The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

Mendelson, Marc; Booyens, L; Boutall, Adam; Cairncross, Lydia; Calligaro, Greg; Dave, Joel A.; Dlamini, Sipho; Dyer, Silke; Eick, B; Fieggen, Karen; Frankenfeld, P; Hoare, Jacqueline; Hofmeyr, Ross; Joska, John A.; Joubert, Ivan; Krause, René; Kropman, Annemarie; Levin, Dion; Maughan, Deborah; Meintjes, Graeme; Muller, Elmi; Ntusi, Ntobeko; Papavarnavas, Nectarios; Patel, Bhavna; Peter, Jonny; Raubenheimer, Peter; Said-Hartley, Qonita; Singh, P; Wasserman, Sean; Hospital, Groote Schuur

doi:10.7196/samj.2020.v110i10.15215

Cited by 16 publications

(18 citation statements)

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“…During this period, each hospital admitted~15À20 COVID-19 positive patients per day. At the end of the study period, GSH had admitted 1342 patients with COVID-19, and had increased ICU bed capacity three-fold to 55 beds, admitting 25À30 ventilated patients to ICU per week during the peak (all HFNO being offered in repurposed medical wards) [16,17]; at TBH, 1016 patients with COVID-19 were admitted during the study period, ICU bed capacity had tripled to 45 beds, and~25 patients were admitted to ICU (both ventilated and for HFNO) per week during the peak (personal communication, Directorate of Health Impact Assessment, Western Cape Government: Health).…”

Section: Settingmentioning

confidence: 99%

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study

et al. 2020

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Background The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in s``ettings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. Methods We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. Findings The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (P a O2/FiO 2 ) was 68 (54–92) in 293 enroled patients. Of these, 137/293 (47%) of patients [P a O2/FiO 2 76 (63–93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3–9) in those successfully treated versus 2 (1–5) days in those who failed ( p <0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31–0.60), as was use of steroids (AHR 0.35, 95%CI 0.19–0.64). A ROX-6 score of ≥3.7 was 80% predictive of successful weaning whilst ROX-6 ≤ 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). Interpretation In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.

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Section: Settingmentioning

confidence: 99%

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study

et al. 2020

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“…The wardbased service eventually expanded to 11 wards, managed by 95 doctors from various disciplines. [6] The ICUs were designated 'COVID' or 'non-COVID' and reserved for patients requiring invasive mechanical ventilation (IMV). On 28 February 2020, the ICU consultants developed a plan to expand ICU resources.…”

Section: Managerial Response and The Planning Phasementioning

confidence: 99%

The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Michell

Joubert

Peters

et al. 2021

South Afr J Crit Care

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Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting. Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa. Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

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“…The pandemic overwhelmed parts of the already over-extended public health system as a result of the growing demand for testing, contact tracing, isolation and quarantine sites, hospital beds, healthcare providers, and supplies such as ventilators, oxygen and personal protective equipment. [4,5] According to a report released by the National Institute for Communicable Diseases (NICD), most COVID-19 admissions were reported from four provinces in SA. [6] Gauteng (n=60 397; 27.0%) had the highest number of admissions, followed by Western Cape (n=45 812; 20.5%), KwaZulu-Natal (n=43 690; 19.5%) and Eastern Cape (EC) (n=29 599; 13.2%).…”

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confidence: 99%

Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response

Phaswana‐Mafuya

Shisana

Jassat³

et al. 2021

S Afr Med J

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The mechanics of setting up a COVID-19 response: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 16 publications

References 0 publications

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study

The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response

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