Johannesburg - As South Africa braces itself for a potentially big coronavirus outbreak, doctors have become increasingly concerned for their own health as they see an influx of patients who fear they have contracted the disease.
The South African Medical Association (Sama) said it had been approached by concerned GPs who were unsure of how to protect themselves and their patients.
“The average GPs in our networks are extremely concerned because it is difficult to understand which patients can you allow into your rooms,” said Dr Angelique Coetzee, Sama chairperson.
“And we’re trying to come up with a guideline to see how we can advise them. You have to understand that at this stage there is no community detection yet.
“As the disease is contained and is yet to present itself in the community, the guideline is that patients can come into doctor’s rooms without wearing protective gear or screening.”
This would change as the country started to see its first cases of local transmission, which Sama believed could be within the next two to three weeks.
“Then, if you suspect a positive case, you as a GP need to at least wear a N95 face mask with gloves and see that patient in a different room, which can immediately afterwards be disinfected. So, it’s extremely difficult.
“We need to understand that the practices in rural areas or townships or informal settlements have a different behaviour pattern. Patients are walk-ins and that might cause a huge problem.
“How are we going to screen them and at what stage are you going to screen them? There’s no one with protective gear, so what are you are going to do?
GPs could not afford to close their practices.
“We only have so many GPs - and if I’m in contact with a positive person, there can’t be two rules. I’m saying to the person you are positive, now you and your family need to go into lockdown or self-quarantine for two weeks, but then I’m not adhering to that rule. As GPs, we cannot afford to close our surgeries for two to three weeks.”
Coetzee suggested that patients worried that they had become infected should not go to their doctor’s rooms.
“If we can get the message out there to the public, if you have a lower respiratory tract infection, please contact your doctor via Skype, via telephone, via social media. Please do not just come into surgeries unannounced, especially when there’s community involvement.”
FEAR
Johannesburg GP Vikash Makan told how he had seen an uptake in patients at his and his father’s surgery in Lenasia.
“A lot of people have been fearful. We have had plenty of patients who have come in with minor colds or other viral illnesses, but who are worried that it’s Covid-19,” said Makan.
“You can see the relief in their faces when we tell them that it’s unlikely that they have the virus.”
Makan’s surgery is well prepared to deal with the influx of patients as they had pre-planned well before the first case of Covid-19 was reported in the country.
“As doctors, we do feel vulnerable but we have implemented measures to essentially both protect us and our patients. Before the virus even hit South Africa we were preparing. We did put a protocol in place.
“Being two doctors at a practice, if something happened and we both get infected, we’ll be forced to close our practice, so we have got cleaning measures in place. If any of our patients are coughing we have masks at disposal for them to prevent any sort of spread.”
Makan said that South Africans should be concerned about the spread of the virus.
“This is just the start, the numbers will rise. If First World countries are battling to deal with the problem, and they’ve got much better infrastructure and health care resources, we are definitely going to battle.
“We have great doctors in the country, but we are resource depleted. We don’t have many ICU beds, we don’t have access to extra ventilators and things like that.”
As of Friday, there were 24 confirmed cases in the country, a week after the first coronavirus patient was reported. The National Institute for Communicable Diseases said the new cases were not linked to the original group of 10 people who had returned from Italy.
It added that there was no evidence to suggest Covid-19 was widely circulating in the community, but it was “highly likely that this could change”.
PRIVATE TESTING SURGES
Priya Patel, a GP in Joburg, also reported seeing an increase in patients over the past two weeks. All the tests have come back negative
“You do feel threatened. However, in my case where you’re an older GP with experience of dealing with previous situations like HIV or TB, or the Sars virus, you sort of go by your clinical acumen,” he said.
Jack Bloom, the DA's spokesperson on health in Gauteng, said an already overburdened health system might in the worst-case scenario force medical personnel to make difficult life and death decisions.
“If we get sudden spikes we could end up with the Italian situation where you decide not to treat elderly people, and you are making decisions on age and other factors,” he said.
He was referring to some cases in Lombardy where the gap between resources and the influx of patients had forced doctors to not incubate older patients, leaving them to die.
Bloom said hospitals around the country had a shortage of ICU beds and ventilators. He said elective surgeries would have to be delayed, as medical personnel tackled the coronavirus. Another concern is protecting health care professions from getting the virus, making sure they don’t burn out if there was a sudden increase in the number of cases.
The Washington Post reported that the Centre for Health Security at Johns Hopkins estimated that America had a 160 000 ventilators available.
Sibongiseni Delihlazo, the spokesperson for the Democratic Nursing Organisation of SA, said members were concerned that they didn’t have enough protective gear.
“We are concerned about the distribution of protective gear to clinics. We made calls to nursing facilities and it appears that some of the nurses are not happy because they don’t have everything they need.”
Across the globe, governments are either considering declaring states of emergency, or have declared them as the number of infections pass the 130000 mark.
Major sporting events have been cancelled, including the India versus South Africa One-Day International cricket series.
RANCH RESORT
On Friday, South Africa’s first large-scale quarantine facility went into lockdown as it awaited the arrival of more than 100 South Africans from Wuhan, in China. They will be taken to the Ranch Resort in Limpopo.
“The Ranch will not be operating as a regular hotel as of today, March 13. The hotel is in full lockdown for a period of at least 21 days and our fellow South African citizens will be arriving from China tomorrow, March 14,” the hotel’s general manager, Paul Shearer said.
This was after the hotel was approached by authorities for it to serve as a quarantine facility. It will be under the control of the military.
Dr Richard Friedland, Netcare chief executive, said across the group staff had been trained and gazebos had been set up at all its facilities to screen patients.
“We’re screening on a daily basis all our staff, all our doctors, nurses and contractors. We’ve been doing this since the first case was announced.
“We are going to be vaccinating staff against the flu virus because we don’t want people to be confused and we also want to reduce the infectivity level.
“That means more than 30 000 people in Netcare, 22 000 staff and we’re making sure cleaners, catering staff and security are vaccinated. That will further protect patients and visitors.”