TOPLINE: Some U.S. cities have now run out of space in their ICUs, with many more on the brink of being overwhelmed as Covid hospitalizations keep skyrocketing to new national records on a daily basis.



<h4 class="wp-block-heading">KEY FACTS</h4>



<a href="https://twitter.com/TCBPubHealth/status/1326888035129176064?s=20" target="_blank" rel="noreferrer noopener">Jackson, Mississippi</a>—the state’s capital—has “zero” ICU beds available, while the rest of the state has “very few,” State Health Officer Dr. Thomas Dobbs said.



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/tulsa-has-run-out-of-icu-beds-and-el-paso-is-out-of-morgue-space-heres-the-latest-grim-toll-of-covid/?sh=78c74f022133">Tulsa</a>&nbsp;health officials announced Tuesday night that the city had run out of ICU beds.



<a href="https://www.stltoday.com/news/local/state-and-regional/running-out-of-room-st-louis-hospitals-forced-to-turn-away-patients-from-rural-areas/article_0e17fc93-3e67-5a49-9a33-0b346618b5c3.html" target="_blank" rel="noreferrer noopener">St. Louis</a>&nbsp;hospitals are so overwhelmed they’re reportedly having to turn away some patients.



In North Dakota, nurses are being allowed to continue working in certain cases even if they are<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/covid-positive-nurses-allowed-to-keep-working-in-north-dakota-amid-staffing-crisis/?sh=392003af60fd">&nbsp;Covid-positive</a>, as Gov. Doug Burgum (R) has warned that the state’s healthcare system could soon be pushed beyond its limits.



A field hospital has been set up for surge capacity in<a href="https://www.npr.org/2020/10/22/926809402/wisconsin-opens-a-field-hospital-at-state-fair-grounds-as-coronavirus-cases-spik" target="_blank" rel="noreferrer noopener">&nbsp;Wisconsin</a>, with<a href="https://www.bostonglobe.com/2020/11/13/metro/mass-reopen-field-hospital-dcu-center-worcester/" target="_blank" rel="noreferrer noopener">&nbsp;Massachusetts</a>&nbsp;planning to reopen one in December, and $10 million going toward converting a parking garage in<a href="https://thehill.com/homenews/state-watch/525995-nevada-hospital-turns-parking-garage-into-covid-19-surge-unit" target="_blank" rel="noreferrer noopener">&nbsp;Reno, Nevada</a>, into a Covid unit.



Vineet Arora, a hospital expert at the University of Chicago, warns that Illinois is “dangerously close” to exceeding capacity, telling<a href="https://www.npr.org/2020/11/12/934266517/illinois-health-care-workers-say-hospitals-will-run-out-of-icu-beds-by-thanksgiv" target="_blank" rel="noreferrer noopener">&nbsp;NPR</a>&nbsp;that ICUs will run out of space by Thanksgiving.



<h4 class="wp-block-heading">WHAT TO WATCH FOR</h4>



Several other places around the country—like Kansas City and<a href="https://www.rochesterfirst.com/coronavirus/strong-hospital-nearing-100-capacity-as-covid-19-cases-surge-in-monroe-county/" target="_blank" rel="noreferrer noopener">&nbsp;Rochester, New York</a>—are also pushing the limits of their health care capacity. In<a href="https://www.npr.org/sections/health-shots/2020/11/14/934185297/covid-19-hospitalizations-surge-in-dakotas-its-like-we-opened-up-a-spigot" target="_blank" rel="noreferrer noopener">&nbsp;South Dakota</a>, a health official told NPR that it’s “a possibility” the state would follow North Dakota in taking the exceptional step of allowing nurses with Covid to work in Covid units at hospitals and nursing homes, provided they are asymptomatic. That’s a step Dr. Steffanie Strathdee, Associate Dean of Global Health at UC San Diego and author of “<a href="https://protect-us.mimecast.com/s/pOQeCZ6ZQ7fAY0XwTysi5X?domain=theperfectpredator.com" target="_blank" rel="noreferrer noopener">The Perfect Predator</a>,” told&nbsp;Forbes&nbsp;earlier this week was “crazy” for North Dakota to take. Another looming problem could be a lack of nurses nationwide. During the spring surge, scores of health workers flocked to New York, which was the hardest-hit city in the country. But the crisis now is nationwide, meaning there could be competition for health workers in many places.



