First published in GroundUp.

For Cape Town ambulance paramedics Claire and Mike (not their real names), the second wave of Covid-19 pandemic has been relentless. Suspected Covid-19 patients have replaced victims of gun-shots, stabbings and car accidents and each day is grimly the same.

“Everyone we transport nowadays is a PUI (person under investigation); we have to assume they have Covid-19,” says Claire as she wipes down the interior of the ambulance. It’s just after 9pm, and she and her colleague Mike have just delivered an elderly woman to the emergency room of a Cape Town private hospital. “Each shift we make six or seven calls, and recently 90% of these are suspected Covid-19 cases.”

Many more of their callouts in this wave have been for younger people, than in the first wave of infections that peaked in July.

These days, the ambulance crew must spend about an hour cleaning their vehicle after handing over a patient to a hospital. Every surface and each item in the back of the ambulance is scrubbed to prevent transmission of the virus. “We don’t want to give it to someone who hasn’t got it,” says Claire.

“This virus has totally changed the way that we work,” says Claire, “We can’t just rush in like we used to. Now, we have to evaluate the situation carefully, and put on all of our PPE (personal protective equipment)  before we can attend to a patient.”

She says patients’ family members are sometimes frustrated by the extra precautions that the paramedics use and do not always understand why they have to take the time to don the PPE before they can assess or treat a patient. But the paramedics cannot afford to take any risks.

Before the pandemic, says Claire, “when we would come across a patient with blood oxygen saturation stats at 58, we’d know that they’d be dead within five minutes without urgent care” says Claire. A healthy person’s blood oxygen saturation levels fall between 94 and 100. Below this level, a person is considered hypoxic. But with the spread of Covid-19, the paramedics regularly encounter ‘happy hypoxics’ who seem alert and will chat away happily while technically starved of oxygen. Claire tells GroundUp that these patients generally respond well to oxygen, and their blood saturation usually improves once the paramedics start administering oxygen, though they still remain in serious condition while under the paramedics’ care. Mike says a couple of weeks ago, he and a colleague attended to a patient whose blood oxygen levels were 25, and who was still talking normally.

Trauma call-outs all-but stopped under level 5 lockdown, says Mike. Then, as restrictions were eased, the paramedics received more callouts to respond to gun-shots, stabbings, and car accidents. With the return of level 3 restrictions, trauma cases have effectively vanished, replaced by a steady stream of Covid-19 related medical emergencies.

Both speak of “Covid fatigue”, in particular as it relates to the types of callouts they face every shift. Pre-Covid, a key element of their job would be the unexpected, now most callouts are grimly similar. Neither could have imagined that their job would come to be like this. “If this is what it’s going to be like, I’m starting to think I should have studied for a B.Com. instead,” jokes Mike.

Claire says she can see the effect of the pandemic on hospital staff as wards are over-run with Covid-19 cases. “Everyone’s on edge, there’s tension in the air. Still, everyone in the healthcare system is doing their absolute best to help with the influx of Covid-19 patients.”

Claire and Mike haven’t heard anything concrete about when or how they will receive vaccinations. As frontline healthcare workers they fall in the priority group announced by the health minister, but they have both taken note that there aren’t enough doses of the first round of vaccines to cover all frontline health workers.

They have praise for the way that their employers have handled the pandemic. They say that they are always kept up-to-date on the latest developments, that they have always had enough PPE, that their PPE provisions have kept up with the latest recommended standards, and that the length of their shifts — 12-hours — has not been affected by the demands of the pandemic. They say that everyone is learning new things about this disease every day, and they share everything with their colleagues.

Despite the routine and the relentlessness, both Claire and Mike speak of their job with pride. “The one good thing about this pandemic is that it’s really shone a light on all essential workers — not just health workers. I’m glad to see people realising how important these people are to their lives,” says Claire. “We don’t do this for the money or recognition — we do it to help people. I do not see it as just a job. It is my passion.”

Claire caught Covid-19 in the first wave of infections. With careful distancing and containment, she kept her family from being infected too. She recalls that as word of her sickness spread around her community, her family received many offers of help.

Mike has not caught Covid-19 as far as he knows, “Each time I return home from work, I wonder if today I might be giving my wife and two kids the virus — it’s a worry,” he tells GroundUp. DM