A report has found that the outbreak of coronavirus disease at the Netcare St. Augustine’s Hospital in Durban, that led to the infection of at least 135 patients and staff the hospital complex and people in a nursing home, was caused by a single patient admitted to the facility’s emergency department early in March.
The virus spread so fast in the hospital, that infections caused by the outbreak in the hospital constituted almost 14% of COVID-19 cases in KwaZulu‐Natal by the end of April.
The study was conducted by researchers at the University of KwaZulu-Natal’s (UKZN) Nelson R. Mandela School of Medicine and the KwaZulu‐Natal Research Innovation & Sequencing Platform, Krisp.
The investigative report into the rapid spread of infections through the 469-bed facility holds crucial lessons for hospitals about the importance of proper infection control and the deadly consequences of identifying COVID-19 patients too late.
The SARS-CoV-2 virus, which causes COVID-19, had infected more than 17 200 people in South Africa by the end of Tuesday and caused 312 deaths, health department figures show.
From the emergency room at St. Augustine’s Hospital, SARS-CoV-2 spread quickly through the facility, infecting 80 staff and 39 patients in at least five different wards between 9 March and 30 April. The hospital outbreak led to an additional 21 cases, including four residents at a Durban nursing home and 17 patients and staff at St. Augustine’s outpatient dialysis unit.
That’s a total of 140 infections. But researchers found five cases they can’t be 100% sure came from inside the hospital, so they’re sticking to 135.
“Overall, we estimate that the hospital outbreak and its spread to these other institutions accounted for about 14% of COVID-19 cases in KwaZulu‐Natal reported up to 30 April,” says Krisp director Tulio De Oliveria in a university statement.
The virus spread so fast by frequently moving patients around inside wards and from one ward to another, the researchers argue. Patients were moved often between wards as the hospital began repurposing wards to prepare for an influx of COVID-19 cases. This way, health workers unknowingly exposed patients and colleagues to coronavirus patients who were still undetected.
The investigators found no evidence that the virus spread through the air. The virus spreads from person to person through droplets that contain the virus, according to the World Health Organisation.
The main way the virus spread through St. Augutine’s hospital, however, is through droplets left on surfaces and transferred by health workers. The findings suggest that facilities be cleaned often since the report shows the environment around a COVID-19 patient could be contaminated for hours or even days depending on the surfaces.
“Hand hygiene remains the most important intervention to prevent transmission of SARS‐CoV‐2 inside and outside hospitals,” the researchers note.
The slow detection of cases also contributed to rapid spread of the virus in the facility, the report shows. By the time the first case of coronavirus disease was confirmed at the hospital, the report shows 16 other patients were already exposed to the virus.
The report concludes: “The safest approach is for healthcare workers to assume that all patients are potentially infectious with COVID-19 and to take precautions on that basis.”
This story was produced by the Bhekisisa Centre for Health Journalism.
Meanwhile Netcare welcomes the release of the report into the cases of coronavirus disease 2019 (COVID‐19) at Netcare St. Augustine’s Hospital. The report was initiated by the National Department of Health under the auspices of the Ministerial Advisory Committee (MAC) on COVID-19 in South Africa, and was authored by infectious disease specialists and researchers from the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal and the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP).
Netcare’s Regional Director, Craig Murphy commented, “All the recommendations and interventions made by the investigators have been fully implemented. In many cases these interventions were already in place and have been further strengthened and enhanced as a result of the valuable recommendations made by the Report.
“In early March, we were rapidly learning about the nature of COVID-19 as many national policy guidelines were being changed and refined as the pandemic unfolded in South Africa. While this has been a sad and transformative experience for us, we are grateful that together with the National Department of Health and the Ministerial Advisory Committee, many valuable lessons have been learnt for our entire healthcare sector,” said Murphy.
During this period, 15 patients died from COVID-19 related complications of their underlying health challenges. Netcare has extended its sincere condolences to the family and loved ones of those who sadly passed away.
“Two of the greatest challenges associated with COVID-19 are that those infected do not always show or have any of the symptoms, and the fact that the virus is highly infectious, notwithstanding the absence of any symptoms. Despite the presence of extensive and effective infection prevention measures, such as those in place within Netcare facilities, any workplace or gathering of people poses a potential risk for infection,” said Murphy.
Preventing the spread into and from the Group’s hospitals has been, and remains, of paramount importance to Netcare. The Group proactively implemented comprehensive precautionary measures based on the information that was known at the time about the virus and how it spreads.