<h4 class="wp-block-heading">KEY BACKGROUND</h4>



The U.S. has set a new record for hospitalizations for four-straight days, according to data from<a href="https://covidtracking.com/data" target="_blank" rel="noreferrer noopener">&nbsp;The COVID Tracking Project</a>, and the trend seems to only be accelerating. Significantly adding to the problem is that new cases are also not only increasing, but constantly increasing at a faster pace, as well. The U.S. added more than 180,000 new cases on Friday, again setting a new record, which keeps getting broken<a href="https://www.forbes.com/sites/tommybeer/2020/11/14/another-grim-new-record-us-tops-180000-new-infections-friday-covid-cases-rising-in-all-50-states/?sh=6c8aa7821ea5">&nbsp;day after day</a>. Just 10 days earlier, the U.S. had never topped 94,000 cases in a single day. And before the fall surge, the daily case record stood at just over 75,000. Hospitalizations stood at 68,516 on Friday, according to The COVID Tracking Project.<a href="https://covidtracking.com/data/charts/us-daily-deaths" target="_blank" rel="noreferrer noopener">&nbsp;Deaths</a>, which lag behind increases in cases and then hospitalizations, have been on a steady rise since mid-October. The U.S. is now averaging more than 1,000 Covid deaths a day.



<h4 class="wp-block-heading">TANGENT</h4>



<a href="https://www.cnn.com/2020/11/10/us/el-paso-covid-mobile-morgues/index.html" target="_blank" rel="noreferrer noopener">El Paso, Texas</a>, is dealing with an even more grim problem than hospitals reaching capacity—the city has run out of morgue space.



<h4 class="wp-block-heading">FURTHER READING</h4>



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/tulsa-has-run-out-of-icu-beds-and-el-paso-is-out-of-morgue-space-heres-the-latest-grim-toll-of-covid/?sh=78c74f022133">Tulsa Has Run Out Of ICU Beds And El Paso Is Out Of Morgue Space—Here’s The Latest Grim Toll Of Covid</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/covid-positive-nurses-allowed-to-keep-working-in-north-dakota-amid-staffing-crisis/?sh=392003af60fd">Covid-Positive Nurses Allowed To Keep Working In North Dakota Amid Staffing Crisis</a>&nbsp;(Forbes)



<a href="https://www.npr.org/sections/health-shots/2020/11/14/934185297/covid-19-hospitalizations-surge-in-dakotas-its-like-we-opened-up-a-spigot" target="_blank" rel="noreferrer noopener">COVID-19 Hospitalizations Surge In Dakotas: &#8216;It&#8217;s Like We Opened Up A Spigot&#8217;</a>&nbsp;(NPR)



<a href="https://www.forbes.com/sites/tommybeer/2020/11/14/another-grim-new-record-us-tops-180000-new-infections-friday-covid-cases-rising-in-all-50-states/?sh=6c8aa7821ea5">Another Grim New Record: U.S. Tops 180,000 New Infections Friday, Covid Cases Rising In All 50 States</a> (Forbes)



-By Nicholas Reimann, Forbes Staff

COVID-19 Intensive Care Unit Within A Houston Hospital Cares For Patients As Cases Continue To Rise

Here’s Where You Can No Longer Get An ICU Bed Because Of Covid

They’re all closed.



Movie Theaters. Bars. Nightclubs. Arenas. Cafes. In New York, Broadway and museums are shuttered. In San Francisco it’s even more dire. Across the country and the world, cities are shutting down, leaving humans from Seattle to Shanghai without traditional ways of finding distraction.



The mandate for social distancing that has proven essential at slowing the spread of the coronavirus will cut about $12 billion of entertainment revenue from the U.S. if the shutdown lasts until July,&nbsp;<a href="https://www.forbes.com/sites/rachelsandler/2020/03/16/cdc-all-americans-should-avoid-gathering-in-groups-of-more-than-10-people/#255b6cb5283d">as President Trump signaled</a>. Billions more are not being spent on creating new content as film and television production is frozen.&nbsp;



Things could get a lot worse.



“This is definitely unprecedented and turning everyone&#8217;s lives completely upside down,” says Ryan Borba, managing editor at concert tracker Pollstar.



