Cape Town’s ‘hospital of hope’ provided relief during Covid-19 crisis

Turning Cape Town’s largest conference venue, the Cape Town International Convention Centre (CTICC), into a Covid-19 field hospital slashed the stays of those treated for the disease in other city hospitals by half, a new study has revealed.

The University of Cape Town (UCT) research, carried out during the first wave of the pandemic last year, also found that Covid-19 patients who were recently diagnosed with diabetes and those with uncontrolled diabetes were likely to experience Covid-19 complications and mortality.

Researchers say these findings could explain the increased susceptibility of the Cape Town population to Covid-19 complications and mortality.

Even though hypertension has previously been identified as a comorbidity that caused Covid-19 complications, this study found no evidence to support that link.

Not only did the admission of patients to the continent’s largest field hospital, dubbed “the Hospital of Hope”, reduce the predicted duration of hospital stay by 50%, reducing pressure at other acute-care hospitals in the region, but its medics also put the brakes on antimicrobial resistance by stopping antibiotic treatment from its newly admitted Covid-19 patients who were given this treatment at other hospitals.

About 25% of patients received empiric antibiotics at treating hospitals, which raised concerns about a high risk to antimicrobial resistance.

According to the study, published in the African Journal of Primary Healthcare and Family Medicine, researchers argue that stopping antibiotics is reasonable as there are low chances of bacterial cross-infection among Covid-19 patients.

“Those that subsequently developed signs of a hospital-acquired infection were treated with second-line antibiotics.”

Apart from the majority (80%) of patients receiving oxygen during their admission, a change in protocols around June last year necessitated that all patients requiring oxygen were prescribed steroids.

Acute kidney injury was the most common complication, affecting about 20% of patients, followed by delirium and hypoglycaemia (low blood sugar), which each affected about 7% of patients.

Worsening respiratory distress, defined as an increased oxygen demand that required an escalation of oxygen therapy, was observed in 5% of patients, while infection of healthcare workers was measured at 3.3%.

The length of hospital stay was about six days, with an average of one death a day and a maximum of five deaths daily.

The majority of patients (74.4%) were sent home upon discharge, while 5.7% were transferred for escalation of care at hospitals, including intensive care units.

Researchers attributed the field hospital’s success to adaptability, rapid response to daily needs of the healthcare service, better communication, clear referral pathways and well-considered admission criteria.

“As the operational needs of the healthcare platform changed in Cape Town, admission criteria were adapted to accommodate the needs through daily communication huddles across the healthcare platform and within the facility,” lead researcher Dr Bonny Bulajic, from the division of emergency medicine, noted.

“Through this flexibility, specific vulnerable populations and needs were accommodated. Communication, responsiveness and teamwork were key attributes of the success behind the adaptable referral criteria system.”

Bulajic said the latest study highlights the role of field hospitals to provide surge capacity during the Covid-19 pandemic. It also demonstrated a high level of dedication to providing a standard of care that was comparable to other traditional health facilities.

Though bed occupancy of the 800-bed facility, which was staffed by 71 doctors, including family and internal medicine specialists, and 203 nurses, was low at only about 32%, Bulajic and colleagues hope the study “will guide more cost-effective use of field hospitals during this pandemic and will assist future health planning regarding the role of field hospitals during future disease outbreaks”.

TimesLIVE