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12 staff test positive at third COVID-infected private hospital

Following last week's shut down of Netcare's St Augustine's Hospital in Durban because of a COVID-19 outbreak that claimed five lives and this week's closure to new admissions of the Netcare Kingsway Hospital, outside Durban, 12 staff at Mediclinic Morningside in Johannesburg have tested positive and been placed in isolation.

Mediclinic Morningside staff in Sandton are demanding transparency from their employers after about 12 employees, including seven health-care workers, tested positive for COVID-19. The Star reports that this comes a week after Netcare St Augustines Hospital in Durban was shut down because 66 people, including staff and patients, tested positive for COVID-19 and five people died.

According to the report, a staff member at the hospital, who asked to remain anonymous, said a theatre nurse allegedly had coronavirus symptoms after a caesarean section on a patient last week. “After the C-section the patient got transferred to the post-natal unit but one nurse presented with symptoms and got sick, and that’s when they decided to test everybody. When they tested the mother and the baby, they found both tested positive,” she said.

The report says Dr Stefan Smuts, chief clinical officer of Mediclinic Southern Africa, confirmed that after a staff member tested positive for the virus more than 100 potential contacts were tested, with the majority showing negative results. “Twelve staff members have tested positive, seven are health-care workers. The staff members are all in isolation and will remain so until they have fully recovered,” Smuts said, adding all contacts were being monitored and isolation protocols applied.

Smuts said Mediclinic had internal and external processes guiding the private hospital’s response to the confirmed cases. “In accordance with our stringent protocols, Mediclinic immediately reviewed the situation to identify as a matter of urgency all staff, doctors, and patients potentially exposed. The National Department of Health also has firm processes in place governing contact tracing of those exposed to a positive individual,” he is quoted in the report as saying.

Mediclinic said staff who had tested positive at the Morningside facility were in isolation and that “all contacts are now being monitored”, reports The Times. The hospital group said it “acted swiftly to mitigate the risk to all involved”.

“We can assure the community that we have established procedures relating to staff exposure, the risk thereof and testing,” it said.

And, in a media release Netcare said that its KZN regional team and the hospital management at Netcare Kingsway Hospital was managing the COVID-19 exposure at the hospital, and have temporarily closed the hospital for new admissions.

According to Craig Murphy, regional director of Netcare, the origin of the exposure has been traced to a patient who was admitted to hospital via the emergency department on 4 April 2020 with a suspected stroke. Upon admission, the patient was risk assessed and screened for COVID-19 symptoms and exposure as per the Netcare protocol, which is aligned to the NICD guidelines. The patient did not exhibit any signs of the virus and on questioning his family, no symptoms or exposure risks were reported.

“During his hospitalisation, the patient was visited by his general practitioner on the evening of 7 April who mentioned to the treating specialist that he had recently treated him for flu like symptom on 1 April. The treating specialist requested a COVID-19 test as a precautionary measure even though the patient was still asymptomatic. At the same time, the patient was placed in isolation as a person under investigation (PUI). The test results of the patient came back on 8 April confirming that the patient had a COVID-19 infection.

“In addition to closing the hospital for new admissions until further notice, we have taken several other measures” says Murphy.

“We embarked on an extensive programme of contact tracing so as to identify all nurses, doctors, paramedics, support staff and contract service providers in the hospital who may have had contact with the patient in question. Healthcare and other workers who have been exposed to the patient were asked to home-quarantine and self-monitor. Most of the identified contacts have been tested for COVID-19, the remainder of the exposed persons will be tested in the next few days. All potentially exposed patients have also been tested.”

“All of these individuals – those working in the hospital as well as patients – who have undergone COVID-19 laboratory testing are regarded as persons under investigation (PUIs) and have been placed in isolation to contain the possible spread of the virus. All of our staff, as well as our patients, have been offered counselling and this support will be ongoing.

“The emergency department was closed for outpatients as of 14 April and emergency medical service providers were notified to divert emergencies to other emergency departments.

“The hospital management also promptly communicated the exposure to the doctors practising at the hospital and requested that they cancel consultations and conduct telemedicine or telephonic consultations where possible, or defer their consultations to a later date, in order to restrict access to the hospital.

