Management of hospital beds and ventilators in the Gauteng province, South Africa, during the COVID-19 pandemic

Mahnaz Alavinejad; Bruce Mellado; Ali Asgary; Mduduzi Mbada; Thuso Mathaha; Benjamin Lieberman; Finn Stevenson; Nidhi Tripathi; Abhaya Kumar Swain; James Orbinski; Jianhong Wu; Jude Dzevela Kong

doi:10.1371/journal.pgph.0001113

Management of hospital beds and ventilators in the Gauteng province, South Africa, during the COVID-19 pandemic

PLOS Glob Public Health. 2022 Nov 2;2(11):e0001113. doi: 10.1371/journal.pgph.0001113. eCollection 2022.

Authors

Affiliations

¹ Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), Laboratory for Industrial and Applied Mathematics, York University, Toronto, Canada.
² Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), School of Physics, Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa.
³ iThemba LABS, National Research Foundation, Cape Town, South Africa.
⁴ Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), The Advanced Disaster, Emergency and Rapid Response Program, York University, Toronto, Canada.
⁵ Head of Policy at Gauteng Office of the Premier, Johannesburg, South Africa.
⁶ University of the Witwatersrand, Johannesburg, South Africa.
⁷ Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), The Dahdaleh Institute for Global Health Research, York University, Toronto, Canada.

Abstract

We conducted an observational retrospective study on patients hospitalized with COVID-19, during March 05, 2020, to October 28, 2021, and developed an agent-based model to evaluate effectiveness of recommended healthcare resources (hospital beds and ventilators) management strategies during the COVID-19 pandemic in Gauteng, South Africa. We measured the effectiveness of these strategies by calculating the number of deaths prevented by implementing them. We observed differ ences between the epidemic waves. The length of hospital stay (LOS) during the third wave was lower than the first two waves. The median of the LOS was 6.73 days, 6.63 days and 6.78 days for the first, second and third wave, respectively. A combination of public and private sector provided hospital care to COVID-19 patients requiring ward and Intensive Care Units (ICU) beds. The private sector provided 88.4% of High care (HC)/ICU beds and 49.4% of ward beds, 73.9% and 51.4%, 71.8% and 58.3% during the first, second and third wave, respectively. Our simulation results showed that with a high maximum capacity, i.e., 10,000 general and isolation ward beds, 4,000 high care and ICU beds and 1,200 ventilators, increasing the resource capacity allocated to COVID- 19 patients by 25% was enough to maintain bed availability throughout the epidemic waves. With a medium resource capacity (8,500 general and isolation ward beds, 3,000 high care and ICU beds and 1,000 ventilators) a combination of resource management strategies and their timing and criteria were very effective in maintaining bed availability and therefore preventing excess deaths. With a low number of maximum available resources (7,000 general and isolation ward beds, 2,000 high care and ICU beds and 800 ventilators) and a severe epidemic wave, these strategies were effective in maintaining the bed availability and minimizing the number of excess deaths throughout the epidemic wave.

Copyright: © 2022 Alavinejad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This research is funded by Canada’s International Development Research Centre (IDRC) (https://www.idrc.ca/en) and the Swedish International Development Cooperation Agency (SIDA) (https://www.sida.se/en) (Grant No. 109559-001). under the Global South AI4COVID Program. The authors who received the funding are AA, JDK, BM, JO, and JW. The content is solely the authors’ responsibility and does not necessarily represent the official views of the funders. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.