Mon, 06 Jul 2020

Mediclinic International, the third-largest private hospital in southern Africa in terms of hospital beds, says it has not had to admit that many coronavirus patients and its intensive care units in South Africa are largely occupied by people brought in for other emergencies.

"There's a lot of talk going around regarding Covid-19, but we don't have that many Covid-19 patients, even within this wave we are currently in," said Mediclinic International CEO, Dr Ronnie van der Merwe on Tuesday, during the presentation of the group's financial results for the year ended on 31 March.

The number of people who have tested positive for Covid-19 in SA increased to 35 812 on Tuesday, while the number of deaths stood at 705 on Monday evening. The department department of health did not yet have the number of deaths reported in the past 24 hours.

Can scale up

Van der Merwe said because most of the people who test positive for the virus don't need hospitlisation, Covid-19 patients made up less than 5% of Mediclinic's total beds occupancy as at the beginning of June. As a result, Mediclinic has been able to carry on performing other emergency operations and even elective surgeries on limited basis when these were allowed again in May.

However, should more people require hospitalisation because of the pandemic, the group would reduce the number of elective surgeries it carries out.

Like its peers, Netcare, Life Healthcare and others, Mediclinic is currently in negotiations with the department of health about accepting people without medical aid who would have relied on state hospitals if diagnosed with Covid-19 and needed hospitalisation. Van der Merwe said they would do this only on a cost recovery basis, meaning private hospitals would not be earning a profit for the beds they avail to the state.

But ICU capacity is limited

While reducing the number of elective procedures is one available option to increase private hospitals capacity when needed, Mediclinic said this does not mean it will automatically be able to accommodate Covid-19 patients should demand start to spike.

Van der Merwe said in SA, the group has slightly over 1 000 ICU and high-care beds. It has 851 ventilators and has ordered another 100. But van der Merwe said these all the ICU beds and ventilators are not waiting for Covid-9 patients as they get taken up by trauma patients and other critical patients.

"When it comes to ICU, one has to remember that our ICUs are not standing idle at the moment, even of we stop all the elective work," said van der Merwe.

He added that when the group recorded 40% drop in revenue this March as patient numbers fell, while Mediclinic ICU revenue dropped 20%. The group continued to see emergency cases from other causes coming through.

Making the matters worse, there is generally a "chronic shortage" of critical care staff who work in ICUs in the country. And training staff to work in critical care takes time, said Van der Merwe.

"We have a shortage of critical care staff as well. The problem is that we can't solve that overnight. There are no short-term solutions to this," added van der Merwe.

Could ICU rationing become a reality?

Van der Merwe said while Mediclinic has enough capacity at the moment, given the relatively low volume of Covid-19 patients it is dealing with, the group has studied how to ration care from countries like Italy, should this be needed. The group has formed an ethics committee to help it make those though decisions should it be required to in future.

"At the moment, there is no reason for us to have any rationing activities taking place. We've got enough capacity; we've got enough people and we can deal with the current cases very easily. However, we have contingencies in place should we be forced to start having to deal with a caseload that threatens to overrun us," added Van der Merwe.

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