Healthcare workers are sounding the alarm as life-saving protective equipment runs critically low in facilities across South Africa, and the world, due to increased demand created by the Covid-19 pandemic. 

As the number of cases in the country continues to rise during the unprecedented 21-day lockdown, the Democratic Nursing Organisation of South Africa (Denosa) told Spotlight that nurses were frustrated, and in dire need of personal protective equipment (PPE).

Denosa’s plea comes as the Business for South Africa’s (BSA) Public Health Workgroup also issued a desperate call for businesses to pool their resources and divert stock of the critically needed equipment for the country’s healthcare sector. 

BSA in a statement noted the country has faced shortages of PPE since January, and stock continues to be affected in light of export restrictions, increased costs and disruptions in logistics.

Stavros Nicolaou who leads the BSA’s Public Health Workgroup said: “We appeal to all South African businesses, whether large or small, to unlock their stocks in the best national interest.” 

Nurses on the frontlines

“Our nurses are not going to expose themselves, to work in an environment where they are not being protected,” Denosa General Secretary Cassim Lekhoathi told Spotlight.

“Just as the president addressed the troops, we are saying our nurses are on the frontlines, and they are not asking for guns, all they are asking for is the protective gear, and then as nurses we will do what we do best, which is to fight and ensure our communities are safe,” he added. 

Lekhoathi told Spotlight that nurses were becoming increasingly frustrated that as well as not being provided with PPE, their employers seemed to be unable to give them answers as to when PPE would be available. 

“Why can’t they disclose as to why they are having a challenge of securing the protective gear, because our nurses are not prepared to risk their lives,” said Lekhoathi. 

“As nurses, we have fought various battles and succeeded in them, including HIV. But we will not expose ourselves and the lives of our families. As nurses we come out clear and tell the communities out there that [nurses] must not be viewed as refusing to perform their function, [because] we need to be protected.”

“We are the ones who need to protect them and save their lives. You can imagine if those nurses who are on the front lines, being the ones who need to be quarantined, [and] there are already existing shortages of nursing personnel, it’s going to be a disaster.” 

More issues than masks

Lekhoathi further told Spotlight that along with shortages of PPE and staff, nurses were also concerned about the lack of water in rural health facilities across the country. 

Two weeks ago, Minister of Human Settlements, Water and Sanitation, Lindiwe Sisulu, announced that water provisions, such as tanks and stand pipes, for rural and informal areas would be drastically increased as a means to further fight the pandemic. She further instructed the department to investigate other possible solutions. 

“There is no fake news here,” said Lekhoathi, “unless you say it is fake that people don’t have running water, or it is fake that our nurses don’t have protective gear.”

“The [case] numbers are not stopping, and hopefully with this lockdown people are getting the message and they will comply and confine themselves and follow all the necessary health guidelines,” he said. 

Spotlight approached Health Minister Dr Zweli Mkhize for comment but he did not provide any by time of publication.  

Spotlight will publish any further information from the minister as it becomes available. 

WHO guidelines on PPE

The World Health Organisation’s (WHO) guidelines for personal protective equipment (PPE) state that unless a person is in direct contact with a confirmed or suspected case of Covid-19, PPE is not required. PPE can consist of a surgical or N95 respirator mask, gloves, a face or splash shield, gown or apron, eye protection and closed shoes or boots. 

Healthcare workers

For healthcare workers examining patients with respiratory symptoms, full PPE is recommended. Should the patient not display respiratory symptoms, the WHO recommends healthcare workers use standard precautions. Patients with respiratory symptoms are also recommended to be given a surgical mask. 

In the waiting area of a health facility, administrative staff are not required to wear any PPE, and nor are patients without respiratory symptoms. However, should a patient in a waiting area be displaying symptoms, the WHO recommends that they be given a surgical mask and removed to an area of isolation or separated from others at a distance of at least one metre. 

In a hospital isolation area, where confirmed Covid-19 patients are cared for, as well as a personal patient room, healthcare workers and cleaners are urged to wear full PPE.

Community caregivers and the public

For communities, it is recommended that caregivers working directly with confirmed cases use a mask, gloves and an apron. For those that might be entering the patient’s room or home, a medical mask is recommended. 

Members of the public who do not display respiratory symptoms, and are visiting public spaces like shopping centres or using public transport, do not need any PPE. Instead, measures such as hand washing, sanitising, coughing/sneezing into one’s elbow, avoiding contact with others, spatial and social distancing are recommended. 

Tracing teams

For tracing teams, the WHO states that workers only need PPE when in direct contact with a confirmed or suspected case of Covid-19, similar to protocols in healthcare facilities. Tracing teams are recommended to first speak with contacts over the phone or via video call. If an in-person meeting is required, to make sure it happens outside, with a metre between each person. In this instance, suspected cases should wear a mask. 

For asymptomatic patients, tracing teams do not need to wear PPE, and are encouraged to keep a one-metre distance. If the interview cannot be held outside, it is recommended that workers use a thermal imaging camera to ensure the patient does not have a fever before entering their home. 

Know the difference: surgical versus N95 mask

In terms of masks, the guidelines state that a surgical or medical mask is sufficient, unless performing aerosol-generating procedures such as intubation. In this case, a N95 or respirator mask is required to ensure smaller respiratory droplets do not enter the healthcare worker’s body. The WHO also confirms that Covid-19 is spread through respiratory droplets, and is not airborne. 

According to the Centres for Disease Control (CDC), the difference between a surgical or medical mask and a N95 or respirator mask are the ways in which it filters different sized particles and droplets. A surgical or medical mask cannot filter small particles or droplets, whereas a N95 or respirator mask can. 

A N95 or respirator mask fits more tightly on one’s face and comes in various sizes, whereas the other masks are one size and are not as tightly fitting. All of these masks are single-use, and must not be reused after a prescribed time limit. The CDC recommends that surgical or medical masks be changed after each patient, and N95 masks be changed after they become dirty or damaged

The WHO notes that all PPE must be disposed of properly, so as to not further spread the virus. 

Private sector in better condition

Spotlight approached the three private hospital groups, Life Healthcare, Mediclinic and Netcare, for comment on shortages of PPE in their facilities. While Mediclinic and Netcare do not appear to be facing an immediate issue, both hospital groups are taking extra steps to ensure stock is available. 

Dr Anchen Laubscher, Group medical director of Netcare, told Spotlight that at this point, Netcare did not foresee a shortage of PPE stock.

“The safety and well-being of our staff, and especially our frontline nursing staff members, are of paramount importance to us. Appropriate personal protective equipment is provided to our staff members, and protocols are in place which staff members should adhere to, in order to protect them from the risk of Covid-19 infection,” she said.

While private hospitals may be better stocked with PPE, Dr Stefan Smuts, chief clinical officer of Mediclinic Southern Africa, told Spotlight that the global supply shortages presented a challenge to the industry as a whole. 

“The levels of PPE are constantly being monitored as the safety of our patients as well as staff and doctors is of the utmost priority. Our procurement teams are utilising new and existing channels to ensure predicted stock demands are met,” added Smuts. 

Life Healthcare did not respond by the time of publication. 

How to help

Businesses and others who have PPE stock and are available to assist with the BSA’s call, can email [email protected]. Businesses are requested to state what stock they have, the quantity, manufacturer/brand, whether the stock is sterile (the BSA will sterilise) and their location. MC

This article was produced by Spotlight – health journalism in the public interest.