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Forced quarantine of 2 Limpopo doctors causes dismay

The forcible quarantining in a Limpopo hospital of two women doctors who had been self-isolating has caused dismay, writes MedicalBrief. Health MEC Dr Phophi Ramathuba's actions, seemingly contrary to the guidelines of the World Health Organisation and SA's National Institute of Communicable Diseases, came after she blamed them for “bringing the virus into my province to infect my rural people”, according to a recording that Maverick Citizen heard.

The SA Medical Association (SAMA) and two Limpopo doctors who were forcibly moved to the TB Hospital in Modimolle to be quarantined for COVID-19 are challenging the government in the Limpopo High Court. According to a Beeld report, attorney Llewellyn Curlewis confirmed that Drs Claire Olivier and Taryn Williams had filed opposing papers in the High Court where an interim order for their incarceration was issued last week.

If the government doesn’t agree to release them, the duo will return to court to seek a discharge of the interim order.

Meanwhile, health organisations and activists have condemned their treatment as a “violation of their human rights” and warned that it may discourage people from testing for COVID-19 and “drive the virus underground”.

According to a Daily Maverick report, Olivier and Williams have been locked in isolation wards in the Modimolle Multi-Drug Resistant TB Hospital since Thursday 2 March. This was after Health MEC Dr Phophi Ramathuba got a court order to remove them from their home and take them into quarantine in the hospital.

Neither doctor was able to get a COVID-19 test at Mmamethlake Hospital, where they work, because they did not satisfy the strict testing criteria. However, Williams was worried about her dry cough so she got tested at a private laboratory, which confirmed she had COVID-19, last Sunday. Olivier then tested and was confirmed with the virus the following day, and both have been self-isolating at the home that they share.

They informed their hospital, which is in Mpumalanga, of their test results and also spoke to Ramathuba last Wednesday. The report says according to a recording, Ramathuba blamed them for “bringing the virus into my province to infect my rural people”.

The report says at no stage did Ramathuba tell them they would be held in forced quarantine, yet the following day a contingent of EMS officers and police arrived at their home with a court order to remove them to the isolation wards of the MDR TB hospital.

Limpopo Health decided last week to forcibly quarantine all those with COVID-19 – something that has not been done in any other country in the world. But the Treatment Action Campaign (TAC) national chair, Sibongile Tshabalala, questioned the wisdom of the MEC’s approach. “Health workers are on the frontline of this pandemic and they are playing an important role. We know that there is not enough personal protective equipment (PPE) for health workers so I don’t know how the MEC can blame the doctors for getting infected,” said Tshabalala.

“Much as the MEC may have been thinking that she was doing the right thing, she should not have forcefully put them in isolation,” added Tshabalala. “She should have talked to them to see if they could self-isolate at home. Just forcefully removing them is unconstitutional and it is a violation of their human rights.”

Veteran HIV activist Dr Vuyiseka Dubula warned that the MEC’s actions would “fuel fear after people test positive”.

Dr Mark Human, chair of SAMA’s human rights, law and ethics committee, said the doctors were asymptomatic and followed the national guidelines developed by the National Institute for Communicable Diseases (NICD). SAMA, which represents the doctors, had received a “groundswell of support with offers of financial and legal support”, added Human. “These are medical doctors and they know what they should and should not do,” said Human. “They followed the guidelines to the letter. They are relatively well and were self-isolating. Taking them from home into forced quarantine is an abuse of limited hospital resources and a waste of time for everyone concerned, from EMS to the judge that had to hear the matter.”

The report says the Mpumalanga Health Department had not responded to queries about whether the doctors’ recent patients had been traced and tested at the time of publication.

SAMA has accused the department of not following World Health Organisation (WHO) protocols, and said it was engaging with Minister of Health Zweli Mkhize to intervene for their release. The Mercury reports that in an open letter, SAMA chair, Dr Angelique Coetzee, appealed to Limpopo Health MEC Phophi Ramathuba to rescind the court order that the Health Department had obtained to force the doctors into quarantine, and to allow them to self-isolate at home.

