the end of January, for now,” Sooliman said.

The pandemic could never be managed by the government alone, he said. 

“It requires the participation of all 60 million of us. Financial support, assistance with medical supplies, infrastructure upgrade and responsible behaviour is key.

Sooliman said he was receiving calls for assistance from everywhere in the Eastern Cape telling him that the hospitals were full, even though hospital managers and other senior personnel had been barred from providing numbers. 

“The casualty can’t cope. The queues are lengthening outside. We have to increase capacity. We have them sitting on chairs. We find many dead there. Funeral parlours, big and small, have never been this busy.” This, Sooliman said, came from conversations he had every day with healthcare workers.

Premier Oscar Mabuyane’s spokesperson, Mvusi Sicwetsha, said the premier was confident that the provincial health system would cope for the moment, but warned that it would not be able to withstand a rise in infections caused by large-scale irresponsible behaviour. 

He said there was a need for PPE, hand sanitiser, pulse oximeters, thermometers, scrubs and more beds, oxygen, high flow nasal oxygen machines, flow meters, oxygen gauges, splitters and oxygen masks — and even basics such as blankets and linen.

“It’s not a good place to be in for healthcare workers, but what strikes me immediately is the resilience, the inner strength, the commitment and the desire to serve, in spite of their own emotional and mental state. You witness the efforts to make it better in the face of all odds against them. You hear the compassion in the voices, witness the mercy in their souls, these are the healthcare workers on the frontline and the last line of defence between us and Covid-19.

“Our Gift of the Givers staff have witnessed CEOs and top management break down in tears, sobbing uncontrollably on receipt of the supplies.

He said they had delivered 120 extra beds to Bhisho Hospital with mattresses and 240 pillows and high flow nasal oxygen machines. “An infrastructure upgrade to provide accommodation for medical personnel is under consideration,” he said.

He said that in the past week, his team was completing a R750,000 upgrade to the Settlers Hospital in Makhanda — this would open on Tuesday, 15 December.

After sending a team of healthcare workers to help hospitals facing a Covid-19 crisis in the Eastern Cape, Médecins Sans Frontières (MSF), or Doctors Without Borders, is also urging the National Department of Health to improve its national emergency response capacity by ensuring that medical staff can be rapidly assigned to developing Covid-19 hotspots throughout the country, to fill critical staffing gaps.

According to MSF, the public health system in the Nelson Mandela Bay Metropolitan Municipality in the Eastern Cape was on the brink of collapse in November due to a catastrophic shortage of human resources unable to handle a surge in Covid-19 cases.

“Covid-19 is a fast-moving pandemic that is very human resource-intensive, whereas South Africa’s health system is bureaucratic and often hampered by staffing shortages. To save lives and provide essential care, a more agile way of responding to Covid-19 outbreaks is urgently needed,” medical coordinator for MSF in Port Elizabeth Dr Colin Pfaff said. 

The rapid assignment of doctors and nurses with Covid-19 experience was an effective way to prevent unnecessary deaths when a Covid-19 wave hit under-resourced areas, he said. 

“They need to be willing and able to immediately travel and rapidly integrate with existing facility medical teams, as the intense wave of infections will typically have passed in just a few weeks,” he added. 

A team of 20 MSF-employed doctors and nurses who were sent to Nelson Mandela Bay metro were rapidly integrated into Livingstone Hospital and the Rev Dr Elizabeth Mamisa Chabula-Nxiweni Field Hospital — a large Volkswagen manufacturing plant that has functioned as a Covid-19 field hospital since late June. 

“During the last week, there has been a reduction in the number of new Covid-19 cases registered in the Nelson Mandela Bay Metro and the situation in facilities has stabilised slightly, although promised human resources have been slow to materialise and the system remains deeply stressed,” Pfaff said.

“Meanwhile,” he said, “additional hotspots have emerged in parts of the Eastern and Western Cape provinces and MSF believes the likelihood of many more hotspots developing is high. With facilities across the country experiencing shortages of critical staff after a bruising first Covid-19 wave, a repeat of the Nelson Mandela Bay metro crisis in other parts of the country is a real risk.”

Eastern Cape Department of Health spokesperson Sizwe Kupelo insisted that six doctors had been appointed to assist at Livingstone Hospital.

He said from 27 November, 33 patients had been admitted to a ward with oxygen that had been converted from an underground parking garage as part of the province’s Covid-19 response. 

But hospital sources said there were only 20 beds that could be used in the basement, and the ward was mostly run by MSF.

Premier Oscar Mabuyane’s spokesperson, Mvusi Sicwetsha, said the premier was confident that the provincial health system would cope for the moment, but warned that it would not be able to withstand a rise in infections caused by large-scale irresponsible behaviour. 

“He appreciates the contribution of the health workers in helping people recover from infection. He is concerned that the reckless behaviour of some of our people puts the lives of our health workers at huge risk. Our health system, like any health system in the world, will not cope with high numbers of people requiring hospitalisation. That is why we are encouraging people to do everything in their power to prevent the spread of infections so that they don’t need hospitalisation.” DM/MC

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