Early trends of this 4th wave, since 15 November 2021, when admissions began to rise, indicate a far less severe form of COVID-19 and a probable decoupling of the rate of community transmission and the rate of hospital admissions.
Johannesburg, South Africa (08 December 2021) – Dr Richard Friedland, chief executive officer of Netcare, today said that after more than three weeks following the discovery of the new Omicron variant in South Africa, data across its hospitals and primary healthcare facilities is demonstrating important early trends for the 4th wave.
“Having personally seen many of our patients across our Gauteng hospitals, their symptoms are far milder than anything we experienced during the first three waves,” comments Dr Friedland.
“Approximately 90% of COVID-19 patients currently in our hospitals require no form of oxygen therapy and are considered incidental cases. While we fully recognise that it is still early days, if this trend continues, it would appear that with a few exceptions of those requiring tertiary care, the 4th wave can be adequately treated at a primary care level.”
Possible decoupling of the rate of community transmission and the rate of hospital admissions
During the first three waves, the rate of hospital admissions rose in tandem with the rate of community transmission (the number of people testing positive).
Dr Friedland noted that in the first three waves of the pandemic, Netcare treated 126 000 COVID-19 patients across its 49 acute hospitals, of which 55 000 (44%) patients required admission and 26% of these patients were treated in High Care and Intensive Care (ICU). Significantly, all COVID-19 patients admitted were sick and required some form of oxygen therapy. The high admission rate, as well as the high percentage of patients requiring ICU or High Care, is indicative of the severity of cases during the first three waves.
“As of today, we have 337 COVID-19 positive patients admitted (72% of these patients are in the Gauteng area and 18% in KwaZulu-Natal). Of these patients, approximately 10% (33 patients) are on some form of oxygenation versus 100% in the first three waves. Eight of these patients (2%) are being ventilated, and of these, two are primary trauma cases that are also COVID-19 positive.”
Netcare’s policy is to test all patients for COVID-19 before or on admission. Patients admitted for other primary diagnoses or surgical procedures who test positive for COVID-19 but do not require any form of oxygenation are considered to be incidental COVID-19 cases. Currently, 90% of COVID-19 cases now in Netcare hospitals are considered incidental.
“During the first three waves, when the overall community positivity rate breached 26% across South Africa, we were inundated with COVID-19 admissions to hospital. Within Netcare, we had over 2 000 COVID-19 patients in hospitals during the first wave, over 2 250 patients in hospital during the second wave and over 3 000 patients in hospital during the third wave. At present the 337 patients represent a fraction compared to previous waves.” said Dr Friedland.
“The very rapid rise in community transmission as compared to previous waves may partially explain this relatively low hospital admission rate. However, there does appear to be a decoupling in terms of the rate of hospital admissions at this early stage in the evolution of the fourth wave,” suggests Dr Friedland.
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Dr Friedland added that of a total of 800 COVID-19 positive patients that were admitted since 15 November, 75% of patients were unvaccinated. Netcare has seen seven deaths over this period in this group of patients, of which four may be ascribed to COVID-19. The ages of these four patients ranged from 58-91 years of age, and all had significant co-morbidities. Of these patients, three were not vaccinated.
In terms of age distribution, COVID-19 patients admitted since the 15 November are on average younger than those seen during the first three waves with over 71% being below 50 years of age, with an average age of 38.5 years. This compares to only 40% below 50 years of age in the first three waves, with an average age of 54 years.
Experience across Medicross Primary Care Clinics and Netcare Hospital Emergency Departments
Since 15 November 2021, of the 32 000 patients seen by general practitioners across 21 Netcare Medicross Medical and Dental Family Centres in Gauteng, 1 100 tested positive for COVID-19 and were symptomatic. In addition, over 22 000 patients have been seen through Netcare’s Emergency Departments in Gauteng, of which 816 were COVID-19 positive.
Virtually all patients have presented with mild to moderate flu-like symptoms, including a blocked or runny nose, headache and a scratchy or sore throat and have been treated symptomatically.
Early trends
Early trends of this 4th wave, since 15 November 2021, when admissions began to rise, indicate a far less severe form of COVID-19 and a probable decoupling of the rate of community transmission and the rate of hospital admissions.
“Most of the cases in hospital that are COVID-19 positive do not require any form of oxygen therapy and are considered incidental findings. In a primary care setting, the same mild to moderate clinical picture is being experienced. It is our considered view at this early stage that, should this trend continue, COVID-19 may be effectively managed at a primary care level, with the exception of certain cases requiring admission to tertiary facilities,” Dr Friedland noted,
Vigilance remains critical
Dr Friedland reiterated that the best way to support South Africa remains to take COVID-19 extremely seriously and to be as cautious as ever.
“Netcare strongly supports the need for all South Africans to be vaccinated, as vaccines have been proven to be safe and highly effective in decreasing transmission and saving lives globally.
“We have already witnessed the positive effects of vaccination in our workforce during the third wave when there was a significant reduction in the number of staff infections, hospitalisation and deaths from COVID-19 compared to the previous two waves,” asserts Dr Friedland.
“We cannot emphasise strongly enough the need for vaccination and all non-pharmaceutical precautions – particularly the wearing of masks, which has proven to be extremely effective in preventing transmission – to be diligently followed, as every person has a responsibility to help flatten this anticipated new curve to avoid contracting and passing on the virus.
“Please also remain vigilant to help protect your loved ones, yourself, and the healthcare system. It is critical for each individual to closely adhere to COVID-19 precautions, including washing your hands regularly, avoiding social gatherings, ensuring that your work and home environment are well ventilated, maintaining social distancing, and always wearing a mask in public and when in the presence of others, to protect themselves and to help prevent the spread of the virus,” he concluded.
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