The impact of government- and institution-implemented COVID-19 control measures on tertiary- and regional-level intensive care units in Pietermaritzburg, KwaZulu-Natal Province, South Africa

Abstract

Background: The COVID-19 pandemic has had a significant impact on healthcare systems globally as most countries were not equipped to deal with the outbreak. To avoid complete collapse of intensive care units (ICUs) and health systems as a whole, containment measures had to be instituted. In South Africa (SA), the biggest intervention was the government-regulated national lockdown instituted in March 2020.

Objectives: To evaluate the effects of the implemented lockdown and institutional guidelines on the admission rate and profile of non-COVID-19 patients in a regional and tertiary level ICU in Pietermaritzburg, KwaZulu-Natal Province, SA.

Methods: A retrospective analysis of all non-COVID-19 admissions to Harry Gwala and Greys hospitals was performed over an 8-month period (1 December 2019 - 31 July 2020), which included 4 months prior to lockdown implementation and 4 months post lockdown.

Results: There were a total of 678 non-COVID-19 admissions over the 8-month period. The majority of the admissions were at Greys Hospital (52.4%; n=355) and the rest at Harry Gwala Hospital (47.6%; n=323). A change in spectrum of patients admitted was noted, with a significant decrease in trauma and burns admissions post lockdown implementation (from 34.2 - 24.6%; p=0.006). Conversely, there was a notable increase in non-COVID-19 medical admissions after lockdown regulations were implemented (20.1 - 31.3%; p<0.001). We hypothesised that this was due to the gap left by trauma patients in an already overburdened system.

Conclusion: Despite the implementation of a national lockdown and multiple institutional directives, there was no significant decrease in the total number of non-COVID-19 admissions to ICUs. There was, however, a notable change in spectrum of patients admitted, which may reflect a bias towards trauma admissions in the pre COVID-19 era.

Contributions of the study: We describe the impact of the COVID-19 pandemic on critical care services in a resource-limited setting. We also demonstrate the ongoing need for intensive care unit beds within the public sector.

Keywords: COVID-19; ICU; lockdown; non-COVID-19 admissions.

Fig. 1

Line graph indicating ICU admission over an 8-month period at Greys Hospital and Harry Gwala Hospital, from December 2019 – July 2020. Level 5 was the level with the tightest restrictions in which movement of persons was significantly restricted.

Fig. 2

Distribution of overall admission before and after the implementation of government and institutional lockdown regulations. Noted decrease in trauma admissions and an increase in non-COVID-19 admissions between the pre and post lockdown periods.

Fig. 3

Line graph indicating ICU admission over the 8-month period, from December 2019 – July 2020. The solid vertical line indicates the division between the pre-lockdown period and the lockdown period. Level 5 was the level with the tightest restriction in which movements of person was significantly restricted. In month 8, the was one orthopaedic, one ‘other’, two obstetrics and gynaecology and three general surgery patients.