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South Africa - Absent Patients Sound Alarm Bells for South African Doctor - “I worry that the problems outside of Covid will be much more severe than Covid itself.” - September 13, 2020

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  • South Africa - Absent Patients Sound Alarm Bells for South African Doctor - “I worry that the problems outside of Covid will be much more severe than Covid itself.” - September 13, 2020

    posted with permission

    h/t @jwgale

    Absent Patients Sound Alarm Bells for South African Doctor (1)
    2020-09-13 10:45:44.424 GMT

    By Janice Kew
    (Bloomberg) -- It’s 5:30 a.m. when Marthinus du Plessis
    wakes up and packs his second pair of scrubs before driving to
    work at a rural hospital in South Africa’s eastern KwaZulu-Natal
    province. He’s one of the doctors who processes patients coming
    in for Covid-19 tests and makes calls on admissions, and has to
    give himself extra time to layer on his boots, gown, mask and
    Before the outbreak reached South Africa, Du Plessis, 30,
    was specializing in tuberculosis and dealt almost daily with
    diabetes and hypertension. Now that the health system mainly
    focuses on the coronavirus, he’s deeply perturbed about the
    patients he hasn’t seen in months.
    South Africa responded quickly to keep the epidemic in
    check, imposing a lockdown in March to allow its health system
    to prepare. Discretionary procedures were canceled and a ban on
    alcohol sales meant that trauma wards received fewer patients
    than usual. That’s helped to keep the country’s hospitals from
    being overrun, even as confirmed cases surged to more than
    600,000, the most in Africa.
    Listen to Dr Du Plessis Talk About South Africa’s Multiple
    But the human cost is slowly becoming evident in the
    country that has the world’s largest HIV epidemic, 300,000
    people with tuberculosis and a range of other diseases. In the
    community of 350,000 that Du Plessis’s hospital serves -- named
    after Catherine Booth, the co-founder of the Salvation Army --
    one in four people have diabetes or hypertension.
    When the lockdown started, Catherine Booth’s nine doctors
    were instructed toadmit only the very ill. Five months later,
    the 170-bed tuberculosis facility was told by the local
    government that it would become a dedicated Covid-19 hospital.

    Patients Redirected

    Tuberculosis hospitals have isolation wards that can be
    adapted easily for Covid-19 patients, so it made sense. Still,
    the move resulted in most patients being directed to other
    hospitals that are at least an hour-and-a-half drive away, and
    widespread poverty meant that many people opted to go home
    The damage that’s done in the community will only become
    clear in a few months’ time, according to Du Plessis.
    “After a few months you realize that a lot of the familiar
    faces aren’t there anymore,” he said. “You make the assumption
    that a lot of these people passed away at home because they
    never made it to a hospital. To send sick people home to
    accommodate often asymptomatic Covid-19 patients makes no
    Near the peak of the epidemic in July, Du Plessis was
    getting about three diabetic ketoacidosis cases a day -- people
    who require intensive management because they’ve stayed away
    from regular treatment longer than they should have. Stabilizing
    these patients could take three to four hours, he said. At the
    same time, less than a handful of people died from Covid-19 in
    Catherine Booth.

    Excess Deaths

    South Africa recorded as many as 42,396 natural excess
    deaths from May to September, according to data from the South
    African Medical Research Council. That number includes both
    those who are likely to have died of the coronavirus without
    having been tested and people who died of other causes because
    they were unable to seek treatment.

    Besides having to switch focus, Du Plessis has also had to
    contend with an increased workload. South African doctors aren’t
    supposed to work more than 80 hours overtime a month and limit
    shifts to a maximum of 16 hours. In June, Du Plessis clocked 132
    hours overtime. Now he still works a 32-hour shift about once a
    A ban on visitors has meant that doctors are now forced to
    give patients emotional and psychological support, even though
    they’re not specifically trained to give counseling.
    “You become not just a doctor, but a life coach of sorts,”
    Du Plessis said. Peers at other, more urban hospitals who are
    seeing some of the worst cases “are really struggling,” he said.

    Asymptomatic Case

    In late July, three days after taking a weekly test, Du
    Plessis received the news that he had tested positive.
    “Even with protective gear, when you are repeatedly exposed
    to the same pathogen, you should assume at some point you will
    get it,” he said. An asymptomatic case, he was back at work 10
    days later.
    Today, the outbreak is slowing down across South Africa,
    with the number of new infections declining to around 1,000 a
    day, from more than 13,000 a month ago.
    Still, Du Plessis sees
    the fallout from the outbreak enduring for some time to come.
    “I worry that the problems outside of Covid will be much
    more severe than Covid itself,” he said.

    To contact the reporter on this story:
    Janice Kew in Johannesburg at
    To contact the editors responsible for this story:
    Eric Pfanner at
    Pauline Bax, Mike Cohen