The concert and live event industry brought in $34 billion last year,&nbsp;<a href="https://www.ibisworld.com/united-states/market-research-reports/concert-event-promotion-industry/" target="_blank" rel="noreferrer noopener">according to market research firm IBISWorld</a>. Simple math suggests that a three-month shutdown at this time of year could cost that industry $7 billion of lost revenue. Any longer and it starts to cut into the&nbsp;<a href="https://www.forbes.com/sites/zackomalleygreenburg/2020/03/06/as-coronavirus-cancels-sxsw-coachella-could-be-next-as-music-industry-braces-for-a-cruel-summer/#24e8eb076886">popular summer concert season</a>, which for LiveNation, the world’s biggest concert promoter, is when 70% of its attendance begins passing through the turnstiles. That’s bad news for the producers, songwriters, technicians and the&nbsp;<a href="https://www.ibisworld.com/united-states/market-research-reports/concert-event-promotion-industry/" target="_blank" rel="noreferrer noopener">269,025 concert employees</a>, including janitors, security personnel and ticket collectors. That’s not to mention the world’s&nbsp;<a href="https://www.forbes.com/sites/zackomalleygreenburg/2019/12/06/the-worlds-top-earning-musicians-of-2019/">top-earning musicians</a>, all of whom make the majority of their money performing.&nbsp;



“We’re beginning to see it affect the entire music ecosystem,” one prominent artist manager who <a href="https://www.forbes.com/sites/zackomalleygreenburg/2020/03/06/as-coronavirus-cancels-sxsw-coachella-could-be-next-as-music-industry-braces-for-a-cruel-summer/#20fa6f7d6886">told Forbes</a> on the condition of anonymity. “We’re getting calls from our agents about promoters canceling individual shows. Songwriters and producers have canceled flights into L.A. for sessions, so it’s starting to trickle down to the songwriting and production communities as well.”



On New York’s Broadway, where all 41 theaters are closed, the hit could be about $600 million, based on the amount they pulled in between mid March and July of 2019. During the 2016-2017 season, those theaters also supported more than 87,000 jobs and contributed $12.63 billion to New York City’s economy, according to&nbsp;<a href="https://www.broadwayleague.com/research/research-reports/" target="_blank" rel="noreferrer noopener">Broadway League</a>.



The effect on movie theaters is far more drastic. A complete shutdown across the U.S. will mean a $4 billion hit on the box office if they remain closed until July. On March 18, less than a month into the crisis, the national association of theater owner&nbsp;<a href="https://apnews.com/734c2aad0321b93811a13273c112d21f" target="_blank" rel="noreferrer noopener">requested a bailout</a>&nbsp;from the government.



“From the point of view of studios they are hemorrhaging money on the movie side,” says Mike Bloxham the senior vice president of global media and entertainment at research firm Magid.&nbsp;“There is a lot of money disappearing in China while 70,000 theaters are still closed.”



Once they do reopen, distributors will begin battling to squeeze a large number of films into a limited number of opening dates, including&nbsp;<a href="https://www.forbes.com/sites/maddieberg/2020/03/12/hollywood-braces-for-coronavirus-slump-the-movie-releases-pushed-back-so-far/#3be198ba2bed">some major releases</a>&nbsp;that include the latest&nbsp;James Bond&nbsp;movie, Disney’s&nbsp;Mulan&nbsp;and Marvel’s&nbsp;Black Widow, all of which have been&nbsp;<a href="https://www.forbes.com/sites/maddieberg/2020/03/12/hollywood-braces-for-coronavirus-slump-the-movie-releases-pushed-back-so-far/#ad8a4d02bed6">pushed back</a>.



“No one can precisely predict when public life will return to normal, but it will return,” Patrick Corcoran, the president of the National Association of Theater Owners, said in a statement on Match 17. “When those titles are rescheduled, they will make for an even fuller slate of offerings than normal as they are slotted into an already robust release schedule later in the year.”



Last year, entertainment companies spent $121 billion to create original content and they were expected to spend even more this year as new platforms, like short-form video platform Quibi, emerge and streaming giants like Netflix and Amazon Prime continue to plow through cash to produce new shows that lure in subscribers. Disney, Netflix, Universal and a number of other studios have all but&nbsp;<a href="https://www.forbes.com/sites/maddieberg/2020/03/13/hollywood-studios-disney-netflix-halt-film-and-tv-production-amid-coronavirus/#327ea2195d28">shut down U.S. production</a>. In California alone, that activity supported more than 722,000 jobs and $68 billion in wages, according to the Motion Picture Association of America. In New York City, television and film production support about 10% of total employment, whether directly or indirectly, and generates almost $9 billion each year.



