Swift and Cruel: Investigation into high Eastern Cape Covid-19 death rate shows many died in casualty units

Graves at the Mbuqe graveyard in Mthatha. (Photo: Hoseya Jubase)

By Estelle Ellis, Hoseya Jubase and Lonwabo Damani

24 Mar 2021

In our second story in the series detailing the collapse of the Eastern Cape public health system, we look at an investigation into the high Covid-19 fatality rate in the Eastern Cape. The analysis, by a doctor within the health department, has revealed that many patients had almost no chance and died in casualty wards or within two days of admission.

An investigation into the high Covid-19 fatality rate in the Eastern Cape has shown that about 40% of patients who died had comorbidities and succumbed to the disease in hospital casualty wards or within 48 hours of being admitted.

The latest official epidemiological report issued for the outbreak in the province also conceded that the deaths caused by Covid-19 in the province have been “vastly understated”, as has the positivity rate in parts of the Eastern Cape.

The report raises the issue that a high positivity rate found during post-mortem testing in the province indicates that there are a “high number” of Covid-19 related deaths that are not being reported.

The Medical Research Council’s (MRC) excess death report has put the cumulative excess deaths at 502/100,000.

Covid death rate Freshly dug graves at Port Elizabeth's Malabar Cemetry. (Photo: Deon Ferreira)

“Although more data are needed on the underlying causes of death, this observation is strongly supportive that a significant proportion of the current excess mortality being observed in South Africa is likely to be attributable to Covid-19,” the MRC stated in its latest report.

Measuring excess deaths is a recognised way of determining how well a health system has coped with an event such as the outbreak of a disease.

The province has a case fatality rate of 6% at present, meaning that 6% of those diagnosed with Covid-19 died. The Chris Hani district, including districts in the former homelands of the Ciskei and Transkei, and the area around Komani (Queenstown), Cradock and Middelburg has the province’s highest case fatality rate at 7.9%.

In February 2021, the case fatality rates in the province had doubled to 12%.

“Covid-19 has humbled us,” one doctor said.

With the department finding itself in deepening financial trouble, doctors have raised the concern that cutting equipment budgets will make the situation worse if a third wave hits the province.

On Monday, specialists at Port Elizabeth’s public hospitals were told that the service provider for blood gas analysis had not been paid. It was owed R20-million and as a result, had stopped its service.

Many ICU patients have been left in crisis as those needing ventilation and care for advanced diabetes are dependent on blood gas analysis for proper treatment.

Despite several requests, the department has not commented on the latest disastrous development.

July (17% of all deaths) and December (24% of all deaths) were the deadliest months in the province since the outbreak of the pandemic.

The report stated that the Buffalo City metro has the highest mortality rate at 293.6/100,000, followed by the Nelson Mandela metro at 273.5/100,000 and the Chris Hani district at 209.1/100,000.

In comparison to the World Health Organisation’s Covid-19 data, these mortality rates are among the highest in the world and significantly higher than those of Italy (175/100,000), the United States (166/100,000), Spain (157/100,000) and Brazil (142/100,000).

Eastern Cape health department spokesperson Sizwe Kupelo said the analysis of Covid-19 deaths by the department’s Dr Nokuzola Ntlangula found that 40% of patients died either in hospitals’ casualty wards or within 48 hours after admission. He said they found that many of these patients had comorbidities.

According to the MRC, 33,072 people died between May 2020 and 13 March 2021 in the Eastern Cape. This puts the excess death rate at 502/100,000 of the population — double the national excess death rate.

The confirmed Covid-19 death rate in the Eastern Cape, according to the province, is 11,336.

One of the nurses in Nelson Mandela Academic Hospital said it was the first time in her career that she had seen people dying like this.

“Emotionally, Covid-19 has affected us so badly. We were not coping at work. Everybody was scared. It was very traumatic,” she said.

“Quite a number of people died in front of me during the Covid-19 second wave.”

Covid death rate Graves at the Mbuqe graveyard in Mthatha. (Photo: Hoseya Jubase)

A frontline health worker at the Dr Malizo Mpehle Hospital in Tsolo, under the Mhlontlo municipality, said “the hospital had to use candles to light wards after an electricity blackout”.

In the Joe Gqabi district, which includes towns like Aliwal North, Nqanqa Rhu (formerly Maclear) and Empilisweni hospital (in Sterkspruit), hospitals lost as much as 66% of their Covid-19 patients.

Kupelo said patients presented to these hospitals with blood oxygen levels lower than 30%.

“The district had an increase in deaths during the peak of the second wave in December. When reviews were done, we found that patients sought medical help very late and some demised within a few hours, or three days of being admitted,” he said.

He said patients presented with hypoxia (very low oxygen saturation) which was difficult to reverse, despite being given oxygen.

Schoolboy Vusumzi Goeieman from Sterkspruit, who lost his mother to the coronavirus in January 2021, said he was still struggling to talk about her death.

“Life was great. Everything was fine until Covid-19 took our mother. She was the pillar of the household and our mentor,” he said.

“We got nothing now... we survive on the grant money from our grandfather and the money that my older sister sometimes sends. I’m trying to cope in school, but life is not easy.

“My life has changed totally. I don’t have much to say because of the pain.” Goeieman’s mother died two days after being hospitalised. DM/MC

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