By Dr Sheri Fanaroff MBBCh FCFP MFamMed, a Family Physician, practicing in Melrose, Johannesburg. Fanaroff is a member of GGPC (Gauteng General Practitioners Collaboration) which has created a platform for doctors to share resources during Covid-19. Look for #voicesthatcare on the GGPC Facebook page

I’ve been asked by many during the last few days why I haven’t sent out my weekly “Covid-19 Update” in nearly 3 weeks, as I have done at least once weekly since the start of the Pandemic in March 2020. The truth is that I’m tired and I’m busy.

Let me give you a picture of what Johannesburg is like at the moment.

Because I think people going about their lives as normal, continuing to deny the severity of the epidemic by socializing, eating out and having play dates, and continuing to debate whether they actually need to complete their 10 days of quarantine after an exposure, must be lucky enough to have not yet had COVID come into their immediate circles.

COVID pandemic is growing in Gauteng

Gauteng has now surpassed the peak of the first and second waves and it looks like we are gaining momentum, rather than slowing down. While people follow the South African numbers, which “only” added 4000 to 6000 cases daily over the last few weeks and only recently picked up to more than 10 000 cases daily, there hasn’t been enough emphasis on the fact that 60% of these daily new cases have been in the geographically smallest province, Gauteng.

For the last two weeks, it has been increasingly difficult to find a hospital bed, both private or public, in Gauteng. Ambulances wait with sick patients in parking lots outside the hospitals, trying to get a space for the patient in the casualty. People struggling to breathe queue up outside casualty hoping to get in to get some oxygen. And these are people who have already been treated at home by their doctors, but have progressed past the point where home treatment can help them.

In my very small practice, I am currently managing dozens of patients at home who are infected with Covid-19. Some of these are in family groups, where everyone at home is sick. The strain of virus we are seeing is extremely contagious and jumping from one person to the next in a few days. Of these patients at home, several are on home oxygen, many are on strong medications like cortisone and anticoagulants, and some have needed hospital admission. (And for the record, some of these patients have been on Ivermectin, and equally, some have not).

Covid doctor

Photo by Magdiel Lagos on Unsplash

Still sick with COVID after one dose of the Pfizer Vaccine

Several of my current COVID patients have had one dose of Pfizer vaccine. Of these, two have COVID pneumonia, demonstrating that one vaccine dose three weeks ago is not yet effective. Three of my patients had had a Johnson and Johnson vaccine over a month ago, but have thankfully had relatively mild illness.

 

Shortage of Oxygen for COVID patients

This week for the first time, it has been a struggle to find enough oxygen for patients needing it at home. The major oxygen suppliers now have waiting lists. Most of the “hospital at home” management and nursing services are at capacity. I have spent hours on some days phoning around to hospitals begging for beds for patients who need, only to be told that there are no high care or ICU beds in Gauteng.

GPs are forced to manage patients at home who fit the criteria for hospital admission. We are told to send our patients via casualty where they will be “triaged” so that the most deserving / ones who need it most will get a bed. We don’t want to do this as we know our patients will spend hours in casualty and possibly be sent home. State hospitals are sending home patients with Oxygen levels in their 70’s.

Some of my GP colleagues are managing literally hundreds of patients at home on their own every day. These patients need close monitoring including of vital signs, blood tests and sometimes chest X-Rays in order to assess and administer the correct medication at the appropriate time. The Jewish community are privileged to have the aid of Hatzola who ease much of the burden for GPs, but who are currently swamped with over 500 patients to look after.

Every day we answer dozens of questions from people who have been exposed at school, at meetings, at lunches and at parties. Every day we send dozens of patients for tests, of which larger and larger percentages come back positive (22% positivity in SA yesterday). Every day I send out quarantine and isolation information and have to convince people that they still need to quarantine for ten days even if they have tested negative.

Essential guidelines

A reminder that you are not fully vaccinated until at least two weeks after your second Pfizer vaccine. There is no rush to have a second vaccine before 42 days and it is not a good idea to queue at crowded vaccine centres. Rather wait for your appointments. Even when fully vaccinated, there remains some risk of getting infected while the volumes of unvaccinated people remain high and the virus spreads rampantly.

You all know what to do.
• Avoid gatherings.
• Wear your masks (double mask if in a high risk place).
• Social distance
• Stay in ventilated spaces
• Wash and sanitise your hands
• Try to get a vaccine if you qualify (teachers very soon and hopefully over 50s to follow)

As busy and tired as I am, hospital doctors and nurses and facilities are much busier and more tired. So please take this seriously for the next few weeks and don’t add to the statistics.

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