CORONAVIRUS PERSONAL PROTECTIVE EQUIPMENT SHORTAGE

It’s a global crisis and SA doctors’ and nurses’ lives are on the line

By Pauli Van Wyk 7 April 2020
Caption
Doctors wearing personal protective equipment (PPE) tend to a patient on board a TGV high-speed train equipped with intensive care units (ICU) as patients are transferred for continued healthcare at hospitals outside the French capital, at Gare dAusterlitz railway station in Paris, France, on Sunday, April 5, 2020. Photographer: Nathan Laine/Bloomberg via Getty Images

The South African Department of Health finds itself being squeezed between a worldwide shortage of protective gear and healthcare workers threatening to down tools if they have to continue treating patients while putting their own lives at risk. The pandemic has put an immense strain on local stockpiles of masks and other protective gear and the increase in demand is showing no signs of slowing.

South Africa has three to four weeks of personal protective equipment (PPE) left, an inventory by Business for South Africa’s (BSA) Public Health Workgroup found. The situation changes for better or worse with every new consignment of PPE secured or every ill-considered word uttered by politicians.

The coronavirus is spread through contact with contaminated surfaces and respiratory droplets expelled in sneezing or coughing. The correct use of PPE by frontline medical staff blocks transmission from infected patients to healthcare workers. PPE includes goggles, visors, aprons and gloves. 

Orders have been placed with PPE manufacturers in China and, if all goes according to plan, new consignments will bring some relief to thousands of doctors, nurses and laundry workers.

The private and public sector holding hands

Pharmaceutical company Aspen’s Stavros Nicolaou, who leads the Public Health Workgroup for BSA, says his team works in conjunction with the Department of Health and has a “clear line of sight of PPE stock”. 

“South Africa hasn’t run out of PPE kits,” he said.

The BSA was formed to fight the economic, social and health impacts of Covid-19 on South Africa and comprises institutions including organised business bodies and companies like Business Unit South Africa (BUSA) and the Black Business Council.

According to Nicolaou “we have about three to four weeks worth of PPE kits available. The situation is fluid and changes along with every new situation. What we see (from complaints being aired by medical staff) is probably PPE kits being rationed by hospitals for when they are really needed.”

When quizzed on the national projections for the number of ventilators and PPE kits needed, government, BSA and private facilities have been reluctant to speculate. Spokespeople working in government and private hospitals and clinics declined to provide their figures “in the interest of not spreading panic”, while at the same time asking not to be quoted.

Department of Health spokesperson Popo Maja claimed it was “impossible to project the amount of equipment we will need for the country”. Industry specialists disagreed with Maja’s assessment, saying that multiple estimations had been done and that none were encouraging.

Nicolaou stressed that there was a global shortage of PPE kits and that every country was vying for the same supplies. US President Donald Trump has admitted that his nation will experience its “toughest” week yet. Last week Trump said the federal stockpile was almost depleted of PPE. In New York City medical staff reported that some hospitals were running out of medication and PPE while New York governor Andrew Cuomo, in a briefing on Sunday, told the nation that scarce medical equipment would have to be shared and transported between cities and states. 

Neither Italy nor Spain are out of the woods either. By the morning of Monday 6 April, deaths due to Covid-19 in these three countries accounted for more than half the world’s fatalities.

Locally, BSA’s Health Workgroup has initiated projects to boost local manufacturing, secure consignments of PPE from companies in lockdown, ensure the importation of PPE and ventilators is prioritised, and to remove any logistical bottlenecks preventing PPE from reaching places where it’s needed.

Even though they are in lockdown, companies in sectors like manufacturing, forestry and agriculture, construction, milling, spray painting and mining have been asked to check their stockpiles of protective gear and contact BSA to find ways for the equipment to be fed into the national health system. 

“This will literally save lives and ensure that our medical workers can continue treating us,” Nicolaou said.

(Companies can email [email protected] to find out how they can help – Ed)

The call comes as unions and organisations warn that medical staff cannot be forced to treat patients infected with Covid-19 if they’re not issued with the necessary protective gear to shield themselves from infection. 

Since the first coronavirus case was diagnosed in South Africa in March, hospitals have started drafting protocols of the standards of PPE to be worn during procedures and care-taking shifts. The heightened insecurity around the availability of PPE has resulted in some medical workers choosing to “hide” their PPE stockpiles while hospitals and clinics begin rationing PPE availability, several medical staff and private-sector manufacturers told Daily Maverick. The disruption of logistics and distribution lines due to the lockdown has increased the perception that the country is running out of PPE.

The country’s largest public-sector union Nehawu and the Democratic Nursing Organisation of South Africa (Denosa) sounded the alarm early in April, saying frontline workers, especially in clinics and rural areas, were complaining about having little or no protective gear.

Nehawu filed an urgent application with the Labour court in Johannesburg against the ministers of health and labour, the department of health and all nine provincial MECs for health in an attempt to force the government into “meaningful” discussions with the union over PPE. Denosa says it will follow suit if a consignment due to be delivered and distributed this week is insufficient or fails to arrive. Denosa is also drafting a report to government listing complaints from its members in all nine provinces.

Inadequate training on how to handle patients suspected of being infected with the coronavirus are hampering their efforts, Denosa’s General Secretary Cassim Lekhoathi said. 

When quizzed on what Denosa’s members would do if hospitals and clinics run out of PPE, Lekhoati said: “We cannot go open-faced into the war zone. They will go to work, but will not put themselves in a position to be exposed to Covid-19. I will not get it past my conscience to send our medical workers to their death.”

On Wednesday last week, the City of Ekurhuleni in Gauteng closed the Duduza clinic indefinitely after a nurse tested positive for the coronavirus.

Meanwhile, the first person to be admitted to Nelson Mandela Bay hospital’s  dedicated ICU is reported to be a nurse. The emergency department at Durban’s St Augustine hospital was closed temporarily on Friday and all new admissions to the hospital halted due to testing of patients and staff. This, after three coronavirus patients died in the hospital last week. By Sunday evening, Mkhize announced 1655 coronavirus infections and a total of 11 deaths countrywide.

Some feel that comments by certain politicians could fuel the shortage of PPE, especially masks. 

Transport Minister Fikile Mbalula last week told commuters that taxis will operate without any passenger number restrictions, but that all passengers must wear surgical or N95 masks and that government would assist in sourcing and providing masks. 

The PPE shortage has in the meantime triggered innovation from the private sector, with the University of Johannesburg and independent education provider Curro Holdings printing 3D medical visors to protect the mouths, noses and eyes of medical workers.

As the world struggles

“We might be currently experiencing a calm before a devastating storm,” Minister of Health Zweli Mkhize warned last week. This comes ahead of South Africa’s winter and the annual flu season. 

For now, we continue to watch other countries and learn as much as we can in the hope of bringing this pandemic to an end. DM

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