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Infectious Diseases

Updated 14 April 2020

Non-urgent surgeries shut down at state, private hospitals, for now

As concern over the spread of the new coronavirus increases, state hospitals and private hospital groups across the country have decided to either suspend or postpone elective surgeries.

More than 1.4 million confirmed Covid-19 cases have been reported worldwide, with cases continuing to rise in South Africa as well. As of 7 April, the country has 1 749 confirmed cases and 13 deaths.

As concern over the spread of the new coronavirus increases, state hospitals and private hospital groups across the country have decided to either suspend or postpone elective surgeries.

Health24 spoke to four prominent South African hospital groups about their reasons for this. Their decision to cancel or postpone certain non-urgent, elective surgeries range from flattening the Covid-19 curve and limiting the exposure of patients to the virus to freeing up hospital beds so that the healthcare system does not become overburdened by an influx of Covid-19 cases.

What is elective surgery?

Elective surgery is surgery that can be scheduled in advance and is usually not life-threatening, explains Johns Hopkins Medicine. Its goal is for patients to attain a better quality of life, like in the case of a knee replacement. However, in some instances, such an operation may be urgent as in serious medical conditions like cancer.

US and Australia also cancel elective surgeries

The US surgeon general Jerome Adams urged a widespread halt of hospital elective procedures on 14 March, and warned that not doing so could spread the new coronavirus and require the use of protective medical gear that should be reserved for Covid-19 cases. The decision came into effect during the very same week.

In Australia, a similar decision was taken on 24 March, with Prime Minister Scott Morrison announcing that all non-urgent elective surgery was to be suspended in both private and public hospitals as they prepared for an influx of Covid-19 patients.

State of SA’s critical care hospital beds

In March, News24 reported that South Africa’s healthcare system had only around 3 000 critical care (including ICU and high care) hospital beds available, and with an escalation in Covid-19 cases, it might not be enough.

Spokesperson for the Hospitals Association of South Africa, Mark Peach, told News24 that, considering the constant increase in the rate of infection, planning for different scenarios is challenging and that the priority is that citizens practice physical distancing and avoid overburdening the healthcare system by requesting unnecessary tests.

However, Premier Alan Winde said on 2 April: "We have got enough hospital beds, enough ICU beds and enough quarantine facilities right now." adding, "But we've got to be preparing for what the impact is going to be in a week, two weeks, and two months' time," according to News24.

As a precautionary measures, five Mpumalanga game reserves have also been set up to ensure sufficient isolation areas to treat patients with Covid-19 in the province.

Why state and private hospital groups made the decision

Popo Maja, Spokesperson for the South African National Department of Health, told Health24 that provincial health departments can make their own operational decisions based on the realities of their situations, but added:

"However, the general rule is that in outbreak situations, all health facilities (both public and private), should postpone elective surgeries to concentrate on lifesaving procedures."

Several attempts to get comment from provincial health departments were unsuccessful, except for the Free State Department of Health.

Mondli Mvambi, Spokesperson for the Free State department of health told Health24: “Since a global pandemic was declared, followed by our 21-day lockdown, state hospitals have put elective surgeries on hold. Due to a restriction in movement of people, we need to contribute to flattening the Covid-19 curve and therefore only want people who need critical care to make it to the hospital,” Mvambi said.

The Gauteng health department also decided to cancel all elective surgeries last month, reported News24.

Mediclinic Southern Africa, was one of the first private hospital groups to suspend elective surgeries on 26 March, and said that they are sticking to their decision.

“The intention of cancelling elective surgeries was to minimise patient movement, in keeping with the lockdown, and to assist in minimising the spread of infection. With numerous exogenous and endogenous factors at play, quantifying the effects of such a decision in isolation is not possible,” Dr Stefan Smuts, Chief Clinical Officer of Mediclinic Southern Africa told Health24.

“We remain in support of the fact that physical distancing (achieved through various mechanisms) remains an important component of the national pandemic response and flattening the infection curve," Smuts added.   

Similarly, Life Healthcare, whose group owns 66 healthcare facilities across South Africa, said they are following guidelines by the South African Society of Anaesthetists, which advises normal elective surgery be postponed under the current circumstances.

Dr Charl van Loggerenberg, GM: Emergency Medicine of Life Healthcare explained: “We continue to provide hospital services and quality care to all our patients. Our facilities currently remain open and operational during the national 21-day lockdown to provide hospitalisation to those who require the services outside of Covid-related care.”

Loggerenberg added that their decision is not a “business as usual” approach and that the group will continuously review this decision with their doctors.

Guidelines by medical societies

Netcare has adopted the same stance and has suspended non-essential elective surgery, with semi-elective surgery which may require admission to the high care unit or intensive care unit, post-operation, also postponed.

Dr Anchen Laubscher, Group Medical Director of Netcare explains: “Semi-elective surgery will be postponed, provided that this will not result in the patient’s outcome or quality of life being significantly altered, based on the individual clinician’s assessment and decision.

“Admission and treatment of persons requiring hospitalisation for medical conditions will continue as usual."

Busamed has also decided to stop all elective surgeries across its seven hospitals nationally.

“The decision is based on the guidelines presented by various medical societies and in conjunction with its Hospital Physician Advisory Boards,” explained Glenn de Villiers, Chief Operations Officer.