Virus vanguard: Cape Town learned painful lessons early on

Published 9:40 am Tuesday, July 28, 2020

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Associated Press
CAPE TOWN, South Africa (AP) — When Cape Town emerged as Africa’s first coronavirus hot spot, Dr. Abu Mowlana was surprised by the fear that broke out among his colleagues.
Morale was crashing among doctors and nurses at Tygerberg Hospital even as infections surged in May and June, recalled Mowlana, one of the senior doctors leading the COVID-19 response there. The staff at the city’s largest hospital soon was fighting two battles: one against their own fear and another against the new disease that was killing their patients.
“It’s scary for the public but it’s scary for all of us,” he said. “Everybody is scared. The critical-care physician. The guy in the wards. The guy cleaning. Everybody.”
By the end of June, when the virus was reaching its peak in Cape Town and the surrounding Western Cape province, the area had 62,481 of South Africa’s 151,209 total cases, more than 40 percent, according to government figures. And 1,859 of South Africa’s 2,657 total deaths at the time from COVID-19 were in the province.
Now, as the situation begins to ease in the continent’s southernmost tip and the focus shifts to South Africa’s most densely populated province, the doctors in Cape Town hope their experience can serve as a blueprint for the rest of their country, as well as Africa’s 1.3 billion people.
Gauteng province, home to Johannesburg, is now Africa’s worst-affected region. It officially overtook the Western Cape for total virus cases on July 8, and in just three weeks its caseload has more than doubled to over 160,000 of the country’s 450,000 confirmed infections.
John Nkengasong, director of the Africa Centers for Disease Control and Prevention, said last week that local transmission has begun in many countries, and once it is seeded in vulnerable communities such as slums, it “spreads like wildfire, which is what we’re seeing in South Africa now.”
For Tygerberg and other hospitals in Cape Town, however, there is a decrease in admissions for the first time in four months, and Mowlana has entertained a thought: “It’s felt like, yes, we have got this under control.”
That was not the case earlier this year, when sun-seeking tourists from Europe and North America brought the virus to Cape Town.
Mowlana distinctly remembers two of the first ICU patients in March were an Uber driver who had ferried tourists to and from the airport and a receptionist at a private hospital where out-of-towners were treated.
The most important lessons he and other doctors learned came through tragedy: The first six COVID-19 patients they put on ventilators died.
“It was tough,” Mowlana said. “People were dying. We didn’t know what to do. So we tried something else. If A didn’t work, we tried B.”
Fewer than than 30% of COVID-19 patients put on a ventilator at Tygerberg survived, he said.
Those early experiences were similar to what was happening in Italy, Spain and New York, where ventilators were thought to be the key to saving lives.
They later learned, through trial and error, as did doctors elsewhere, that high-flow oxygen given early through noninvasive masks and nasal tubes produced much better results.
Once they had high-flow oxygen, only four out of every 10 seriously ill patients went on ventilators.
In the meantime, workers at the hospital also were getting sick — 600 staff members contracted COVID-19 and four of them died.
Through July 15, the hospital treated 1,099 patients with the virus, and 310 died, Mowlana said.
It was a heavy burden for everyone who worked at Tygerberg, and there was no time to prepare the staff properly in terms of counseling, Mowlana said, calling it their biggest non-clinical mistake.
Tygerberg was near the breaking point with 30-40 seriously ill COVID-19 patients coming in every day at the start of July. Hospital officials feared they would be “overrun,” Mowlana said. The turnaround started, he said, when staff members who had been quarantined after falling sick were mentally ready to come back to work.
“Look after your staff,” Mowlana advised hospital administrators in places where the virus has yet to hit.
For another Cape Town doctor, learning lessons early was critical in saving lives.
A field hospital was opened in June in Khayelitsha, a poor township of nearly a half-million people on the city’s neglected outskirts. The residents are among South Africa’s most vulnerable — the poor, the elderly and those with preexisting health conditions
Dr. Celeste Jonker was the clinical manager of the facility, where a total of three doctors and eight nurses worked in around-the-clock shifts to care for as many as 55 patients at a time at the height of the outbreak. They kept going even when a storm ripped off part of the roof.
They had already learned about using oxygen, even with the less-technical breathing machines they had, as well as how blood-thinning drugs would reduce complications, Jonker said.
They also learned that turning patients onto their stomachs made a difference, even if the procedure was difficult with their limited staffing because it took several workers to safely turn a patient struggling to breathe, she said.
“We were able to pick up that this worked, this worked, this worked,” Jonker said.
Their motto was simple, she said: “Let’s put it all together in combination and pull our patients through.”
Although 28 people died in the field hospital, at least 138 survived the virus under her watch.

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