“Management have taken the decision to close the radiology department at the hospital for any investigations of persons who are not admitted to the hospital until further notice.

“Netcare has employed the services of two independent infectious disease specialists and epidemiologists to assist in investigating this incident at Netcare Kingsway Hospital.

“A systematic deep cleaning and decontamination process was started immediately, including the deployment of an ultraviolet disinfecting robot which has proved highly effective in destroying viruses, bacteria and fungal spores in healthcare facilities. This process is expected to continue over the next days.

“We understand that these precautionary measures will cause concern and inconvenience to the community, especially those with family members or friends being cared for in the hospital, as well as our staff members, doctors and other persons working at our hospital and their families. However, we believe these measures are absolutely necessary to safeguard all patients and persons working at Netcare Kingsway Hospital. The management team are contacting the family members of patients who have been admitted to Kingsway to explain the situation to them.

“The National Health Department is the authority that officially announces information on COVID-19 cases, and we are thus not in a position to provide specific information on the exposure at the hospital. We are working closely with the KZN Health Department (KZN DoH) with regard to the situation at Netcare Kingsway Hospital. We will provide more specific details after meeting with the KZN DoH”, confirmed Murphy.

“All persons whose test results are still awaited are regarded as PUIs and are either in self-isolation or are being accommodated in isolation by Netcare until such time as their test results are known, after which a decision will be made regarding staff members as to their return to work or continued self-isolation.

“PUIs and confirmed COVID-19 patients in Netcare hospitals are separately isolated and cared for either in isolation rooms or isolation cubicles, with doctors and nurses wearing appropriate personal protective equipment specific to the risk associated with each individual each case, and following Netcare’s protocols to prevent the spread of the infection to other patients and others working in the hospital.

Commenting on the development, Dr Anchen Laubscher, group MD of Netcare said that two of the greatest challenges associated with COVID-19 are that those infected do not always show or have any of the symptoms, and the fact that the virus is highly infectious, notwithstanding the absence of any symptoms.

“Even in the presence of extensive and effective infection prevention measures, such as those in place within Netcare hospitals, any workplace or gathering of people poses a potential risk for infection. Unfortunately, it has been shown that COVID-19 can be transmitted by carriers before they show symptoms that can be screened for, and where one person is contagious, the virus can very quickly spread to others.

“For this reason, Netcare took the decision a number of weeks ago of suspending visiting and public entry to its hospitals except in specific exceptional circumstances and closed its in-hospital pharmacies’ retail services to the public as well as its coffee shops. Daily screening of all persons entering our premises is also continuing, and where indicated, testing is then done,” notes Laubscher.

According to Laubscher, Netcare is sparing no effort or cost to keep every person in its care, as well as staff and doctors, as safe as possible.

“Netcare has already spent R150m to enhance the readiness of its ICU and high care facilities, including purchasing additional ventilators, and we are also deploying more ultraviolet disinfection robots and specialised air filters to ensure appropriate disinfection measures,” she notes.

She adds that Netcare has so far also spent R300m on additional, appropriate personal protective equipment (PPE) to supplement its stocks for staff and healthcare colleagues to ensure their safety while they work in the front line combatting the pandemic.

“Staff members and doctors at Kingsway Hospital, and those at all other Netcare facilities, have all been provided with appropriate PPE on an ongoing basis. Our PPE policy includes a directive on the wearing of masks during the COVID-19 pandemic which is, in fact, more conservative in that it provides greater protection than the current recommendations and guidelines of two highly respected health organisations, namely the World Health Organization (WHO) and the National Institute for Communicable Diseases (NICD).

“We wish to reiterate again that no Netcare facility has ever expected of a staff member to work without appropriate PPE as that would be contrary to our values. Importantly, we have re-trained over 20 518 healthcare workers, other staff members and doctors on the appropriate and correct use of PPE, and compliance in this regard is being closely and continuously monitored,” Laubscher said.
Issued by: MNA on behalf of Netcare

The Netcare St Augustine’s Hospital in Durban has been temporarily shut down by KwaZulu-Natal’s Health Department, following an outbreak of more than 60 confirmed cases of COVID-19 linked to the private hospital. This was confirmed by provincial health MEC, Nomagugu Simelane-Zulu, in a briefing together with KwaZulu-Natal Premier Sihle Zikalala on Wednesday of last week. But, City Press reports, doctors and surgeons say they are being ostracised by other private hospitals in the province.