“Right now, we’re working to keep everyone safe, support the industry and find ways to help it come back stronger than ever,” a spokesperson for Mayor’s Office of Media and Entertainment said.



The sentiment mirrored that of Colleen Bell, the executive director of California’s Film Commission who said, “The entertainment production industry in California has overcome challenges in the past, and it will endure this sudden shutdown. Until the COVID-19 situation improves, the focus is rightfully on the public health crisis. After that’s behind us, the industry will once again thrive here in the Golden State.”



While those logistics will reverberate widely across show business sectors, consumers may be in for even bigger, long-lasting changes.&nbsp;



For TV shows, the near-term effects could be disappointing for fans looking forward to fresh episodes of their favorite shows. FX’s&nbsp;Fargo&nbsp;has shut down production and will have to delay new episodes. More series are sure to follow. Streamers have already changed the way we watch TV—introducing binge-watching and slowly eliminating cable subscriptions—and the more that cable and broadcast series are delayed, the more likely we will continue to move away from the appointment viewing of television’s past.



In film, a far more dramatic shift just happened: consumers may no longer need to fight crowds at movie theaters on opening nights. Universal Studios announced Monday that it would begin releasing films like&nbsp;Invisible Man, Emma&nbsp;and&nbsp;The Hunt&nbsp;available for in-home, on-demand rentals despite the fact that these films were only recently released, blowing up the entrenched windowing schedule that gave theater chains exclusive rights to show movies first before they were released to in-flight entertainment, rental platforms and then television. Sony followed, releasing Vin Diesel’s&nbsp;Bloodshot&nbsp;for digital purchase only 11 days after its theatrical release.



Others will likely do same and if they do, it could&nbsp;lead the Academy of Motion Picture Arts and Sciences to&nbsp;<a href="https://www.marketwatch.com/story/oscars-keep-rule-requiring-movies-to-have-theatrical-release-to-be-nominated-2019-04-24" target="_blank" rel="noreferrer noopener">change their theatrical-release&nbsp;</a><a href="https://www.marketwatch.com/story/oscars-keep-rule-requiring-movies-to-have-theatrical-release-to-be-nominated-2019-04-24" target="_blank" rel="noreferrer noopener">rule</a>,&nbsp;which only allows films that open in a theatre and stay there for seven days to be considered for Oscars. It may also prompt Netflix to tighten its grip on the entertainment business with the purchase of a theater chain of its own. In 2018, the streaming giant looked at buying Landmark Theatres, but Cohen Media Group beat Netflix to the arthouse chain.



“If this continues for a long time, that will cause a change in how we consume content and allow newer titles to get to home video much faster,” says Asaf Ashkenazi, the COO of Verimatrix, a technology company that works with distributors in Hollywood. “If it’s a new title, you can delay it, continue to follow the traditional system and just wait. Or you can be more experimental and go directly to selling or renting online, which will allow more people to access it and get the revenue now.“&nbsp;



Other businesses are also turning to streaming, including&nbsp;<a href="https://www.forbes.com/sites/zackomalleygreenburg/2020/03/18/zombie-jamboree-for-a-struggling-livestream-startup-coronavirus-lockdown-offers-one-last-chance/#7811d2e15e24">concert-streamer StageIt</a>. The startup, which offers concerts from the likes of Jon Bon Jovi and Sara Bareilles, is on track to have revenue of $250,000 this week—about the same as its best month until now—and added&nbsp;10,000 subscribers in two days while hosting virtual festival “Shut In &amp; Sing.” Even New York’s Metropolitan Opera is in on it,&nbsp;<a href="https://operawire.com/metropolitan-opera-to-offer-up-nightly-met-opera-streams/" target="_blank" rel="noreferrer noopener">streaming nightly performances</a>.



The stars themselves are also shifting their approach to how they entertain and communicate with fans. “Together, at Home,” a new series of online concerts presented by the World Health Organization (WHO) and Global Citizen, has recruited Chris Martin and John Legend to give casual concerts from their living rooms via Instagram Live, taking requests from fans and singing songs like David Bowie’s “Life on Mars.” Using Instagram, pop star Lizzo led a meditation, Frozen’s Josh Gad read kids a story, and, on Twitter, Yo-Yo Ma played a “<a rel="noreferrer noopener" href="https://twitter.com/YoYo_Ma/status/1238572657278431234" target="_blank">song of comfort.</a>” Entertainers have already <a rel="noreferrer noopener" href="https://www.nytimes.com/2019/10/15/style/celebrity-phone-numbers.html" target="_blank">fully embraced </a>this kind of direct connection with fans and the pandemic may only accelerate that.



