COVID-19: George Hospital gears up for expected surge in cases

The national lockdown has bought the country some time to get health facilities ready for COVID-19. In a matter of months health facilities and healthcare workers had to put in place new infection control measures and prepare for the anticipated surge in cases.

Professor Shabir Madhi, an infectious disease expert at Wits University, says the lockdown was important because health facilities were not ready. But, speaking on a Daily Maverick webinar over the weekend, he also stresses that only so much can be done and health systems cannot be built in three to five weeks.

George Hospital is no exception.

At George Hospital, a 266-bed, level two hospital that services the Garden Route area, management and health authorities have been putting heads together to prepare for COVID-19.

By Friday the Western Cape had the highest tally of both confirmed COVID-19 infections and deaths of all South Africa’s nine provinces – 4 584 and 87. The vast majority of the province’s cases are however more than 400 kilometres down the N2 from George in the Cape Town area.

By Friday, the Garden Route district had 64 confirmed COVID-19 cases. While this is low compared to Cape Town, numbers are expected to rise all over the province and hospitals are in a race against time to ready itself for screening, testing and treating infected patients.

Getting ready for the surge

George Hospital is the referral hospital for all health facilities in the Garden Route and Central Karoo districts – which includes the District Hospitals of Knysna, Mossel Bay, Riversdale, Ladismith, and Oudtshoorn. Level two hospitals such as George Hospital typically provide specialists’ services like occupational therapy, oncology and chemotherapy, ophthalmology, orthopaedics and orthopaedic aftercare, and pacemaker testing.

Nadia Ferreira, Principal Communications Officer for Garden Route and Central Karoo Districts, told Spotlight they have not yet had to admit a COVID-19 positive case at George Hospital, but that they have been doing vigorous screening and testing.

Ferreira said the hospital has designed and custom-built a complete Virus Testing Unit (VTU) in record time and that a building on the hospital grounds was transformed into a Testing and Triage Centre.

Ferreira said similar facilities are already operational at Tygerberg, Paarl and Khayelitsha hospitals. The VTU at George hospital is one of 17 such facilities planned for the province.

“These facilities have been designed to relieve the pressure on emergency services, and allow for patients to be tested, assessed and assisted separately from the other services,” Ferreira said.

“Designed with social distancing in mind, the unit has been set up so that symptomatic and asymptomatic patients are seated in separate areas as they are being assisted.”
The VTU enables the hospital to test and screen everyone that enters the hospital premises for COVID-19.

Anyone who visits George Hospital has to enter through the VTU and must be screened upon entry and where necessary, swab samples will be taken and send for testing.

Ferreira said all other entrances to the hospital have been closed to allow everyone coming into the hospital to go through the VTU.

George Hospital CEO Michael Vonk points out that architects and other experts were called in to help.

“A mechanical engineer designed the ventilation system which is important to keep the public and staff safe,” he said. “Most of the building work was done by the hospital workshop staff with the support of an electrician and plumber. It was quite a challenge to obtain materials during lockdown.” Vonk said a tent will be erected to add waiting space at the hospital. Two six-seater golf carts are used to transport patients, where needed, from the Testing and Triage to the emergency centre.

Vonk explained screening at the VTU is a quick process. “The person’s temperature is checked with an infra-red thermometer and a few quick questions are asked. If the person meets certain criteria, swab samples will be taken for testing.”
The hospital has its own National Health Laboratory Service (NHLS) lab, but all COVID-19 swabs are sent to laboratories in Cape Town for testing. As Spotlight and others have reported, turnaround times for getting test results back can however be a problem.

Premier of the Western Cape, Alan Winde, said in a statement last week that in the last two weeks the province more than doubled the total number of tests conducted as part of a targeted testing strategy aimed at identifying pockets of infection.

Business unusual

George Hospital, like most facilities across the province, have restructured their service package as of end May.
The hospital has diverted all resources to essential and emergency services, resulting in all none-urgent surgery for gallbladder removal, cataract, elective removal of tonsils, elective knee replacement, hysterectomy among other elective surgeries being cancelled for the time-being.
All outpatient department visits have been rescheduled for a later date except high-risk antenatal clinic visits, dialysis treatment and emergency cancer treatment.

The hospital also rescheduled all day-theatre cases, and some planned surgeries. Surgeries that need to be performed within three months will go ahead. Anything from cataract surgery to gallstone removal with health consequences to the patient will proceed.
Despite having to restructure their service package, the hospital is working around the clock to ensure that though more focus is being given to COVID-19 patients, the health of other patients is not compromised.

Ferreira said restructuring of their services has implications. “Notwithstanding the inconvenience and impact on patients, with restructuring comes the mental burden on staff as it is a massive change which is most often accompanied by anxiety. It is therefore important that each person take responsibility for their own health, especially chronic lifestyle diseases. On a positive note, we’ve had fewer trauma cases. It is important for the public to remember that we are still there to render a service for trauma cases such as heart attacks among other health issues,” she said.

Hospital capacity

The hospital has two separate isolation wards for COVID-19 patients where they are treated by staff assigned to only those specific wards.
“The current capacity is adequate for the current need,” Ferreira said referring to bed capacity. “Bed numbers will constantly change in line with need. We have admitted no COVID-19 patients to date,” she said.
“One COVID-19 ward is an intensive care ward, and one a general ward and has capacity for maternity patients. We have adequate staffing at present to treat all patients at George Hospital with 750 medical staff,” Ferreira said. She noted, as with many facilities, they had to change their service structure to plan and prepare for the anticipated influx of COVID-19 patients.

“We also had limited stock of Personal Protective Equipment which is [also]globally the case. Staff are naturally also concerned about the well-being of their families at home. Good communication within the facility has been a very high priority. We streamline communications and keep staff informed,” she explained.
Ferreira said the hospital is also in regular contact with the private sector, working closely with Mediclinic through regular video conference meetings to understand their planning. The hospital is also part of an integrated health cluster which includes all aspects of health.

Vonk was full of praise for the staff at the hospital. “Staff at George Hospital see this (pandemic) as their opportunity to really respond to their calling and commitment to the community. We have been working hard to prepare for the influx of COVID-19 patients as best as we can. We have been encouraged and even inspired by many people and organisations who want to assist us at this time, making available resources,” Vonk said.

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