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Sentinel Hospital Surveillance Week 36

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COVID-19 SENTINEL HOSPITAL SURVEILLANCE UPDATE SOUTH AFRICA WEEK 36 2020 OVERVIEW This report summarises data of COVID-19 cases admitted to sentinel hospital surveillance sites in all provinces. The report is based on data collected from 5 March to 5 September 2020. HIGHLIGHTS Coloured and Indian race; admission in ∙ As of 5 September, 64 705 COVID-19 the public sector; and having comorbid admissions were reported from 438 facilities hypertension, diabetes, chronic cardiac (194 public-sector and 244 private-sector) in disease, chronic renal disease, malignancy, all nine provinces of South Africa. There was HIV, current tuberculosis alone or both an increase of 6 111 admissions reported since current and past tuberculosis, and obesity. the last report, and 24 additional hospitals (21 Compared to the Western Cape province, public-sector and 3 private-sector) reporting individuals hospitalised in Eastern Cape, COVID-19 admissions. There were 22 099 Free State, Gauteng, KwaZulu-Natal, (34%) and 42 606 (66%) admissions reported Limpopo and North West provinces were in public and private sector respectively. more likely to die in-hospital. The majority of COVID-19 admissions were reported from four provinces, 17 632 (27%) in Western Cape, 17 179 (27%) in Gauteng, 10 290 (16%) in KwaZulu-Natal and 8 735 (14%) in Eastern Cape. Admissions have decreased over the past six weeks. ∙ ∙ Of the 64 705 admissions, 4 656 (7%) patients were in hospital at the time of this report, 48 747 (75%) patients were discharged alive or transferred out and 11 302 (18%) patients had died. There were 1 510 additional deaths since the last report. ∙ ∙ Of the 59 317 COVID-19 patients who had recorded in-hospital outcome (died and discharged), the case fatality ratio (CFR) was 19%. On multivariable analysis, factors associated with in-hospital mortality were older age groups; male sex; Black African, www.nicd.ac.za PAGE 1 METHODS DATCOV, sentinel hospital surveillance for COVID-19 admissions, was initiated on the 1 April 2020. Data are submitted by public and private hospitals that have agreed to report COVID-19 admissions through DATCOV surveillance in all nine provinces of South Africa. A COVID-19 case was defined as a person with a positive reverse transcriptase polymerase chain reaction (RT- PCR) assay for SARS-CoV-2 who was admitted to a DATCOV sentinel hospital. An individual was defined as having severe disease if treated in high care or intensive care unit (ICU), or ventilated or diagnosed with acute respiratory distress syndrome (ARDS). Case fatality ratio (CFR) was calculated for all closed cases, i.e. COVID-19 deaths divided by COVID-19 deaths plus COVID-19 discharges, excluding individuals who are still admitted in hospital. Data are received from all private hospitals nationally. As new hospitals join the surveillance system, they have retrospectively captured all admissions recorded. As of 5 September 2020, a total of 438 facilities, 194 from public sector and 244 from private sector, submitted data on hospitalised COVID-19 cases (Table 1). There were 24 additional hospitals (21 public-sector and 3 private-sector) reporting COVID-19 admissions since the last report. Table 1: Number of of hospitals reporting data on COVID-19 admissions by province and sector, South Africa, 5 March-5 September 2020 Facilities reporting Public Private Eastern Cape 78 17 Free State 28 20 Gauteng 6 88 KwaZulu-Natal 8 45 Limpopo 3 6 Mpumalanga 12 9 North West 2 12 Northern Cape 1 7 Western Cape 56 40 South Africa 194 244 RESULTS Epidemiological and geographic trends in admissions From 5 March to 5 September, a total of 64 705 COVID-19 admissions (6 111 additional from last report) were reported from 438 facilities in all nine provinces of South Africa. Of these admissions, 22 099 (34.2%) and 42 606 (65.8%) were reported in public and private sector, respectively. Initially, most admissions were reported in the private sector; from week 17 a higher proportion of total admissions was reported in the public sector; and since week 24 a higher proportion was reported in the private sector. There has been a decrease in reported COVID-19 admissions for the past six weeks following a peak in weeks 29 and 30 (Figure 1). www.nicd.ac.za PAGE 2 8000 Public 7000 Private 6000 5000 19 Admissions - 4000 3000 2000 Number Number of COVID 1000 0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Epidemiological week of diagnosis Figure 1: Number of reported COVID-19 admissions by health sector and epidemiologic week of diagnosis, 5 March-5 September 2020, n=64 705 The majority of admissions (53 836/6 4705, 83.2%) were recorded in four provinces, with the highest number reported in Western Cape (17 632, 27.2%), followed by Gauteng (17 179, 26.5%), KwaZulu-Natal (10290, 15.9%) and Eastern Cape (8 735, 13.5%) provinces (Figure 2). 