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Study tells ‘remarkable story’ about COVID-19’s deadly rampage through a South African hospital
By Linda Nordling
May. 25, 2020 , 4:30 AM
On 9 March, a patient who had recently traveled to Europe and had symptoms of COVID-19 visited the emergency department of St Augustine’s, a private hospital in Durban, South Africa. Eight weeks later, 39 patients and 80 staff linked to the hospital had been infected, and 15 patients had died—fully half the death toll in KwaZulu-Natal province at that time.
Now, scientists at the University of KwaZulu-Natal have published a detailed reconstruction of how the virus spread from ward to ward and between patients, doctors, and nurses, based on floor maps of the hospital, analyses of staff and patient movements, and viral genomes. Their 37-page analysis, posted on the university’s website on 22 May, is the most extensive study of any hospital outbreak of COVID-19 so far. It suggests all of the cases originated from a single introduction, and that patients rarely infected other patients. Instead, the virus was mostly carried around the hospital by staff and on the surfaces of medical equipment.
“It’s a remarkable story and testimony to the virus’s capacity to spread through a facility if appropriate controls are not in place,” says Michael Klompas, an infectious disease specialist at Harvard Medical School who was not involved in the study. Hospital infections are not uncommon, as the large number of infected healthcare workers worldwide attests; by documenting the routes of spread, the report “holds valuable lessons in how healthcare institutions need to function in the COVID era,” says Salim Abdool Karim, a HIV scientist based in Durban who chairs a scientific COVID-19 advisory group serving South Africa’s Department of Health.
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But on the whole, patients infected few other patients directly. Instead staff members spread the disease from patient to patient and from department to department—perhaps sometimes without becoming infected themselves. “We think in the main it’s likely to have been from [staff] hands and shared patient care items like thermometers, blood pressure cuffs, and stethoscopes,” says Richard Lessells, an infectious disease specialist at the KwaZulu-Natal Research Innovation and Sequencing Platform and one of the study leaders. He and the other authors found no evidence that aerosol transmission contributed to the outbreak.
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With Covid-19, neither the hospital nor Parliament is safe
A. Kathirasen -May 22, 2020 7:00 AM
We know how badly the Covid-19 pandemic is affecting us: people are dying, we are facing lockdowns and an increasing number of workers are losing their jobs. But would any doctor have ever thought that he or she would one day tell a patient that the hospital is not a safe place?
This is exactly what happened to an 84-year-old man who had a fall resulting in a slight fracture of the pelvis. His doctor told him he’d live longer staying at home than being admitted to a hospital ward.
I was talking to a friend, who is 86, on the phone yesterday when he related this incident. He said his cousin fell in the bathroom of his home and was taken to a private hospital where, after an x-ray, he was told there was a fracture on his pelvis but that it did not require surgery.
The cousin was told that with the Covid-19 pandemic, even hospitals were not safe, especially for vulnerable people like him. Most of those who are dying of Covid-19 are above 60 or who already have major health problems.
He would be most safe in his own home, the doctor told the cousin. So within a few hours, he was back home with the necessary medicine.
Who would have thought a private hospital would not want to let a patient stay a few nights so that it could make more money, or perhaps even perform the surgery to make even more money?
The gentleman whom I was speaking to has a regular doctor’s appointment next month at another hospital for a heart-related problem. He has been advised by several doctors whom he knows to postpone the appointment to a later date.
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Even before the pandemic, the World Health Organization had revealed that the occurrence of “adverse events” due to unsafe care at hospitals was likely one of the 10 leading causes of death and disability in the world.
It estimates that each year, about 134 million such “adverse events” occur in hospitals in low-and-middle-income countries alone due to unsafe care, causing 2.6 million deaths.
WHO says as many as four in 10 patients in the world are “harmed in primary and outpatient health care” and that 80% of the harm is preventable. “The most detrimental errors are related to diagnosis, prescription and the use of medicine,” it adds.
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The views expressed are those of the author and do not necessarily reflect those of FMT.
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