ABSTRACT
The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.
Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Hospitals, University/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Tertiary Care Centers/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Electronic Health Records/organization & administration , Emergency Service, Hospital/organization & administration , Humans , Intensive Care Units/organization & administration , Materials Management, Hospital , Pandemics , Patient Care Team , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Secondary Care Centers , South Africa/epidemiologyABSTRACT
The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.
Subject(s)
Anticoagulants/therapeutic use , COVID-19/therapy , Glucocorticoids/therapeutic use , Hypoxia/therapy , Oxygen Inhalation Therapy/methods , Oxygen/supply & distribution , Patient Positioning/methods , Psychosocial Support Systems , Anti-Bacterial Agents/therapeutic use , Anxiety/psychology , Anxiety/therapy , Blood Gas Analysis , COVID-19/blood , COVID-19/physiopathology , COVID-19/psychology , Cannula , Citalopram/therapeutic use , Counseling , Dexamethasone/therapeutic use , Disease Progression , Enoxaparin/therapeutic use , Factor Xa Inhibitors/blood , Female , Healthcare-Associated Pneumonia/complications , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/drug therapy , Hematoma/chemically induced , Humans , Hypoxia/blood , Hypoxia/physiopathology , Middle Aged , Oxygen Inhalation Therapy/psychology , Patient Care Team , Patient Positioning/psychology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Prone Position , Psychiatry , Resilience, Psychological , SARS-CoV-2 , Selective Serotonin Reuptake Inhibitors/therapeutic use , Severity of Illness Index , Social Work Department, Hospital , Thigh , Treatment OutcomeABSTRACT
The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.