/ 29 May 2020

Covid infections among health workers increasing in Eastern Cape

Doctors and nurses were held at gunpoint to stop giving patients treatment.
Health worker infections have risen to 170 at state and private hospitals and two healthcare staff succumb to the disease in a space of seven days. (Paul Botes/M&G)

As the Eastern Cape recorded the death of a second health worker from Covid-19 in less than seven days, healthcare workers in the province are lamenting a critical shortage of personal protective equipment (PPE) and the slow pace of contact tracing once frontline workers test positive.

As of May 26, the number of active cases in both public and private hospitals stood at 170, with the Nelson Mandela Bay and Buffalo City metros showing a significant increase.

The province’s health department says the complaints about personal protective equipment are from “nurses who did not want to work”. 

The death of an administrative clerk at the Life St Mary’s Private Hospital in Mthatha — one of nine employees to contract the virus — has led to an outcry about management apathy at the hospital. 

Several health professionals, speaking on condition of anonymity, said the hospital provided personal protective equipment — masks, gloves, gowns and face shields — only to staff working with Covid-19 positive patients, while the rest had to make do with limited protection. For example, if a patient came in with, say, a broken foot, the person was not screened for Covid-19 and hospital staff, including non-medical employees, were exposed to the person.

The deceased, whose name is being withheld because the Mail & Guardian could not establish whether her family had been informed, worked as an admissions clerk in the hospital’s casualty area. 

She is one of nine workers, including three administrative staff, at the hospital to have tested positive for Covid-19.   

The professionals also spoke of poor contact tracing, the slow pace of getting test results and a limited supply of personal protective equipment as some of the problems at St Mary’s Private Hospital, adding that management was sitting on top of a ticking time bomb.

“She came in contact with a patient who had tested positive at casualty. She did not have PPE, because PPE is only given to people who work in wards where there are positive cases, but casualty is the first point of contact with people whose condition is unknown,” said one source. 

Another said: “In one ward at St Mary’s hospital, two nurses have had positive tests, and there are another five whose results are outstanding since the 18th of May. This group was informed on the 13th that they were in contact with a positive person and it took five days to test them.

“Some of these people are state nurses who moonlight at private hospitals and live with people at home, so you can imagine what is about to happen here,” she added. 

Another person, with direct knowledge of the nursing situation at St Mary’s said: “One of the nurses who was at St Mary’s tested positive, and while the procedure is for the department to visit their homes and assess their living environment [to see whether or not there is a need for quarantine], it’s been a week of her living with her husband and child.

Wednesday’s death of the administrative clerk is the second of a healthcare professional within a week. Matilda Maneli, a nurse at Victoria Hospital in Alice and the wife of the Amathole district municipality mayor, Khanyile Maneli, died in a Stutterheim hospital on Sunday.

An internal department of health report sent to the National Institute of Communicable Diseases noted with concern the rising number of healthcare workers getting infected in the province. 

Sizwe Kupelo, the spokesperson for the provincial department of health, said nurses’ complaints at public hospitals about the shortage of personal protective equipment was a smokescreen by “nurses who did not want to work. We have teams that have gone around the entire province and screened and tested over 30 000 residents, with a return of about 3 700 positive results, and not one of them has tested positive,” he said.

“How does that happen if they don’t have PPE? Our nurses must be honest and remember why they took the oath,” he added.

On the rising number of infections among healthcare workers, Kupelo said: “The increase in healthcare workers being infected is acknowledged and the first nine workers to test positive were directly linked to funerals. To date, there are still very limited chances of contracting the virus within health facilities due to usage of personal protective equipment — notwithstanding the disputed shortages.”

His sentiments on community infections manifesting themselves at healthcare centres was echoed by Life Healthcare Group’s general manager for emergency medicine, Dr Charl Van Loggerenberg, who said there wasn’t enough information to determine whether the Mthatha employee’s death was a result of exposure at the hospital or where she lived because she had been off work when she took ill. 

“Life Healthcare acknowledges and appreciates all frontline employees who are caring for patients during these unprecedented times. We can assure all employees and the community that the safety and health of our healthcare workers and patients remains top priority,” he said.

Van Loggerenberg confirmed that workers at the hospital had tested positive for Covid-19, saying all cases were reported to the department of health, and were treated in terms of the group’s policies on quarantine, isolation and sick leave. 

“All healthcare workers who are in self-isolation are routinely contacted telephonically by a hospital representative, as well as an occupational nurse within the hospital,” he said. “All employees, regardless of whether they are in administration or nursing personnel, are required to wear masks at all times and are provided with the appropriate PPEs as required.

“In addition to masks, social distancing and hand hygiene, protective shields have been installed at reception areas,” he added.

Meanwhile,  Andisile Pampila, the Chris Hani regional chairperson of the Democratic Nursing Organisation of South Africa, said the union was in discussions with two state hospitals, Frontier and Cala, about making the working environment friendly for nurses.

“In Frontier Hospital we have two nurses in isolation that were confirmed positive. One of them has fully recovered but still at home. There was a shortage of gloves, which I think the district had to intervene.

“We’ve got two nurses who tested positive in Cala Hospital as well. The two institutions have indicated they have PPEs and everything they need now. There is a PUI [people under investigation] side that has been closed in Cala Hospital. Those cases have been transferred to Mjanyana Hospital [in Ngcobo]. The department of health is conducting training with the institutions to properly equip staff on ways of applying safety measures,” said Pampila.

A nurse at Frontier Hospital in Komani, who spoke on the condition of anonymity, described working at the hospital.

“Since March, when our first Covid-19 patient came, having personal protective equipment  was our struggle. We fight with management everytime we run out of PPE. They gave us gowns that do not even cover the whole body” she said. “There is no separate entry point for Covid-19 patients here. The patients use the same entry as general patients, [and] in this whole process, three of our staff members also got exposed. Contamination is everywhere in the hospital.”

One source said the shortage of personal protective equipment was linked to supply chain departments around the country reading the treasury’s instruction note on disaster management procurement and saying they could only purchase the more expensive N95 respirator masks, yet there were cheaper masks of the same specification level available. 

But this was clarified by the treasury, which said “government institutions may buy any mask respirators that complies with the national department of health and World Health Organisation specifications”.

“We have not been made aware of  issues in securing PPE related items since the issuance of Instruction No 05 of 2020/2021,” treasury said. 

Competition Commission spokesperson Sipho Ngwema confirmed there was a complaint, from the Eastern Cape, regarding the wording of the instruction note. “National treasury and department of health have no obligation to consult with us when drafting Covid19 regulations,” he said.