Mkhize said that Simelane-Zulu had been instructed to initiate investigations on protocols in place at other private hospitals in the province after several complaints were lodged with the department. There are currently 58 patients at St Augustine’s, a 464-bed hospital, who cannot be transferred. There are also outpatients who have no option but to continue visiting the hospital’s renal care unit, which is based in a building on the precinct but has its own entrance.

The report says the COVID-19 Ministerial Advisory Committee head Salim Abdool Karim and a team of epidemiology and infectious diseases specialists from the University of KwaZulu-Natal were dispatched to St Augustine’s to investigate the underlying cause and nature of the COVID-19 outbreak.

A health worker based at St Augustine’s is quoted in the report as saying that Netcare had been among the most proactive group in implementing protocols with regards to COVID-19. However, no one had experienced this before, said the source. “The public must remember that a few weeks ago there were not enough test kits in the country and patients still came to the hospital for a variety of reasons. The guidelines for testing were different to what they are now,” said the health worker.

“If patients did not fit the profile, they were treated as normal patients. To blame nurses for not following protocols is misplaced.”

The health worker said that even in the best hospitals, mistakes were bound to happen. “In 10-days’ time, what happened at St Augustine’s could very likely happen at any number of government hospitals. But government’s persistence in somehow making out as if private hospitals are the weak link is wrong. It is well known that the public health sector is close to collapse, and that is without this current crisis.”

The report quotes the health worker as saying most of the hospital had already been decontaminated. “Recently, the hospital built two new intensive care units. The COVID-19-positive patients are in one of them. In the wards there is strictly one patient to a room. All patients are being seen to by nurses in personal protective equipment and nursing staff are doing a deep clean.

“There are two ultraviolent R-Band robots cleaning the hospital. These machines completely sanitise any area. The hospital has had one of these machines for nearly two years, while another one was brought in recently. There may be a lot of frustration towards the hospital management for their poor communication to the staff during this crisis, but they have not been negligent.”

According to a Sunday Times report, doctors, nurses, patients and their families are demanding to know why staff fighting the coronavirus pandemic were left unprotected at the hospital. The report says after Mkhize’s announcement, nurses and doctors, as well as their unions, accused the hospital of mismanagement and flouting standard infection-control procedures.

The report says although Netcare strongly denies this, health workers at the hospital alleged that it failed to provide them with proper protective gear, refused to allow them to wear masks in case they frightened their patients, and did not tell them which ward the COVID-19 patients were being treated in “until it was too late”. Already, one nurse employed at Durban’s flagship government hospital, Inkosi Albert Luthuli Central Hospital, and who works at St Augustine’s for extra money, has tested positive for COVID-19. The provincial health department is now awaiting the results of 40 other nurses at Inkosi Albert Luthuli with whom she had been in contact.

And, the report says Mkhize and his department are bracing themselves for the figures to rise further as they await a list of agency nurses who came into contact with infected staff so that they, their colleagues and their families can also be traced and tested.

Health workers and their unions at St Augustine’s also charged that management failed to tell them that they were treating patients with COVID-19 or to ensure that doctors and other medical staff who had travelled to the UK and US self-isolate for 14 days before returning to work.

Netcare vehemently denies the allegations, saying it was the first private healthcare provider to implement preventative measures including screening patients and visitors, sealing off multiple entrances, limiting visiting hours and closing hospital pharmacies and coffee shops. Netcare group medical director Dr Anchen Laubscher said a full epidemiological report will shed light on what happened.

The report says Laubscher denied that nurses were kept in the dark when a COVID-19 patient was admitted, saying they “immediately communicated this” to the health department and National Institute of Communicable Diseases (NICD), and that 30 nurses were subsequently tested.

Mkhize said an ongoing investigation into the allegations of non-compliance at the hospital in Durban will reveal how and why the nurses tested positive for COVID-19. According to a Sowetan report, Mkhize reaffirmed that the hospital had been closed, following his announcement earlier this week that 66 people at the private facility had tested positive for the virus. Forty-eight were nurses.

