Infection rates drop, yet SA’s hospital horror intensifies, say experts

The third wave of the coronavirus pandemic seems to have reached its peak in most of SA, but the hospitalisation aftershock is catching many communities by surprise.

That’s because the flattening of the peak is always followed by the most recent infections turning into severe cases, with some requiring ICU and some also resulting in death.

Analysing the third wave in the country, Dr Francois Venter, Ezintsha director at Wits health sciences, said: “The worst thing comes two weeks later and people don’t realise that.”

He added: “We are still picking up the pieces. It’s been so severe and we are hitting the worst in some of the provinces now. We may be past the peak in many provinces, but the hospitalisations are still coming and we need to protect the health system.”

This is something of which the public should be aware, concurred Keith Cloete, head of health in the Western Cape, where daily infections are now only slightly behind those of Gauteng.

“There are more infections in the population, our services are much better at identifying infected individuals, and the health services are much more efficient in treating symptomatic patients and moving them to higher levels of care when needed,” said Prof Landon Myer of the University of Cape Town’s School of Public Health and Family Medicine.

“Our third wave looks like a flattening in the number of cases, but if you look at oxygen use there is still an increase, and if you look at hospitalisations and daily deaths, they’re also increasing,” he said.

He said this pattern, and the ratio of people in hospital or ICU to those who are infected, had not been much different across the three waves, but experts have also warned that direct comparisons are not easy because the definition of a wave’s inception has changed since the pandemic first struck.

The numbers alone, however, do paint a grim picture.

According to Discovery Health spokesperson Dr Ronald Whelan, the group registered 1,678 ICU admissions in the first wave, taken from June 24 to August 10 in 2020. In the second wave — December 10 2020 to January 30 2021 — that figure was much higher at 3,506. In this current wave, counting from June 16 to July 18, it has been 2,502.

Earlier in July, the National Institute for Communicable Diseases released predictions created by the SA Covid-19 Modelling Consortium.

“Nationally, total hospital admissions and deaths over the course of wave three are likely to be higher than in wave one, while deaths (in-hospital and total) may be comparable to or exceed the values seen in wave two,” the consortium said.

With wave three subsiding, but hospitalisations and deaths continuing, it is too soon to say if this has come to pass.

But according to some experts, those struck by severe disease and admitted to ICU were not an easy statistic to analyse in trying to figure out which wave was the worst.

According to Myer “it’s a slightly complex thing to estimate”, for a number of reasons.

First, there are only so many ICU beds available, and occupancy rates depend on “admissions policies (how clinicians admit patients to ICU) as well as turnover and deaths”.

In other words, as people improve or die, beds become available and “more new patients can enter”.

He added: “With that said, I would not be surprised if ICUs are more occupied in this wave.”

For associate professor Mary-Ann Davies, a public health specialist at the Centre for Infectious Disease Epidemiology and Research at the University of Cape Town, if wave comparisons were possible, that would only be at a much later stage.

“I think it is too early to say,” she said, “and we would need to do a formal analysis accounting for private and public sector admissions as ICU use is generally higher in the private sector. We will be looking in due course at comparing disease severity across the three waves.”

Prof Wolfgang Preiser, from the University of Stellenbosch, points out that stats are also skewed by the way they’re framed into categories.

“The ‘recovery rate’ is, in my humble opinion, misleading,” he said. “It is calculated as infected people who were diagnosed.” Yet there are those who “did not get tested and do not figure in any data sets”, but in the case of adverse outcomes, they will “contribute to the excess mortality that the SA Medical Research Council calculates”.

Also, he said, when someone is sick but does not die, they’re recorded as a recovery, but in fact “it does not mean someone’s health has been restored fully”. 

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