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Covid-19: No easy day in the life of a healthcare worker

Tuesday July 14 2020
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A nurse turns on equipment in the High Dependency Unit at Coast General Teaching and Referral Hospital in Mombasa County on April 10, 2020. PHOTO | WACHIRA MWANGI | NATION MEDIA GROUP

By ELIZABETH MERAB

Marvin Kairu does not remember how he got exposed to coronavirus but suspects that he must have got it when drawing samples from one of the patients referred to him.

Being a laboratory technician in a small facility where the sheer number of patients walking in to get treated, it was commonplace to sometimes ignore his personal protection. That was until Covid-19 hit, he says.

Mr Kairu works at Ngara Health Centre in Nairobi, the first health facility where three other health workers contracted the highly infectious virus in the line of duty.

“To date, we have not been able to pinpoint the exact patient we saw but my thinking is that I got into contact with the patient who was seen by the clinical officer,” he said when Nation caught up with him three months since he tested positive for Covid-19.

Ngara Health Centre was temporarily shut down in April after three health workers (a laboratory technician and two clinical officers) and a security guard tested positive for Covid-19.

EVERYTHING CHANGED

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The ordeal, Mr Kairu says changed everything at the facility which used to attend to more than 300 patients daily.

“When I went back to work, I was more cautious when handling each patient,” he says.

Although patient traffic has significantly reduced at the facility, he has not faced any stigma from his colleagues or friends, something the 33-year-old attributed to having been an asymptomatic patient.

While he found it easy to dive back into work, Mary* is not so enthusiastic about it. Just like Kairu, she too cannot trace how she got infected but is certain that it happened while on duty.

On June 29, Mary who works in one of the country’s top private facilities had her samples taken for a Sars-CoV-2 test after developing a fever, cough, and running nose. She had been ill for some time, she recalls.

“At first, they queried pneumonia but I insisted on having a Covid-19 test,” said Mary, who before falling ill, had been rotating between the isolation unit and the normal wards at the Nairobi-based facility.

On July 1, it was confirmed that the mother of one had indeed contracted the virus.

“I was told to take my family for testing too since I had been in contact with them. My husband tested positive,” the nurse who requested to remain anonymous said.

Both chose to isolate at home instead of being admitted at the hospital, saying: “As it is, it’s easier to contract other diseases while admitted at the hospital because the area designated for infected health workers does not have adequate infection, prevention control.”

AGGRESSIVE SPREAD

At least 292 health workers have been tested positive for the virus in the country, with most of them being nurses.

So rapid and aggressive has the spread of Covid-19 been that scientists have been advising medics and the public to maintain a safe distance between each other and limit their interaction, to stop the spread of the Sars-CoV-2 virus,  which has been found to also lurk in the hospital environment.

According to scientists, a single cough can produce up to 3,000 droplets, while a sneeze can produce as many as 10,000. According to a study published last month in the Journal Annals of Internal Medicine, 41 health care workers tested positive after attending to a middle-aged patient who required intubation (a process of inserting a tube, called an endotracheal tube (ET), through the mouth and then into the airway to help a severely ill patient breathe).

The team of 41 were identified as having exposure to aerosol-generating procedures for at least 10 minutes at a distance of less than two meters from the patient.

As numbers of infected people continue to rise in the country, so will the number of healthcare workers who test positive, health experts have said. According to the outgoing Kenya Medical Association Vice-President, Prof Lukoye Atwoli, unlike the general population, health workers face double the risk of infection.

“Firstly, their baseline risk is the same as that of the general population where there is community transmission. But these groups of people also work and spend a lot of time in facilities where every patient walks in,” he explained.

STRATEGIES

Unlike in the general population where proper adherence to public health measures like hand washing, maintaining distance from one person to the other, and donning of masks are enough to protect an individual, the scenario in health facilities is a bit intense.

“You need intense observance of infection prevention control measures. The workers in that hospital need to work in a well-ventilated area where wards are decontaminated after every discharge of a patient,” he added.

Prof Atwoli further said that health workers are just but the tip of the iceberg, and represent what is happening in the community.  Yet, despite the country announcing strategies to stop the virus, four months later, most of these strategies are yet to kick-off, said KMA’s Secretary-General, Dr Simon Kigondu.

“With Covid-19, you need a high workforce to prevent or reduce infection. There is a lot of talk about increasing this workforce but nothing has happened. There is also no routine testing of these health workers, yet, we know that the number of asymptomatic patients overrides that of symptomatic ones,” Dr Kigondu noted.

Consequently, he said, medics across the board are getting overwhelmed by both Covid-19 and non-Covid-19 patients visiting health facilities.

“When you only have one intensivist in a facility and you are expected to intubate four patients, some in the Covid-19 unit and others in the general wards, who will you leave,” asked Prof Atwoli.

PROTECTIVE EQUIPMENT

Although little is known about the effectiveness of personal protective equipment (PPEs) for health care workers who take care of patients infected with the novel coronavirus (SARS-CoV-2) that recently originated in China and has spread globally

Two studies published in a monthly open-access medical journal JAMA Network Open reveal that one percent of healthcare workers (HCWs) in hospitals contracted Covid-19 in the southern Netherlands and Wuhan, China.

The first study, involving 9,705 HCWs screened at two teaching hospitals in Breda and Tilburg, the Netherlands, identified 1,353 who reported fever or respiratory symptoms.

Of those workers, 86 (6.4 per cent) tested positive for the novel coronavirus, representing 0.9 per cent of all HCWs. Only 3 (3.5per cent) reported exposure to a patient who tested positive for Covid-19.

The second study, involving 9,684 HCWs at Tongji Hospital in Wuhan, found that 110 (1.1per cent) tested positive for the virus.

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