Shrikant Peters continues his series looking at the impact of COVID-19 on the country’s medical resources. In this piece, he examines the statistical models that point to a sharp increase in the number of infections nationwide, which will place heavy strain on the number of available hospital beds. He addresses the already high infection rates in the Western Cape and warns that the rest of the country is only a few weeks away from presenting similar figures.
For some time now there has been growing disquiet with the government’s perceived lack of transparency with regard to the COVID-19 data upon which its extensive lockdown strategy (and the massive repercussions for the economy) is based.
In the last few days, this statistical rationale has been discussed — controversially at times — by the consortium of university-linked demographers, health economists and statisticians who have been advising the national government.
Their predictions are grim to say the least. The statistical models they have produced are bounded, on the one hand, by pessimism (higher numbers of total infections with earlier peaks) and optimism on the other (lower numbers of total infections with later peaks).
Worryingly however, the optimistic scenario predicts almost 900 000 active symptomatic cases by the end of July. The pessimistic scenario predicts almost a million active symptomatic cases by the end of June. And in both instances, the models represent only 20% of the total infections, the majority being asymptomatic (but still infectious).
The statistical models estimate that 70 000 to 85 000 people will require admission to general hospital beds, just under the maximum of South Africa’s total hospital beds).
The number of deaths range between 40 000 and 45 000 by November 2020. The number of ICU beds required at the peak will be between 24 000 and 35 000. The problem is, we only have about 3 300 ICU beds currently. Even with this resource, mortality rates in ICU remain high: in some tertiary centres so far the mortality rate for intubated patients has been over 80%.
All of these models are based on projections, are subject to change and will be refined as new data is analysed on a week-to-week basis.
One region which has behaved unexpectedly is the Western Cape, which has seen an exponential growth in cases far sooner than initially predicted.
Much is being made of this difference in infection rate. One reaction has to ben to blame the province for being complicit in the high numbers that have been recorded. The political differences between provinces add another element to the blame game.
There are multiple factors which the scientific community have put forward as having caused this early take-off. Being a tourism hotspot, the Western Cape would have had a higher “dose” of first phase travel-associated cases among the more affluent sections of the population. This resulted in a larger “first peak” that then had more opportunities to cross over into the majority of the population before the lockdown measures were introduced.
Thereafter, there have been ‘super-spreader’ events that occurred in the province, with high infection rates in a handful of supermarkets, prisons, police stations and industrial factors. The provincial Department of Health’s efficient method of ringfence testing a large number of contacts around each hotspot cluster, added to the drastic increase in cases detected over time.
The trouble with this narrow view that the Western Cape did something wrong, results in the mistaken assumption that other regions of the country have been relatively spared from a catastrophic rise in infections. Instead, the situation in the Western Cape should serve as warning to the rest of the country of how easily the virus can spread.
How it all ends
Currently, ICU beds in the Western Cape are already at capacity, and further increases in severe infections are predicted. The cataclysmic scenes witnessed in New York and Italy spring to mind when reviewing the number of cases which will present over the coming month. But, to be sure, none of the statistical models envision the Western Cape’s prognosis to be any different to the rest of the country.
Despite the relatively slower growth in other parts of the country, other urban areas are only three weeks away from the situation in which the Western Cape now finds itself. Rural rural areas lag a bit farther behind, but also have far fewer resources to respond to dramatic increases in exposure and wide-scale infections.
Overwhelmed hospitals will require difficult triage decisions be made by doctors and nurses exhausted by the need to care for an ever-increasing number of patients. Outbreak clusters amongst healthcare workers themselves threatens to deactivate entire facilities, placing additional burden on the entire health system.
To counter this rapid increase in the number of hospitalized cases, the country will require the rapid training and capacitation of functional and adaptive clinical teams. Leadership and coordinated governance within our facilities will be sorely tested and is needed now more than ever before.