Booze being made a scapegoat for poor preparation?

Banning alcohol will not take the flooded health system out of crisis, experts say, as the country reels from a second ban on booze, among further restrictions announced on Sunday following the worst month for Covid-19 cases in June.

However, professor Alex van den Heever, head of the Wits School of Governance, wanted to know what had happened to the millions of rands poured into creating field hospitals.

In one of the harshest alcohol prohibitions since the apartheid-era ban on alcohol sales to black citizens, the government used the rationale that it had an indirect and direct effect on the public health system’s resources. Little data was available to support the correlation between the lifting of the first alcohol ban and public health resources.

But according to the latest figures, Chris Hani Baragwanath Academic Hospital treated nearly 3,000 patients in its trauma unit in June.

Picketers scuffle with police at a ‘physically distanced’ picket outside Chris Hani Baragwanath Hospital in Soweto, 1 May 2020. They were demanding PPE equipment for all frontline health care workers. Picture: Tracy Lee Stark

Statistics compiled by the Gauteng department of health showed from 1 to 30 June, the trauma unit treated 2,730 patients. The cases were gunshots, stabbings, motor vehicle accidents, passenger vehicle accidents (buses and taxis), burns, assaults, falls, cuts, motorbike accidents and other trauma.

In March, the hospital’s trauma unit treated 2,217 people. The hard lockdown, when alcohol was banned, was effected on 27 March.

The breakdown of statistics shows the trauma unit saw more than 100 cases on seven individual days – on 1 June, 117; 2 June, 120; 13 June, 132; 20 June, 109; 27 June, 133; 29 June, 104 and 30 June, 141 patients.

According to research published in 2018 in BMC Medicine, an estimated 62,300 South Africans died from alcohol-related causes in 2015. According to an article published in the South African Medical Journal in 2014, the tangible financial cost of alcohol harm alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP.

This trend was also picked up in the private sector. According to Jacques Du Plessis, managing director for Netcare’s Hospital division, trauma cases in the company’s hospitals picked up significantly with the unbanning of alcohol and the loosening of lockdown restrictions.

“While we do not keep specific statistics relating to alcohol-related trauma cases, we can confirm that trauma-related incidents in Netcare’s emergency departments countrywide increased following the relaxation of the lockdown restrictions to level three and the unbanning of alcohol. As we know, there is a direct correlation between alcohol abuse and trauma,” said Du Plessis.

But some have argued that the rise in trauma cases could not directly be blamed on alcohol consumption alone without the context of the opening up of industries, increased freedom of movement and more road traffic.

Criticism

However, Professor Alex Van Den Heever, head of the Wits School of Governance has questioned what happened to all of the millions poured into creating field hospitals, when some provinces have not even admitted any patients to them.

According to Van den Heever, government had yet to make a sufficient argument for banning alcohol in order to reduce the burden on the healthcare system. He believes government should have used the three-month hard lockdown to prepare the system sufficiently, which did not happen.

“I haven’t seen a detailed rationale and if they have it in writing that the reason for the surge in in-patients is because of alcohol-related trauma that would be correct, but the current increase in relation to hospitalisation has been predominantly because of Covid-19,” said van den Heever.

“It’s hard to actually understand what they were actually doing for this period. You can see what was done in the Western Cape and they don’t even need to stop. They don’t need an alcohol ban. They don’t even need private hospital beds anymore. The number of patients went down and if they keep up the prevention strategy and maintain it, they are perfectly fine and that is what Gauteng should have done.”

Van Den Heever argued that alcohol-related trauma cases would be a drop in the ocean compared to the expected number of cases the country was facing in the next few weeks. It could therefore be argued that the ban would be relatively ineffective in dealing with the Covid-19 healthcare crisis in which none of the provinces, save for the Western Cape, appeared to be sufficiently ready and resourced for Covid-19 healthcare.

According to a recent government reply to the Democratic Alliance (DA), the Eastern Cape only had one field hospital, constructed with assistance from car manufacturer Volkswagen. At 35% completion the hospital was far from ready, but the completed section was being used for Covid-19 admissions.

None of the country’s other seven field hospitals, including extensions to existing hospitals, were complete. But some were in partial use.

In Gauteng, Nasrec was the province’s only field hospital, with 500 beds obtained and was currently being used for Covid-19 treatment and quarantine. Despite this, Van den Heever and DA MPL Jack Bloom pointed out the place had yet to be equipped with sufficient ICU support and high-care support equipment.

Limpopo, the Northern Cape and Mpumalanga did not have any field hospitals. In contrast, the DA-led Western Cape government had completed the construction of all of its field hospitals. This included the Cape Town International Convention Centre, which now housed a field hospital with 870 beds, and Brackengate, which was expected to receive its first patients over last weekend.

Private sector to help

As public hospital beds fill up with Covid-19 cases, the private sector is ready to assist, with service level agreements already signed in the Western Cape and Gauteng. These would see government patients transferred to private healthcare facilities.

According to Du Plessis, Netcare, along with other private healthcare stakeholders, have committed to standing shoulder to shoulder with government to provide care for all patients who may require hospitalisation for Covid-19.

The national health department engaged with all provinces in early July on the finalisation of the pricing arrangements and provinces were currently finalising SLAs for the treatment of Covid-19 patients at Netcare hospitals in the provinces on a cost-recovery basis.

The requirement is to assist with critical care beds in the event of a possible need.

“Thus far we have only treated a handful of state patients. These are indeed extraordinary times and we will assist where possible where the need exists and in line with our available resources,” said Du Plessis, adding that other types of services in the private sector needed to be protected regardless.

“It is also important to continue to provide assistance, for example, to patients giving birth or who may be in need of services such as cardiac or neurological support.”

• Simnikiweh@citizen.co.za

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