The Gauteng health department has prepared for the Covid-19 third wave by decommissioning the 1,000 bed Nasrec Field Hospital at the end of February – a move which has one of the country’s leading vaccinology experts perplexed.
The potential for a third wave of Covid-19 infections and the challenge in preparing healthcare facilities has become a constant source of concern for health departments across the country.
No one can say when the next resurgence will be, how long it will last, or where it will hit first.
The only constant in the virus’s pattern is change, which results in a tricky balancing act of bolstering responses while keeping an eye on wasteful expenditure, of which Gauteng has seen plenty in the past year.
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The department said the decision to close the Nasrec Field Hospital came as a result of 4,264 functional beds being added to the public healthcare system.
Empty beds are seen inside the Nasrec Field Hospital for Covid-19, 25 January 2021. Picture: Michel Bega
This prompted Gauteng health MEC Nomathemba Mokgethi to explain the province no longer needed to keep the facility open, as its closure “will not have a major impact in the treatment of Covid-19 patients”.
The field hospital admitted 1,658 patients since opening in April last year.
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All financial commitments, materials and equipment used in the field hospital will now be repurposed for use in other healthcare facilities.
A fever tent for patients at Tembisa Tertiary Hospital on the East Rand in Johannesburg. Picture: Nigel Sibanda
However, the permanent closure of the Nasrec site has raised some eyebrows, in part due to the uncertainty associated with the third wave.
Head of vaccinology at the University of the Witwatersrand and chief investigator of the Covid-19 variant 501Y.V2 Professor Shabir Madhi said dismantling the entire facility would be “short-sighted”, because no one is sure what the next wave will be like.
“If it’s about a temporary shutdown because too few people need it right now, that makes sense for financial benefits.”
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Gauteng health department spokesperson Motalatale Modiba confirmed to The Citizen the Nasrec field hospital had been permanently closed.
Madhi said two major factors were at play in providing challenges for the prediction of the third wave of infections.
The first is the mutation of the virus and antibodies associated with those who have been infected by SARS-CoV-2, or 501Y.V2.
“This is beyond anyone’s ability to plan for.”
What can be controlled, however, is mass gatherings of people.
A mass, community protest on Rondebult road in Boksburg. Picture: Neil McCartney
Largeer gatherings were allowed by President Cyril Ramaphosa last month. Up to 250 people are now permitted to gather outdoors, subject to mask wearing, sanitising, and social distancing.
Madhi said large gatherings over periods such as the upcoming long Easter weekend will likely see a “sharper resurgence much sooner” than if gatherings were kept small.
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“Mass gatherings should not be allowed. It is not sustainable. Herd immunity is not going to transpire in South Africa any time soon, even with the vaccine. And with variant resistance, much of the immunity is not going to protect the magnitude of people you want it to.
“Before mass gatherings are allowed, we need to ensure high-risk groups are vaccinated first,” Madhi noted.
But Gauteng does have a plan, said Modiba.
Gauteng’s plan comes in the form of the first phase of vaccine distribution to 215,000 healthcare workers, to bolster the healthcare system and prepare healthcare workers for phases two and three of the vaccine implementation plan.
Healthcare workers are given the jab of the first batch of Johnson & Johnson vaccine at Chris Hani Baragwanath Hospital in Soweto on 17 February 2021. Picture: Michel Bega
This is known as the Sisonke Programme.
“The phase we’re in now is actually preparing that team or cohort of people who will then be the ones who are actually leading the charge in ensuring that mass groups are vaccinated.
“At the moment, we are still in the implementation phase of the study, which means the vaccines in terms of the rollout of the public are not yet here, because we are waiting for the studies.
“With the Johnson & Johnson vaccine, it has been made available in terms of an early access implementation study so that while we’re waiting for the vaccines to arrive, the healthcare system can continue to be protected.
“By the time we get to phase two, healthcare workers will all have been vaccinated,” Modiba said.
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The J&J vaccine is yet to be licensed. This is likely why information regarding mass vaccination plans and accompanying administrative issues is lacking.
Madhi, however, feels provinces need to lay out their plans how they plan to vaccinate such large numbers of the population “before the vaccine even arrives.”
Groups of people must be registered and allocated provisional dates already, despite South Africa and other countries waiting for the J&J vaccine to be licensed, he said.
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