sharon sanders
Editor-in-Chief & President
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
visor.
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
Epidemics
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
instead.
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
sense.”
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
week.
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 jkew4@bloomberg.net
To contact the editors responsible for this story:
Eric Pfanner at epfanner1@bloomberg.net
Pauline Bax, Mike Cohen
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
visor.
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
Epidemics
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
instead.
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
sense.”
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
week.
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 jkew4@bloomberg.net
To contact the editors responsible for this story:
Eric Pfanner at epfanner1@bloomberg.net
Pauline Bax, Mike Cohen