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Mkhize Shines Light on COVID-19 Case Management

July 3, 2020

Department of Health

The Ministerial Advisory Committee on COVID-19 will soon issue advisories on the use of high flow oxygen for patients who are very ill but can be managed without intubation and ventilation.

The health minister, Zweli Mkhize, revealed this in a statement on case management in the context of the South African Coronavirus COVID-19 surge.

The minister added that the “case management of COVID-19 has come into the spotlight as the numbers of active cases rises, putting our health care system to the test”.

Reference was made to the National Institute of Communicable Diseases’ (NICD) sentinel report completed on June 21.

“This report brings all these issues home and gives us a sense of the burden we have faced, how the system has coped and marries these lessons to the projections that have been modelled of the coming surge.”

The NICD reported 10 700 COVID-19 admissions from 269 facilities (71 public- sector and 198 private-sector) in all nine provinces of South Africa between March 5 and June 21, 2020.

Key findings include:

• The median age of COVID-19 admissions was 50 years; 338 (3%) admissions in patients ≤18 years and 1386 (13%) in >70 years. Fifty-four percent (5 778/10 700) were female.
• Among 8 245 (77%) patients with data on co-morbid conditions, 2 810 (34%) had one co-morbid condition and 3126 (37%) had two or more co-morbid conditions.
• Of the 5 836 patients who had a co-morbid condition, the most commonly reported were hypertension 3419 (59%) and diabetes 2813 (48%); and there were 1 116 (19%) patients admitted with HIV, 240 (4%) with active tuberculosis (TB) and 579 (10%) patients with previous history of tuberculosis.
• Obesity, while not consistently recorded for all reported COVID-19 admissions, was noted by clinicians as a risk factor in 297 (3%) patients.
• Of the 10 700 admissions, 3 260 (31%) patients were in hospital at the time of the report, 5 925 (55%) patients were discharged alive or transferred out, and 1 515 (14%) patients had died.
• Of the 7 324 COVID-19 patients who had recorded in-hospital outcomes (died and discharged), 1 515 died, equating to an in-hospital case fatality ratio (CFR) of 21%.
• Some of the factors associated with in-hospital mortality were older age groups; male sex; and having co-morbid hypertension, diabetes, chronic cardiac disease, chronic renal disease, malignancy, HIV and obesity.

According to the minister, recommendations such as frequent hand-washing, avoiding touching the face, cleaning of surfaces, social distancing and the wearing of face masks are “easy enough to follow for a few weeks, but they now need to become a new normal. We need to establish and keep new habits and inculcate them into our traditions, our customs and our working lives forever”.

The minister called on the public to partner with government in dealing with the challenges posed by COVID-19.

“We are riding into the storm, but, together, we will prevail.”