The fear of Covid19 has severely affected various operational systems of our country including the health, economy, and education systems. There has been various mitigatory attempts at managing the situation. Unfortunately, some of the efforts have been disjointed, leading to some counterproductive decisions. One such decision is a demand for Covid tests before one receives medical and other services. Some ambulance services have refused to take patients to hospital for fear of COVID19. Some renowned funeral parlours workers are refusing to do body removals while some companies and statutory bodies are now demanding a COVID19 negative result before one gets permission to enter their premises.
In a pandemic with well- established local transmission, all persons should be considered infected until proven otherwise. At the same time, in a situation of limited resources and constrained global supplies, such as we find ourselves in, strong and strategic guidance is urgently needed, so that fear does not drive the decision-making process.
There has been an accelerated increase in cases since 28 May 2020, now 4649 as at August 9, 2020 with local transmission accounting for 70% of cases. Al this stage more attention must be given to case management while continuing prevention strategies. As such we propose the following measures, many of which have been raised in different fora.
Testing strategy
Reagents and consumables are an expensive and finite resource therefore covid testing cannot be business as usual, whether in the public or private sector.
- RDTs should no longer be allowed for diagnosis, both in public and private labs. The WHO and Africa CDC only recommend these tests for use in public health surveillance, not diagnosis of individual patients. The high false negative rate may lead to delayed presentation at a health facility, and poorer outcomes consequently.
- We need a national conversation to guide who should be tested. In our view it is a waste of resources to lest everyone. Priority should be given to close contacts (as described by WHO), those with risk factors and symptomatic individuals.
- Testing at companies must be on clinical grounds. Random testing of an entire workforce on the basis of one positive co-worker without meeting any definition of contact status is clogging the system and for little reward.
- As such the rapid response teams must be increased, equipped, and incentivized. There is need for acceleration of the use of technology in contact tracing and telehealth in managing and the monitoring of both COVID and non- COVID patients.
- Government and the private sector must come together to streamline procurement. Innovative models such as the Africa Medical Supplies Platform could be exploited.
- We are therefore asking for a revisit and amendment to Statutory instruments 136 and 174 of 2020 and other Statutory Instruments which set out the national testing strategy as a matter of urgency.
Case management
We continue to urge government to urgently address the issues of PPE and staff remuneration in the public sector so that both Covid-19 and non-Covid-19 patients can receive necessary medical services. The legitimate concerns and requests of healthcare personnel are well known. Most public sector institutions are well-primed to deal with the coming surge if they are capacitated with staff, consumables, and PPE.
In terms of the private sector, all hospitals with a casualty should identify a space where they can house patients who need care but do not yet have their PCR results (“Person Under Investigation” Unit). The need to wain their staff to handle such cases and equip them with the necessary PPE. The Government should seriously consider including such institutions for distribution of the donated PPE from NatPharm. PPE is a huge, and often prohibitive cost for these institutions which are struggling in this current economic climate. This would assist them lo offer a service while remaining viable and partly cushion patients from having the cost passed onto them via exorbitant hospital bills. Institutions cannot justify turning away patients in acute asthmatic attack, accident victims or any other medical emergencies because they do not have a PCR results, which takes 24-48 hours to come out.
There is need for all to remember that the vast majority (80 to 85%) of people who are infected with this virus will recover with no to minimal intervention. Therefore, we must wisely use our resources to preserve the lives of the 15% who need active hospital assistance, and the many citizens who will still develop other medical emergencies such as appendicitis, diabetic crises or need maternity services etc. Let our response be guided by science and the national good, not fear or profiteering.
Source: Senior Hospital Doctors Association (SHDA)