&#8211;<a href="https://www.forbes.com/sites/maddieberg/">Madeline Berg</a>, Forbes Staff, <a href="https://www.forbes.com/media">Media</a>

High angle view of audience enjoying comedy movie at cinema hall

Coronavirus Could Be A $12 Billion Hit To Entertainment And Audiences May Never Be The Same

Instead of saving lives in hospital, 27-year-old Sherwin Prim, who spent 10 years qualifying as a doctor at the University of the Witwatersrand, is in jobless limbo.
This is Prim&#8217;s depressing lot since he finished his internship on April 30 in Cape Town. The Department of Health (DOH) told him there was a delay over the allocation of posts in community service and internship positions, the next stage in his career.
&#8220;Fortunately, my mom has taken me in and I still have my car,&#8221; he says.
Every day Prim hopes for a post before his life savings run out – a reality unimaginable when he moved down from Johannesburg to take up a bright future as an intern two years ago at the Tygerberg Hospital.
&#8220;I can&#8217;t practice as a doctor at the moment. It is illegal. It would be against our professional regulations… I can only do so once I have completed my community service,&#8221; says Prim.
The rules say doctors need to intern for two years, after graduation, plus complete a year of community service to be allowed to operate within the law. According to the DOH, posts open in two cycles. Once at the beginning of the year, to accommodate those who have qualified in the standard period, and in mid-year for those who qualify later.
<div id="attachment_33206" style="width: 310px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-33206" class="wp-image-33206 size-medium" src="https://www.forbesafrica.com/wp-content/uploads/2017/08/Sherwin-1-e1503343147389-300x248.jpg" alt="" width="300" height="248" />Dr Sherwin Prim. (Photo supplied)</div>
Prim hoped in vain for the second cycle, which would have meant a starting date of May 1.
&#8220;I have been waiting for the last three months without a salary. It is a serious administrative issue.
<div class="mceTemp"></div>
Doctors are being misinformed, they are not being allocated to positions.&#8221;
<a href="http://www.forbesafrica.com/woman/2017/02/01/mercy-or-monster/" target="_blank" rel="noopener">Mercy Or Monster?</a>
It means Prim went from an average internship salary of R380,000 ($28,400) to moving back home to Johannesburg with his mother. These days all he can do is part-time work as a tutor at the university where he graduated.
&#8220;I have been doing some casual work through the university, invigilating and facilitating clinical skills with med students in the meantime. But most of this has been once or twice a week. I am not allowed to work more than 23 hours a month. It’s nowhere near my salary as an intern and works out to just R200 ($15) per hour.&#8221;
Prim isn&#8217;t alone. Other medical staff have found themselves scraping by as waiters in Spur, call center agents and estate agents.
Doctor Naira Langenbach works as a stand-in secretary in Johannesburg.
&#8220;The worst part is the unknown. The worst part is that you sit there and ask ‘when are they going to call me?’ I say to myself ‘just breathe, its fine, it&#8217;s going to be alright’,&#8221; says Langenbach.
&#8220;[At the reception desk] I try not to tell people I am a doctor, because I get very indignant, very quickly. I just want to be done with this. As soon as I am given my post I am going to go do my year of community service and then my degree will be worth something. I&#8217;ll probably do an MBA or maybe biomedical engineering. I am not going to do this anymore.&#8221;
<a href="http://www.forbesafrica.com/woman/2017/07/25/carry-child-someone/" target="_blank" rel="noopener">Would You Carry A Child For Someone?</a>
It is worse for Langenbach because she was born in Amsterdam, Netherlands. Despite being educated in South Africa since she was nine years old, she feels she is pushed to the back of the queue.
<div id="attachment_33230" style="width: 235px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-33230" class="wp-image-33230 size-medium" src="https://www.forbesafrica.com/wp-content/uploads/2017/08/Naira-Langenbach-225x300.jpg" alt="" width="225" height="300" />Dr Naira Langenbach (Photo supplied)</div>
&#8220;What bugs me most about this is my degree is the same. It&#8217;s not that I have a dodgy degree. My degree is the same as the people from my year; exactly the same, 100 percent.&#8221;
It isn&#8217;t the first time she has had to work as a secretary either. When Langenbach graduated from university in 2015, she was forced to scrape for work for five-and-a-half months before her international work permit was issued.
&#8220;Last time [I was working for] one of my lecturers, I was helping them out with their accounts. That’s what I ended up doing. It&#8217;s not a good use of my skills. Now I&#8217;m back [where I started].&#8221;