Head of Limpopo Health, Dr Thokozani Mhlongo, said Limpopo had taken a “uniform” approach to quarantining anybody who tested positive for the virus, as it was not possible to monitor self-isolation.’ She said 20 people had tested positive for the virus in the province, and that the MEC had nothing to do with the quarantining of the doctors and two nurses.

She said the department was forced to get a court order because the doctors had advised they would not move without one. Coetzee said the doctors, who live in Limpopo and work at Mmametlhake Hospital in Mpumalanga, had tested positive for COVID-19 at a private hospital in Bela Bela on 29 March.

Coetzee reportedly told The Mercury they had a problem with the forced quarantine as it was a violation of their human rights, not in line with WHO protocols and meant they were using health facilities that could be required by sick patients. Mkhize’s spokesperson, Popo Maja, said he was not in a position to comment as the Minister was still consulting on the issue.

Coetzee condemned the two doctors' treatment in the letter, reports News24. "The resulting court action you embarked on to force these doctors into a provincial facility, and the manner in which these doctors have been treated by yourself and certain healthcare staff of the province, is most unsettling," she said.

"You (Ramathuba) informed them that they had brought the virus to the people of Limpopo, and that they should have stayed where they were at the time, despite their explanation that they work in Mpumalanga but live in Limpopo.

"Further to this, you informed the doctors that since they don't work for the Limpopo provincial health department, they should go back to where they are employed. They were further told they can self-isolate anywhere they want, just not in Limpopo."

Coetzee explained in the letter that it was misleading of Ramathuba to suggest the virus was linked to economic status and ignored available research. "This approach also politicises the spread of coronavirus at a time when the exact opposite approach is required."

“What is of greatest concern, however, is that your approach seemingly negates that of national government which is calling for strict self-isolation instead of hospitalisation, particularly of those who are asymptomatic.

"At a time when beds, equipment, PPE, medicines, and human resources are at a premium, surely those who can self-isolate within the parameters should be allowed to do so?"

Coetzee added this approach by Ramathuba would have "unintended consequences".

The report says Ramathuba slammed the letter, saying the health department had taken a decision to take everyone who tested positive to an isolation site due to some patients not complying with the "rules of self-isolation".

"The government has taken these kinds of decisions due to the appreciation of the material conditions on the ground considering the rurality and the limited resources in the province to do whatever it takes to arrest the spread of this virus before it can reach the ICUs and the wards. To this end, the department took a decision that this can be done by screening, testing, quarantining and isolating all those who need to without fear, favour or prejudice," Ramathuba said.

Coetzee, however, is quoted in the report as saying this was an abuse of power.

[link url="https://www.netwerk24.com/Nuus/Hof/hofstryd-dreig-oor-2-modimolle-dokters-in-isolasie-20200406"]Full Beeld report (subscription needed)[/link]

[link url="https://www.dailymaverick.co.za/article/2020-04-07-quarantined-covid-19-doctors-to-know-fate-on-wednesday/?utm_medium=email&utm_campaign=Afternoon%20Thing%20Tuesday%207%20April%202020%20Pan%20MacMillan&utm_content=Afternoon%20Thing%20Tuesday%207%20April%202020%20Pan%20MacMillan+CID_96c4a1fe8830689f6613874dd3632a32&utm_source=TouchBasePro&utm_term=Doctors%20challenge%20forced%20quarantine%20in%20Limpopo"]Full Daily Maverick report[/link]

[link url="https://www.iol.co.za/mercury/news/durban-family-receives-death-threats-after-news-of-fathers-covid-19-results-go-viral-46371336"]Full report in The Mercury[/link]

[link url="https://samedical.org/cmsuploader/viewArticle/1112"]SAMA open letter[/link]

[link url="https://www.news24.com/SouthAfrica/News/watch-2-doctors-allegedly-forced-into-quarantine-after-claim-of-bringing-coronavirus-to-limpopo-20200403"]Full News24 report and video[/link]

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