Blood shortage in COVID-19: A crisis within a crisis To the Editor: The coronavirus pandemic has had a devastating impact on healthcare resources in South Africa (SA) and the world at large. [1] Donor blood supplies are not exempt, with national blood banks reporting critical depletions. This is a chronic, multifaceted issue that SA has had to face long before the onset of the pandemic, as fewer than 1% of citizens are active blood donors. [2] Concerns had already been expressed by the South African National Blood Services (SANBS) prior to lockdown, as mentioned in early March 2020 by the SANBS chief marketing officer Silungile Mlambo, who stated that blood stocks were already declining. [3] This deficit has been further exacerbated by the implementation of strict lockdown measures, effectively cutting down daily blood collections by more than 60%. [4] Fortunately, a decrease in demand owing to cancellation of elective surgical procedures, a reduction in occurrence of trauma, and decreases in non-emergency medical treatment provided some compensation. However, compounding factors such as loss of crucial access to corporate blood drives at schools, universities and businesses [5] have upset the balance once more. At the time of writing (21 December 2020) the shortage of blood products was expected to have disastrous implications during the festive season, when incidences of trauma and travel-related accidents generally soar. Our country has a significantly high burden of trauma, [6] so it is of no surprise that this issue has reared its head yet again. The two providers of this essential service, SANBS (which caters for eight of the nine provinces) and the Western Cape Blood Service (WCBS), have both reported shortages of the O blood group, a type of blood that can be universally transfused to all blood groups. [2] At any given time, national blood banks are required to have a minimum blood supply for 5 days. [7] However, at the time of writing, the SANBS reported that its blood reserves were deemed to last the better part of 3.5 days, with a platelet reserve that was expected to last 0.4 days. [2] The healthcare system is almost bursting at the seams owing to the demanding pressures of resource allocation and record-breaking This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Loadshedding and healthcare: Salt in the wound?To the Editor: South Africa (SA)'s energy crisis is a longstanding problem. With no permanent solution in sight, the worsening power cuts continue to detrimentally impact the quality of public healthcare across the nation. [1,2] At present, the country is experiencing the highest numbers of loadshedding hours since its inceptionaveraging over 1 500 hours in 2022. [3] As the effects of the COVID-19 pandemic remain apparent, it is questionable whether we can handle another crisis.Currently, only 72 hospitals are exempt from loadshedding nationwide! [4] This is frightening, as state-run hospitals nationwide care for >80% of the population. [5] Of most concern is the impact on intensive care units, which utilise electronic machinery to keep patients alive. [5][6][7] Multiple technologies involved in critical care are unable to function without power, which leaves numerous healthcare workers forced to do these tasks manually. [6] In an already shortstaffed system, where there is only 1 doctor per 3 198 citizens, [8] this proves deadly. The pandemic saw the lives of over 1 300 SA healthcare professionals lost -replacements for whom have proven difficult to come by. [9] Loss of massive aid from technology, even for minutes, leaves opportunity for worker exhaustion and patient mismanagement.Another major blow affects surgical departments, where doctors have had to resort to torches during surgery. [10] Poor lighting in procedures is associated with a higher error rate and increased postoperative complications. [11] More importantly, the inability to carry out emergency procedures and scans causes untimely deaths and emotional trauma for all involved. [12] In less urgent instances, multiple procedures must be delayed or cancelled, resulting in an increase in the backlog -which was already an issue post-COVID. [13,14] Such circumstances lengthen hospital stay, which puts patients at risk of acquiring serious nosocomial infections. [15] The only 'solution' in place is that of backup generators, which also provide a challenge, as these are poorly maintained and prone to failure. [16] Moreover, the cost of diesel is proving difficult to maintain, since hospitals spend millions of rands to function when cuts occur. [17] It has been stated that other power sources are being investigated, as generators are not meant to be utilised for long periods. [18] The Health Professionals Council of SA has voiced a plea that all healthcare facilities be exempt from loadshedding, [19] but this has not yet occurred. [4] With no effective solution in sight, the morale of healthcare workers is on the decline. Aside from the lingering 'side-effects' of the COVID-19 pandemic, the exacerbation of power cuts brings an already dilapidated system to its knees. If not addressed, this problem is one that will further place patients' lives at risk, and doctors and nurses may not be able to work under such challenging conditions much longer.

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