Johannesburg - Cassim Lekhoathi has clear advice for South Africa’s nurses working on the front lines of the Covid-19 pandemic without adequate personal protective equipment (PPE): no-one must be sacrificial lambs.
“We can’t afford to have any nurse or doctor perish as a result of the lack of PPE,” said Lekhoathi, the general secretary of the Democratic Nursing Organisation of South Africa (Denosa).
“Where the employer is not providing PPE, our nurses will not become sacrificial lambs and subject themselves to possibly being infected with Covid-19.”
This week, the trauma unit of Netcare Kingsway Hospital in eManzimtoti was shut after six health-care workers were infected with Covid-19.
Last week Netcare was forced to close portions of Durban's St Augustine’s hospital after 48 staff members tested positive for Covid-19. At the Mediclinic Morningside in Sandton, 12 staffers, including seven health-care workers, tested positive.
The shortages of PPE is a “nightmare for us”, said Lekhoathi.
“Our nurses are complaining there are still departments and institutions not having PPE. We have had an undertaking from the national Department of Health (NDoH) that it is doing everything in its power to make sure PPE is being rolled out.”
This week, Business4SA‘s Health Workgroup reported “significant successes” have been achieved in partnership with Health Minister Dr Zweli Mkhize and the NDoH and the Minister of Trade, Industry and Competition, which have assisted in unlocking global medicine procurement challenges.
“Procurement of PPE stock for SA’s front-line medical staff, across both the public and private sectors remains a key priority. PPE procurement is being supported by funding from the Solidarity Fund, Motsepe Foundation, SPIRE (RMB) and Naspers and, to date, PPE worth R400 million has been acquired, with pipeline funding for a further R360 million, bringing our current procurement order book to R760 million.”
The procured stock includes 900 000 sterile gloves; 20 000 face shields; 1.12 million N95 masks; 6 million surgical masks for healthcare workers; 8.5 million surgical masks for patients; and 200 ventilators. The focus is to secure PPE stock for
the next six to eight weeks, and monthly thereafter.”
Natalie Zimmelman, chief executive of the SA Society of Anaesthesiologists, welcomed the considerable progress. “However, we are far from ‘there’ yet and it’s not time to relax.
“Although 1.12 million N95 masks sounds like a lot, it really is not. We estimate every critical ill patient will require between 14 and 20 sets of PPE each, including an N95 mask per day of treatment. This includes every person on the healthcare team being appropriately protected.
"Each person could be receiving critical care for about 10 days. If you start expanding on these numbers, as our curve grows exponentially, the numbers needed get frightening.”
While stock has been ordered, only some has started to come in.
“We’ve seen instances where secure orders have been diverted, even once in the air on the way here. We remain anxious until the stock is in the warehouse and regularly flowing. That is not to detract from the team working on securing these orders - they are doing an amazing job and are navigating, as best they can.”
Having the stock is one thing, but getting it distributed and accessible is another.
“Much of the initial stock has gone to the community health workers doing the tracing and testing. This is appropriate and very much needed. Some stock has started to flow to the hospital/clinic level, but in the public sector only so far and where there is a critical need. A secure flow is not yet visible to all tertiary level workers.”
The private sector, she said, is still attempting to procure PPE “in a less than co-ordinated manner” but are “clearly dedicated to trying their best” to secure PPE.
“Remember, we need PPE for all sectors - public, private, NGO
and many different users, for every front-line worker - doctors, nurses, community health workers, social workers, cleaners, catering staff, mortuary staff, paramedics and emergency care staff, home-based carers, patients, police, military, pathology testing staff, prison guards, port health and airport staff, etc. You see how the needed numbers grow.”
The lack of visible flow has two consequences, said Zimmelman.
“Health workers remain anxious and everyone is very cautious about using PPE. Being cautious in usage must be encouraged and will have to remain throughout the pandemic - we will never have enough... Stock needs to be secured, but locking it up in a way that it is not accessible when needed does not help.”
There is talk, she said, of PPE re-use or attempts to sterilise existing stock.
“The science is not guaranteeing the equipment is safe and retains its efficacy... Once the safety is clear and guaranteed, we would support the re-use, so long as everything follows the strict guidelines required to ensure success. Until then, we do not recommend any re-use.”
Stavros Nicolaou, the chairperson of the workgroup, said all stocks landing in SA, or being collected from local donors and suppliers is delivered to the Imperial Health Sciences warehouses, which specialises in the distribution of healthcare products.
“We have already begun the distribution process and are working
closely with the NDoH and the provinces to ensure PPE is delivered across all provinces.
“We’re deeply grateful to the companies that have heeded the call-to-action... We are also procuring PPE stock from the global market, as
well as capacitating and accelerating local production."
The global market for PPE is an incredibly competitive space.
“Over 180 countries are competing for the same protective products for their health care systems. We’re making good progress.”
Local production is being accelerated. “This includes identifying and engaging with local production companies to either expand their current production capacity or to retool or re-purpose their operations to meet demand,” he said.