It took a year for Langenbach to get word of a community service post, and when it came she missed it.
&#8220;On Saturday, because I am an orthodox Jew, my phone was off. On Monday morning I get a snotty email saying you didn&#8217;t pick up the phone and you will have to start work on the first of January 2018,&#8221; she says.
Langenbach tracked the caller down but was too late – her post had been given to someone else. The man on the phone promised to resolve the matter. Two days later, on July 11, Langenbach received an email saying she was awarded a post for a hospital in Mpumalanga; she didn&#8217;t even apply for it.
&#8220;I might have been allocated a spot, but I don&#8217;t trust it. There have been a lot of hoax emails going around and I can&#8217;t get hold of anybody to confirm it. I have no proof, no contract, no letter, no nothing.&#8221;
&#8220;I&#8217;m broken. I&#8217;m so defeated. Even when I tried to call Mpumalanga they hang up the phone after three rings.&#8221;
&#8220;You reach a point where you accept [the delay] and say okay I&#8217;m going to [give up], if I start work I start work. But in the meanwhile I think &#8216;am going to become a specimen cutter for Lancet?&#8217; The same week that you resign your hopes, the same week, the national department says they are going to open up applications. This hope that you tucked away is suddenly the size of three houses. Then they crush your hope. And you are back to asking ‘am I doing this again?’&#8221; says Langenbach.
<a href="http://www.forbesafrica.com/focus/2017/05/01/rat-race-silent-killer/" target="_blank" rel="noopener">The Rat Race Against The Silent Killer</a>
Zahid Badroodien, a doctor and chairperson of the Junior Doctor Association of South Africa (JUDASA), says four South African community service doctors, 20 international community service doctors,  139 South African interns and 63 international interns remain unlikely to receive any employment this year because of insufficient posts.
<div id="attachment_33231" style="width: 430px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-33231" class=" wp-image-33231" src="https://www.forbesafrica.com/wp-content/uploads/2017/08/Zahid-Badroodien_JC-5-e1503483209160-300x200.jpg" alt="" width="420" height="280" />Dr Zahid Badroodien (Photo by Jay Caboz)</div>
Badroodien works at the Site C Youth Centre in Khayelitsha, a township 30 kilometers south east of Cape Town, where he sees the cost of the shortage of doctors.
&#8220;This facility sees 200 people a day and we turn people away. We have three or four doctors here depending on the day. We need more people to come into the system.&#8221;
&#8220;As a community service doctor, who works in a clinic on an ordinary day, I am here from 8AM to 4PM every day. My call [at the hospital in Khayelitsha] then starts at 5PM and finishes at 7AM. I am then back at the clinic at 7AM until 12PM. Then I go home. Then I come back the next day and it starts all over again,&#8221; says Badroodien.
This dispute is just one of many complaints by junior doctors about an online system that came in August last year. The system places around 1,200 interns and 400 community service doctors a year.
&#8220;There have been many excuses as to what the problems are. Initially we were told there were technical difficulties with the online application system. Subsequent to that we were told the difficulties were with internship posts, specifically that there weren&#8217;t enough internship posts for the number of applicants that were applying,&#8221; says Prim.
In November, JUDASA cried foul that 307 (of about 1,700) medical students applying for internship had either not been placed or were placed inappropriately.  This included neglecting special circumstances because of a computer glitch which overlooked whether a student is married, pregnant or an owner of property.
The issue dates back to November 2015, when doctors got fed up with the manual paper application system that would regularly lose applications, says Badroodien.
&#8220;What I gauged at that stage was the [DOH] didn&#8217;t really understand the extent to which this impacts doctors&#8217; personal lives, but also the people they needed to serve, the clinics where doctors needed to serve,&#8221; he says.
Beneath the surface there is also an internal battle between the DOH and provinces for the control of posts and placements. Provincial departments, that run the hospitals, make the final call. This means the DOH cannot guarantee whether a province accepts the doctor, once the posts are issued.
The process of acceptance can cause months of delay. Letters of employment are issued by the DOH according to vacancies supplied by provinces. The doctors then have to be interviewed by provinces and then issue contracts, which is the guarantee of employment. Then doctors must travel back to Pretoria to submit the contract of employment, along with the DOH&#8217;s letter of acceptance, to the Health Professions Council of South Africa (HPCSA).
