An open letter to the community

Dr Carron Zinman, Dr Anton Meyberg, Dr Andre Pieterse, Dr Sharon Goldburgh, Dr Zaheer Laher, Dr Ian Hunt

What’s readily apparent to the frontline physicians of the Netcare Linksfield Hospital is that the number of admissions related to COVID-19 have increased dramatically and both the Covid high care/intensive care unit as well as the Covid general ward have a much higher number of patients than a mere three weeks ago. Hatzolah has also issued a warning about the surge in the number of cases in the community in the past week.

We have no way of knowing exactly how many people there are who are actually infected with the virus in South Africa. As of 13 June, there were 65 736 reported cases in South Africa, 9 897 in Gauteng. We do know that abut 10% to 20% of patients with SARS Co2 require admission. The National Institute for Communicable Diseases COVID-19 surveillance in selected hospitals (not all hospitals in South Africa submit their data to them) reported that on 13 June, there were 2 263 admitted patients of whom 329 were in intensive care, and 135 on mechanical ventilation.

As of 13 June, 1 423 people had lost their lives to COVID-19, with just more than 50% of the deaths being in the 50 to 69 age range. Looking at it in a different way, people between 50 and 59 have a 3.7% case fatality rate, people between 60 and 69 have a 8.9% case fatality rate, and people over the age of 65 have a 14.5% case fatality rate. So although the bulk of the deaths are in the 50 to 69 age range, it reflects the fact that the highest number of admissions occur in that age range, whereas one in seven people over the age of 70 have died, and about one in 11 people between 60 and 69 have died.

An additional compounding factor is the presence of comorbidities like hypertension, diabetes, obesity, chronic obstructive pulmonary disease, and so on. A simplified way of looking at this is that if you have a two or more comorbidities, you are twice as likely to die as someone with one comorbidity, and four times as likely to die as someone with no comorbidities.

This coronavirus is nothing like the coronaviruses we are used to dealing with. It has made its own rules, and has defined a new spectrum of disease which is multisystem and which has to be managed in a way contrary to all previous principles. It is a novel virus, which means that no one was immune and as such, it could run unchecked through the population.

This virus doesn’t discriminate. It affects men and women of all ages and across all population groups. There are definitely people with asymptomatic infections who inadvertently infect the people around them. It’s likely that individuals may be highly contagious 48 hours before they display symptoms. There is as yet uncertainty as to whether you can become re-infected. There is no cure, and no specific treatment for this virus.

The lockdown gave us time to learn to respect this virus, to learn what medical interventions are likely to be successful and which inadvertently caused harm, and it allowed the country’s healthcare system to prepare as best it could. We’ve watched and adhered to fluid and dynamic changes in protocol so as to protect the healthcare of workers, hospital support staff, and patients.

Gauteng is just starting to see a steepening rise of its curve, and estimates of when the peak will be reached vary from the end of July until September 2020. Ironically as the numbers rise and healthcare workers become more anxious, people seem to be behaving recklessly. Instead of being even more vigilant about wearing masks, maintaining social distance, and washing/sanitising their hands, they are showing an alarming tendency to make their own rules. People are frustrated by the restrictions imposed by the rules of lockdown and instead of behaving correctly, they are having their hair and/or nails done, dinner parties and play dates, and are getting together with their families, among other things.

The healthcare system is already stretched, and it’s only going to get worse. There is no doubt that irresponsible behaviour will result in even more infections in our community than there are now. We sincerely believe the Covid wards will fill up further, and we will have to take over some of the non Covid wards. A time is coming where beds will not be as readily available, personal protective equipment will be more difficult to acquire, and healthcare workers will be burnt out. It’s an exhausting way to practice medicine for nurses, doctors, and allied health workers who have all uncomplainingly just waded in.

We, the Linksfield Hospital team, are doing our best to protect ourselves and the people around us. It’s imperative that the more vulnerable members of our community are protected to the best of our ability. It’s thus unbelievably frustrating and annoying to see the imprudent behaviour of members of the community who are ignoring the gravity of the situation and are conferring an unnecessary risk of becoming infected or infecting the people around them. 

COVID-19 can be very serious, and we desperately need to curb the spread of the SARS Co2. It can be done only by people respecting the guidelines (rules). We implore you to please behave responsibly by wearing a mask over your nose and mouth at all times when out in public (even when exercising), by maintaining proper social distance, by not going out unless it’s really necessary, by not allowing play dates, by not having dinner parties, by not taking off your mask during tea breaks and meetings, by sanitising commonly used surfaces, and so on.

There is only one way to halt the spread of the SARS Corona Virus 2, and that’s to stop providing it with a substrate to live and replicate in. Now is the time that you need to be most vigilant and careful to stop the transmission of this virus. While it’s true that most people will survive COVID-19, not everyone does.