“That's a very large number of staff to be infected at a popular institution. Therefore, we have asked that the provincial government must institute an investigation in terms of why (and) how we ended up with so many people infected in one place – particularly if it's professionals,” he said. He said the St Augustine's issue was “more serious” to the department because the first people they needed to ensure were safe and protected, were the health workers.

“One of the weaknesses in the private sector is that they sometimes have staff who are not fully employed – they are moonlighting – so there might be a break in the chain of information flow,” Mkhize is quoted in The Times as saying.

Moneyweb reports that there are conflicting reports in terms of the number of staff and patients at the hospital who have tested positive for COVID-19. Both Mkhize and Simelane-Zulu have said that 66 confirmed cases are linked to the hospital, including 48 staff.

However, the group’s CEO Dr Richard Friedland said 47 of the hospital’s staff had tested positive and 15 current patients were being treated for COVID-19. A staff member and a patient within these numbers had recovered and have since tested negative.

The report says Friedland also confirmed that the hospital had four deaths associated to the virus since South Africa’s first case was reported in KwaZulu-Natal on 5 March. However, during her address on Wednesday night, Simelane-Zulu said five COVID-19 deaths are linked to the hospital.

Meanwhile, the Public Servants Association (PSA) has criticised disciplinary action launched against eight emergency medical services (EMS) employees who refused to assist a COVID-19 patient. The employees are based at Grey’s Hospital, Pietermaritzburg, notes a TimesLIVE report.

The PSA said the employees were on night-shift duty, which starts at 7pm, and were informed by the shift supervisor that a patient in Northdale had tested positive for COVID-19 and had to be transported to the hospital by ambulance. “They then raised serious concerns with the supervisor as there was no personal protective equipment (PPE) supplied. They also raised concern about the fact that they never received training on handling COVID-19 patients,” said the association. It claims discussions were held with the workers’ seniors before a decision was taken to charge all eight employees for failing to take a lawful instruction.

However, the KZN Health Department said this was untrue and an exaggeration. “We can confirm that this is an old misunderstanding that has long been exhausted, which certainly does not warrant this level of distortion of facts and grandstanding,” said spokesperson Ntokozo Maphisa, adding: “Allegations concerning the ‘non-training’ of EMS personnel or their purported lack of access to PPE are not true.”

[link url="https://www.iol.co.za/the-star/news/staff-at-mediclinic-morningside-in-sandton-fearful-after-12-employees-test-positive-for-covid-19-46670696"]Full report in The Star[/link]

[link url="https://www.timeslive.co.za/news/south-africa/2020-04-14-12-mediclinic-morningside-staff-contract-covid-19-100-potential-contacts-tested/"]Full report in The Times[/link]

[link url="https://city-press.news24.com/News/inside-the-hospital-of-death-st-augustines-battles-covid-19-stigma-20200412"]Full City Press report[/link]

[link url="https://times-e-editions.pressreader.com/@nickname11468100/csb_TPpo_OHAiOapNFF39zJi-sVksisSA6VlWJS35b6wsZ9fDuJElmk8CzoQRv3T9sN7"]Full Sunday Times report (subscription needed)[/link]

[link url="https://www.sowetanlive.co.za/news/south-africa/2020-04-10-how-and-why-mkhize-orders-probe-into-how-48-nurses-tested-positive-for-covid-19-at-durban-hospital/"]Full Sowetan report[/link]

[link url="https://www.timeslive.co.za/news/south-africa/2020-04-10-how-and-why-mkhize-orders-probe-into-how-48-nurses-tested-positive-for-covid-19-at-durban-hospital/"]Full report in The Times[/link]

[link url="https://www.moneyweb.co.za/news/companies-and-deals/covid-19-kzn-health-dept-shuts-down-netcare-st-augustines-hospital/"]Full Moneyweb report[/link]

[link url="https://www.timeslive.co.za/news/south-africa/2020-04-14-union-slams-kzn-health-department-after-workers-suspended-for-refusing-to-treat-covid-19-patient-without-ppe/"]Full TimesLIVE report[/link]

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