Medical expert to investigate Covid-19 outbreak at St Augustine's hospital

Acclaimed epidemiologist Prof Salim Abdool Karim will lead an investigation into the outbreak of the coronavirus at St Augustine's hospital in Durban.

This was revealed in a statement from Netcare management on Wednesday who moved swiftly to deny that medical staff and employees at Durban’s St Augustine’s hospital — at which 66 people have tested positive for Covid-19 — were not given appropriate personal protective equipment.

In the statement, in response to health minister Zweli Mkhize’s announcement  and concern at the situation at the hospital on Tuesday, Netcare CEO Dr Richard Friedland, said the hospital was “deeply saddened that, despite our very best efforts and precautions, there have been a total of four Covid-19-associated deaths” there.

Friedland said a number of measures have been implemented at the hospital including sanitisation, swabbing of almost 2,000 employees and working with acclaiming epidemiologist Prof Karim to investigate the underlying cause and nature of the outbreak.

He said contrary to certain misleading claims, staff members and doctors at the 464-bed hospital — regarded as one of the flagship private hospitals in the country — had been provided with appropriate personal protective equipment (PPE). 

“No Netcare facility has ever expected a staff member to work without appropriate PPE. 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 Organisation (WHO) and the National Institute for Communicable Diseases (NICD).

“In addition, we have retrained over 16,750 health care workers, other staff members and doctors on the appropriate and correct use of personal protective equipment, and compliance in this regard is being closely monitored.

“Since the spread of infections began as a result of two patients, who were admitted for other medical reasons and initially had no travel history or symptoms of Covid-19 but subsequently tested positive, we have been in close consultation with the KZN DOH and the NICD and continue to strictly follow their guidance and instructions,” said Friedland.

He added the clinical team was working closely with Karim, a special adviser to the minister of health, and a team of epidemiology and infectious diseases specialists from the University of KZN, to fully investigate the underlying cause and nature of this outbreak.

He said the hospital has a total of 15 pre-existing community acquired Covid-19 patients in its dedicated Covid-19 isolation units at present and that one person had recovered and was due to be discharged.

“Of the staff and doctors tested, we confirm that 47 people who are connected with our hospital have tested positive for Covid-19. Of the 47 positive cases, 33 are in self-isolation and a further 14 are being accommodated by Netcare to ensure that they are able to safely self-quarantine. Of those who tested positive, one person has since tested negative following his period of self-quarantine and has since returned to work.”

Friedland said challenges associated with the virus — that people infected didn’t always display symptoms and that it was highly infectious — made it difficult to address and it was for this reason extraordinary measures, including suspending visiting hours and closing its pharmacies and coffee shops were implemented.

“The ideal would be if all health care facilities could test, and not just screen, every person coming into our hospitals, and to do that on a repeat basis as some may at first test negative. The reality in SA, however, makes this impossible, so the risk remains of Covid-19 entering our hospitals, and any other hospitals, in this way despite our best efforts to prevent this from happening,” Friedland said.

He said additional measures were implemented including:

• Closing the hospital’s emergency department effective April 2 and cancelling all planned surgery and admissions cancelled until further notice;
• Decontaminating and disinfecting the hospital since April will continue. In addition precaution terminal cleaning using a high dosage of chlorine, followed by disinfection with the aid of ultraviolet disinfection robots is being done. This will be completed by Thursday;
• Testing of the 1,982 people working at the hospital — including health care workers, nurses, contractors and doctors. More than half of these individuals have already been swabbed. Thus far, a total of 504 people have tested negative and we are awaiting the results of a further 318 people. These results are reported on a daily basis to the head of the KZN department of health’s (DOH) Covid-19 task team;
• Tracing all patients who were treated at the emergency department or admitted into the hospital as from March 1 2020;
• Establishing a dedicated 24-hour communication channel to manage queries, as well as to answer other concerns which our patients may have, has been set up.

He said the group was mindful of the concerns about the “serious situation” at the hospital.

“Our deep and heartfelt thanks go to all our health care workers, nurses and doctors and their families and loved ones for their incredible efforts under these very trying and challenging circumstances. We salute their efforts and remain deeply grateful to them all,” said Friedland.

Meanwhile, KZN health MEC Nomagugu Simelane-Zulu said her department had to put it's foot down and close the hospital as a precaution after discovering irregularities in how Covid-19 cases were being reported to the government.

"The biggest issue that got us worried was the fact that the cases we got from there were not cases that had initially been reported. These were cases that were admitted to the hospital without being tested properly for Covid-19 and they were put in a normal ward and tested for pneumonia instead of following proper protocol and testing for Covid-19," she said.

"We decided to randomly test not even patients at the time we decided to test their health care workers and out of the first 20 we tested, 11 came back positive. We have tested everyone and already we are on 48 health care workers that have been exposed," she added.

On Friday, following three Covid-19 deaths within 72 hours, the hospital decided to close its trauma unit and halt admissions. This was followed by mass screening of all staff and patients.

"We tested everybody and we are still awaiting the results of about 90 people. We need to test all the patients that are there regardless of why they are in the hospital. Those whose results come out negative will have to be moved to other hospitals but those whose results come out positive will have to stay in the facility and be treated there," said the Simelane-Zulu, adding that the same applied for health workers who tested positive.

She said the hospital would then be fumigated.

Simelane-Zulu did not mince her words about her department's dismay regarding the number of deaths at the hospital. Out of the seven deaths in the province four were from St Augustine's.