20000 Western Cape Gauteng 18000 KwaZulu_Natal Eastern Cape Free State North West 16000 Mpumalanga Limpopo 14000 Northern Cape 12000 19 admissions - 10000 8000 6000 Number Number of COVID 4000 2000 0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Epidemiological week Figure 2: Cumulative numbers of reported COVID-19 admissions, by province and epidemiological week of diagnosis, South Africa, 5 March-5 September 2020, n=64 705 www.nicd.ac.za PAGE 3 Most patients admitted in the public sector, were admitted to district hospitals (8 705, 39.4%), national central hospitals (4 954, 22.4%), regional hospitals (4 140, 18.7%) and provincial tertiary hospitals (2 750, 12.4%) (Figure 3). 10000 9000 8000 7000 6000 19 admissions - 5000 4000 3000 2000 1000 0 Centre Field Hospital Number Number of reported COVID Military hospital District Hospital Regional hospital Community Health Long-term care facility Specialised TB hospital National central hospital Provincial tertiary hospital Facility type Figure 3: Cumulative numbers of reported COVID-19 admissions, by facility type in public sector, South Africa, 5 March-5 September 2020, n=22 101 www.nicd.ac.za PAGE 4 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF COVID-19 ADMISSIONS The median age of COVID-19 admissions was 53 years (interquartile range [IQR] 40 – 64). There were 1 986 (3.1%) admissions in patients 18 years and younger and 10 325 (16.0%) in patients older than 70 years. Among admitted individuals with COVID-19, 35 508 (54.9%) were female. The sex ratio was equal in patients between 40 and 80 years; females were more common than males in patients between 10 and 40 years and over 80 years; and males more common in patients younger than 10 years (Figure 4). 18000 100% Female Male % Male 16000 90% 14000 80% 70% 12000 19 admissions 60% - 19 admissions - 10000 50% 8000 40% 6000 30% 4000 20% 2000 Number Number of COVID 10% 0 0% Percentage male COVID 0-9 >80 10-19 30-39 50-59 20-29 70-79 60-69 40-49 unknown Age group (years) Figure 4: Number of reported COVID-19 admissions by age, gender and percentage of males, South Africa, 5 March-5 September 2020, n=64 705 www.nicd.ac.za PAGE 5 Of the 47 132 (72.8%) patients for whom race was known, 36 192 (76.8%) were Black African, 3 144 (6.7%) were Coloured, 3 132 (6.7%) were Indian, 4 593 (9.7%) were White and 71 (0.2%) were classified as Other race group. There were 2 798 (4.3%) health care workers (HCW) that were reported to be hospitalised. Among the 15 678 admissions in females of child-bearing age 15- 50 years, there were 1 421 (9.1%) females admitted who were pregnant or within 6 weeks post- partum. Among 54 935 (84.9%) patients for whom comorbid conditions were known, 28 083 (51.1%) had no comorbid condition reported, 1 4104 (25.7%) had one comorbid condition reported, 9 130 (16.6%) had two comorbid conditions and 3 618 (6.6%) had three or more comorbid conditions reported. Among the 26 852 (48.9%) patients who had reported a comorbid condition, the most commonly reported were hypertension (17 071, 63.6%) and diabetes (13 237, 49.3%); there were 4 331 (16.1%) patients who were HIV-infected, 765 (2.8%) patients with active tuberculosis (TB) and 1 390 (5.2%) patients with previous history of TB (Table 2). Obesity, defined by the subjective opinion of the attending HCW, while not consistently recorded for all reported COVID-19 admissions, was recorded as a risk factor in 1872 (2.9%) of all patients hospitalised. Table 2: Reported comorbid conditions among COVID-19 admissions reporting at least one comorbid condition, South Africa, 5 March-5 September 2020 n=26 656* Comorbid disease** n % Hypertension 17 071 63.6 Diabetes mellitus 13 237 49.3 Chronic cardiac disease 1 087 4.0 Chronic pulmonary disease/ Asthma 3 437 12.8 Chronic renal disease 1 390 5.2 Malignancy 417 1.6 HIV 4 331 16.1 Active tuberculosis 765 2.8 Previous history of tuberculosis 1 390 5.2 * Multiple comorbid conditions are counted more than once so the total number may be more than the total number of individuals reporting comorbid conditions. ** Presence of a comorbid condition includes only the conditions reported in the table; obesity is not included. OUTCOMES Of the 64 705 admitted individuals, 4 656 (7.2%) were currently in hospital, 48 015 (74.2%) were discharged alive, 732 (1.1%) were transferred out to either higher level care or step-down facilities, 11 302 (17.5%) had died in hospital.
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