Kenyan nurses wore protective gear during a demonstration for preparations for any potential coronavirus cases at Mbagathi Hospital, isolation centre for the disease, in Nairobi earlier this  month.     REUTERS
Kenyan nurses wore protective gear during a demonstration for preparations for any potential coronavirus cases at Mbagathi Hospital, isolation centre for the disease, in Nairobi earlier this month. REUTERS

Front-line worker’s lives at risk due to the lack of adequate personal protective equipment

By Sheree Bega Time of article published Mar 28, 2020

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Front line health-care workers are “grossly” at risk of being infected by Covid-19 without adequate personal protective equipment (PPE).

Natalie Zimmelman, chief executive of the SA Society of Anaesthesiologists (Sasa), warned health-care causalities could skyrocket.

One in six of the current 614 000 Covid-19 patients globally is a health-care worker infected at work, says Zimmelman.

“Sadly, they’re faring worse in many cases, as they are being repeatedly infected, or infected while intubating or treating patients in close confines. The severity of the infection is influenced by the dose of virus or inoculum to which the patient was exposed.”

Sasa and the Critical Care Society of Southern Africa are working with business and government to address the shortage, which is exacerbated by non-health professionals buying up available stock.

Hospital Association of SA spokesperson Mark Peach says "significant numbers" of PPEs are being sourced in a joint national Department of Health and business effort.

Zimmelman says: “The common theme of those further on the curve than we are: the US has a month supply left. Vancouver has 500 full sets left and used 10 on two patients a few days ago. All territories are low on N95 respirator masks.

“SA has a tiny window period as we sit now, where we are not yet fully paralysed by its impact and are able to be proactive and creative in trying to find solutions to what is inevitably coming in the weeks ahead."

For now, it is more of a distribution gap than actual stock gap. “People are being as creative as they can (swimming goggles, divers masks, mining equipment, and even self-fabricated shields) - as these are not verified as effective, it is not ideal.”

Staffing is massively compromised by isolation and illness, she says, citing Italy which lost 10% of its workforce before PPE became mandatory.

SA has 10% the number of critical care specialists that Australia has per 100000 population and 15% of the UK.

“If the UK drops their workforce by half, they have four times what we have at full capacity. The people that will have to take care of our critically ill (5% of the total population infected using global trends) are anaesthetists, internal medicine and critical care.”

Sasa members include intensivists - there are around 100 in SA. “Cross-skilling will be essential. The point is without protection we can expect whatever casualties we have from Covid-19 to skyrocket

“The stock of N95 masks, a core component of any PPE set, is just over 5million. We estimate we will need approximately 6million sets of PPEs for the first month of delivery, and this is for the use of health-care workers specifically.

"There are still stocks internationally and there is a galvanised effort to procure. However, these will run out. We can, and must, produce locally, as we will not be able to rely on international supply for long."

A collaborative team from NDoH, Department of Trade and Industry and Business Unity SA "are urgently working to get the supply chain going".

Moeketsi Modisenyane, the president of the Public Health Association of SA, notes how the WHO has warned how severe, mounting disruption to the global supply of PPE, caused by rising demand, panic-buying, hoarding and misuse, is putting lives at risk.

“Shortages are leaving doctors, nurses and other front-line workers dangerously ill-equipped to care for Covid-19 patients.”

Prices have surged. “Surgical masks have seen a six-fold increase, N95 respirators have trebled and gowns have doubled. Based on WHO modelling, an estimated 89million medical masks are required for the Covid-19 response each month. For examination gloves, that figure goes up to 76million while international demand for goggles stands at 1.6million per month.

“The imperative is to import quality goods where available but the key will be to produce locally that can then be sustained for supply for the pandemic.”

Syntech, a tech distribution company, is spearheading an emergency drive calling on corporates to get medical face masks to all those on the front lines.

If corporates collectively order 1million masks, first responders will get 100000 free masks.

The first 500000 medical face masks will hopefully arrive by next week. "Our team are hard at work trying to bring in additional equipment," says Ryan Martyn, the firm's co-founder.

"We've seen demand for a wide variety of protective equipment in South Africa," says Martyn. "We've already been contacted by independent GPs and specialist firms looking for N95 masks and other protective gear. It's safe to say that there are huge shortages everywhere and we expect this to worsen. 

"At this point, we've sourced medical face masks along with the infrared thermometers, but our team are hard at work trying to bring in additional equipment (like surgical gowns, N95 masks, FFP2 respirators, and even test kits). Since there are significant shortages globally, and because our team in China are verifying the quality of products at the factory level, this can be a time-consuming process."

SA Medical Association chair Dr Angelique Coetzee commended the huge public-private partnership drive. "They are really working hard behind the scenes to get it sorted out and there are already some donations coming into the GPs. There's a lot of goodwill."

Sasa's Zimmelman points out how guidelines for many aspects of the disease and management are deficient globally.

"Sasa has taken an active role in consolidating to avoid the 'noise' and anxiety of what to follow and where to find the information. This is being done by our established Covid19 task team of 16 SASA specialists (who have to earn a living aside from the voluntary work) and four full time staff at Sasa doing the administration."

Required Equipment:

Disposable surgical masks 

Disposable surgical masks with visor Disposable protective respirators 

Disposable aprons Protective surgical gowns (sterile and non-sterile) 

Protective eyewear/goggles/face shields 

Disposable surgical gloves (sterile/ surgical and non-sterile/examination) 

Overshoes 

Protective hoods 

Proposed PPE pack contents

N95 or equivalent protective respirator mask 

Disposable surgical gown 

Disposable surgical gloves x 2 sets

Overshoes 

Protective hood 

Protective eyewear/goggles 

Face shield

Added ideal extras: 

Disposable apron 

Disposable surgical mask for travelling through hospital to designated areas, prior to full donning and doffing 

Clear, pliable plastic sheet for face cover of intubated patient (minimum size 60x60cm) 

Source: South African Society of Anaesthesiologists

The Saturday Star

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