&#8220;There is a lot of bias that comes in. When I was employed as an intern I was approached by a hospital to come and work for them, before I had even applied. That to me is problematic … We all have South African degrees, we all are South Africans, how are you choosing who is better placed for your hospital,&#8221; says Badroodien.
The DOH tells a different story. Aaron Motsoaledi, the Minister of Health, refutes claims that the system has been delayed and has denied the freezing of posts.
He claims that doctors are at fault, turning down positions.
“There are those who were placed in January and they declined those placements, saying they’d rather wait for the next cycle because they are not going to a certain hospital which is too rural or whatever. Others give religious reasons while others quote illness,” says Motsoaledi.
In a statement in January, Motsoaledi also addressed the concerns of JUDASA concerning the freezing of posts.
&#8220;Since the beginning of the year, we have been inundated with media queries about doctors and pharmacists who could not get employment in the public service because the government allegedly failed to place them into posts, or alternatively failed to create posts.&#8221;
&#8220;Despite trying very hard, the department is not always in a position to accommodate all the needs.&#8221;
South Africa needs every doctor it can get; a rising concern is when hospitals are forced to limit posts due to budget cuts.
In a 2016 announcement Motsoaledi said: &#8220;We want to put it on record that there are no medical posts frozen in this country. If there is freezing of posts by government departments, they have nothing to do with medical doctors as posts in the health sector are exempted. The country needs doctors to work in health facilities and therefore there is no way we can put moratorium on medical posts.&#8221;
Although the minister has denied there was a lack of posts, the DOH’s director-general, Malebona Precious Matsoso, told a parliamentary standing committee in March the DOH could not afford to hire the doctors they needed.
In Matsoso&#8217;s presentation she said the healthcare system had 45,733 vacant posts, and 351,925 filled posts. The vacancy number included frozen posts. The situation is so bad that two state-of-the-art buildings in the Free State cannot be opened because there are no health workers.
At the clinic in Khayelitsha, reality hits home. Badroodien says patients come as early as 4AM to queue and, due to the lack of doctors in other provinces, patients will travel more than 600 kilometers for treatment.
&#8220;When a patient from the Eastern Cape comes to our clinic with a broken neck to be seen by a doctor here, you need to say that is unacceptable,&#8221; says Badroodien.
&#8220;The national health department now finds itself at a tenuous junction: Find the money to open posts for medical interns or risk leaving dozens of graduates essentially unemployable,&#8221; says Badroodien.
South Africa’s dwindling economy and recent ratings downgrades could topple the country’s already fragile public health systems, experts have warned. So the next time you are sitting in the hospital and asking where the doctors are, they could be waiting on tables, answering phones or sitting at home.
<h2>Understaffed, Undersupplied, Unhappy</h2>
A 2015 study by research group Econex shows the extent of the health crisis. South Africa had 60 doctors per 100,000 citizens in 2013, while the world average was 152 doctors per 100,000 citizens.
The South African Medical Journal (SAMJ) in June released a report from 2,225 doctors that revealed the most significant reason doctors gave for leaving the public sector was dissatisfaction with working conditions.
The survey showed 60.73% of public sector doctors said the state of supplies was inadequate. Just over 66% of public sector doctors were concerned about the lack of equipment and infrastructure compared to 20.41% in the private sector. Around 38% of doctors in the public sector said hygiene and management was not of a good standard. In the private sector this was only 5.37%.
The report, conducted by the Colleges of Medicine of South Africa (CMSA) that included South African Medical Association (SAMA) members, found further underlying reasons for doctors leaving: immigration, better opportunities in private practice as well as being unable to apply for posts as they were frozen.

Tag: health crisis

FORBES AFRICA SOCIAL MEDIA

Here’s Where You Can No Longer Get An ICU Bed Because Of Covid

Coronavirus Could Be A $12 Billion Hit To Entertainment And Audiences May Never Be The Same

The Waste Of Doctors Waiting On Tables And Answering Phones