The second wave of Covid-19 infections in South Africa should more accurately be referred to as a tsunami.
A new, more transmissible, variant means many more people are contracting the virus in this wave, at a more rapid rate, resulting in a major spike in hospitalisations and deaths.
As of Tuesday, 5 January 2021, the number of hospitalisations in the Western Cape alone exceeded 3,200, at least 1,200 more than during the peak of the first wave. As a result, our healthcare system has been under extreme pressure, and our healthcare workers are exhausted.
While many residents were taking a break from a difficult year, these workers didn’t get to relax or enjoy time with loved ones and family. They were fighting to save lives in the most difficult of circumstances.
We all owe them for their dedication and passion.
The Western Cape government has been taking a number of steps to ensure that there is available capacity to respond to this unprecedented challenge and to help relieve this pressure, both in terms of infrastructure enhancements and staff. In doing so, we have learnt from the first wave and adapted our plan, given the different circumstances in which the province has found itself subsequently.
One of the strategic decisions that we took after the first wave was to rather make beds available at existing hospitals, as opposed to rebuilding the Cape Town International Convention Centre (CTICC) facility – which in the end would need to be taken apart again and which has no lasting legacy for the people of the Western Cape.
Let me start with the reasoning behind not rebuilding the CTICC, and why it had to be closed in the first place.
From the start, the CTICC intermediate care facility was a temporary hospital and based on a contract with the convention centre, which was immediately available at short notice when required.
Because of lockdown regulations then, the CTICC could not operate at all, and we were graciously given the use of the facility without being charged rent. We then had to turn what was an empty space into a modern hospital in a matter of weeks.
This is expensive, especially if you consider it does not remain there permanently and it has to be taken apart again. Indeed, the CTICC needed to be handed back at the end of that contract, so that it could also function as a business – which was permitted through the relaxing of restrictions.
In our planning, we factored this in.
We had at around the same time opened the 338-bed Hospital of Hope at Brackengate. As part of our plans, this would remain our key field hospital available for a second surge, and its capacity was more or less the number of beds used at the CTICC during the peak of the first wave.
Our health department’s contingency planning also includes a scaling up of health capacity, should it be needed, as well as de-escalating certain healthcare services to make available additional capacity.
In considering these contingency plans, we had to think about whether building additional temporary field hospitals from scratch would be the right investment, especially when they would all need to be taken apart, with little benefit to the community in the future.
We also had to consider that hospitals are highly complex. They are not just beds. They require staffing, kitchens, cleaning, X-ray and ablution facilities, among others. It is therefore a major investment in infrastructure, and this also needed to be factored in. We also learnt during the first wave that having one major facility in one geographical location, like the metro, makes us less agile in assisting people in different regions.
Factoring in this, we took the decision to rather make available capacity at our existing hospitals, which already had the infrastructure, the management, the staff and were close to affected communities, instead of additional temporary field hospitals which would need to be broken down eventually.
The major benefit of this approach is that by enhancing infrastructure in existing hospitals, we are creating a positive legacy in our communities. These infrastructure enhancements can continue to be used beyond Covid-19.
Through this strategy of using beds already introduced during the first wave, such as Brackengate Hospital of Hope, adding new beds where possible, and repurposing existing ones, capacity is being brought online to cope with the second wave.
To summarise, we have provisioned for 685 intermediate Covid-19 care beds, which are broken down as follows:
- 336 beds at the Brackengate Hospital of Hope, which was opened towards the end of the first wave (21 July 2020) and kept open for a second wave;
- 200 beds at the Mitchells Plain Hospital of Hope, which became operational on 1 January 2021. The bed capacity is up from the originally planned 187. It is on the grounds of Lentegeur Hospital and includes repurposed beds and new beds, with new infrastructure enhancements to allow for high-flow nasal oxygen. It is run like a field hospital with a facility manager;
- 60 beds at the Freesia Ward at Lentegeur Hospital, refurbished with assistance of Gift of Givers and which was opened towards the end of the first wave;
- 30 beds at Ward 99 in Lentegeur Hospital. This was opened after the peak of the first wave and had very low occupancy. It was retained in preparation for a second wave; and
- 59 beds at the Sonstraal Hospital, which was prepared and opened after the first wave peak and which had low occupancy. These beds were retained in preparation for a second wave.
The Western Cape government has also made provision to make available a further 136 intermediate care beds, should the staff be available and the need arise. These would also be at existing facilities, such as Tygerberg Hospital.
In addition, 72 acute beds have been added to rural hospitals since March, as this was their main capacity requirement. The breakdown is as follows:
- 20 beds in Vredendal;
- 32 beds in Hermanus; and
- 20 beds in George.
We have also reactivated 216 acute beds across metro acute wards to be made available for the second wave.
It should also be noted that the Western Cape Department of Health runs its entire health capacity as a single platform, allowing for patients to be moved from busy hospitals to less busy hospitals, and therefore the response should be viewed as a single system.
To assist with this, EMS and the Department of Transport and Public Works taxi service have implemented a streamlined transport system to assist with interfacility transfers and rapid discharges in order to optimise capacity.
In addition, our data team has developed a dashboard where we can track available hospital bed capacity daily, which will be linked to available staffing and oxygen capacity in order to give us a full and detailed picture of our response.
In viewing these interventions, however, it is important to realise that a bed is of little use if there isn’t the equipment, oxygen and staff available to provide care.
Indeed, a healthcare worker is an essential support to every bed we bring online.
Since March, healthcare workers have taken a combined total of over 36,000 Covid-19-related leave days. When a healthcare worker tests positive and must isolate, we also typically have colleagues who are considered close contacts who will also need to quarantine.
During the first wave, we were able to make use of healthcare workers from other provinces (including at the CTICC) as our wave hit before other provinces, but this is not possible this time around, given the growth of cases being experienced at more or less the same time countrywide.
To respond to this challenge, we are currently in the process of recruiting over 1,300 nurses — with 44% of these coming from extensions of existing short-term contracts.
The remaining 56% will be recruited and appointed. While these processes are underway, we have also made an official request to the SANDF for military healthcare personnel to be made available to us.
Thus far, our recruitment drive has resulted in 565 applications, and we have now made 495 offers. The first 80 successful applications started on 4 January 2021.
In addition to our healthcare worker capacity, we have also taken a number of steps to ensure we have adequate oxygen for our facilities to use at our peak.
Given the major increase in hospitalisations, oxygen usage is significantly higher in the second wave. This has meant that the combined oxygen utilisation in the Western Cape, including both public and private hospitals, has reached 76.4 tons a day. This exceeds the capacity of Afrox in the Western Cape.
To ensure that we do not run out of oxygen, contingency plans were also put in place and the oxygen supply in the Western Cape has been increased to 95 tons per day. This includes five bulk oxygen tankers delivering oxygen this week. We are grateful for all those involved in addressing this challenge.
As we near our peak in the Western Cape, we must all remember that the most important weapon we have in our fight against Covid-19 is our own behaviour. We have to do everything possible to not get infected with Covid-19, and not to spread Covid-19 if we are infected.
If we all play our part, by wearing our masks, washing our hands, avoiding gatherings, as well as crowded and confined places, we will be able to save lives and we will be able to get the Western Cape moving forward again. This should be every person’s priority. DM