Warning of system collapse in Livingstone Hospital as Covid rises
GLOBAL medical rescue organisation Doctors Without Borders has warned of a possible system collapse in Livingstone Hospital as Covid-19 case numbers continue to rise in the Eastern Cape's Nelson Mandela Bay Municipality, calling on the hospital's top brass to ensure that sufficient doctors and nurses are made available to staff the hospital's primary Covid-19 ward.
“The issue of senior leadership in Livingstone Hospital needs to be addressed urgently since it hampers life-saving progress. A permanent CEO needs to be appointed, and adequate staff should be rostered to work in the Covid-19 wards.
“A fourth Covid-19 wave is coming, and emergency preparations for this surge should be prioritised in all public hospitals as soon as possible.
Plans should be activated in between waves and not when admissions begin to rise,” said Brett Sandler, Doctors Without Borders (MSF) emergency co-ordinator.
The organisation has been supporting the Covid-19 ward since June on a sustained basis.
During the second and third wave of infections, the organisation's teams worked in Livingstone Hospital, specifically in the basement Covid-19 ward – a hospital car park turned into Covid-19 treatment centre. The 70-bed basement ward is equipped with piped oxygen, and when sufficiently staffed it is able to receive most of the hospital's Covid-19 cases.
However, two doctors made available to the ward by the provincial department of health (DoH) both left for posts elsewhere in July, leaving MSF doctors working at the peak of the third wave alongside an overstretched team of nurses, consultants, physiotherapists and nutritionists.
Admissions to the basement ward have been limited to less than 60% of capacity (30-40 beds) in order to ensure adequate patient care, given the “extreme staff” shortages.
“A team of MSF doctors and nurses will continue to support the basement ward in September, but this support has to be supplementary. It is not sustainable for the hospital to continue to rely on external support to the extent that it has. MSF acknowledges the rostering of DoH doctors for this ward from August 30 – this will go some way towards ensuring that more beds can be used in the basement ward, taking pressure off other parts of the hospital,” said Sandler.
Dr Rosie Burton, a senior MSF clinician, said: “Because all the beds in the basement ward cannot be used, patients are now backed up in the emergency department or referred to other wards, not all of which have optimal care for Covid-19 patients or access to high levels of oxygen, which is essential for patients severely ill with Covid-19 pneumonia.”
The current waiting time for a bed in the basement ward is between 24-72 hours.
“With Covid-19 you simply cannot play catch-up, and often deteriorating patients are getting to us too late,” said Burton.
The third wave of Covid-19 infections in Nelson Mandela Bay has been protracted.
Hospital admissions have continued rising for a longer period compared to previous waves. Most of the patients seen in the basement ward are critically ill and often include people in their 40s and even 30s, and with sometimes the admission of more than one member of the same family. Despite their best efforts, the MSF team reports that mortality rates in the basement ward have been high, said the organisation.
“In this wave of infections, patients we thought would make it simply have not. I don't think there is much more we can do, clinically. I think the bottom line is that when it comes to Covid-19 there is simply no magic bullet. The vaccine is the best tool we have,” Burton said.
The Eastern Cape health department did not respond to requests for comment by deadline.
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