A story of hope: Despite the odds, patients recover from Covid-19 at Cape Town home for the elderly

Highlands House, a home for the elderly in Vredehoek, Cape Town, has seen a steady stream of recoveries after 12 of its residents tested positive for the coronavirus in early May.

Doctor Leon Geffen, executive director of the Samson Institute for Ageing Research at Highlands House, said nine residents had “completely recovered”.

“Three of the residents are slowly recovering but are over the acute phase of coronavirus,” said Geffen.

The first confirmed case at the home was a resident who had developed a fever and was referred for a coronavirus test. Two days later, the resident  collapsed and died. It was only confirmed after the death that the resident had tested positive for Covid-19.

Following the news, the facility sprang into action and enlisted two private laboratories to conduct tests on all the residents and staff over four days.

“We tested almost 190 residents, most of whom were asymptomatic at the time, and tested 274 staff.”

Thirty-two staff members tested positive. Geffen said this response was “unprecedented globally” at any other care home.

“At very short notice, the facility decided that in order to try and contain the virus we needed to identify all the people who could potentially be positive, because research had just come up that many people were asymptomatic carriers, particularly in care facilities.”

But Highlands had already instituted precautionary measures before the outbreak in the care home. On 18 March, they implemented an internal lockdown. Residents were asked to stay in their rooms and any resident that left the home was placed under quarantine for two weeks upon return. Care workers and residents were screened daily for symptoms. 

Despite these measures, there was still an outbreak, but it was successfully contained.

“At this point, all staff that were asymptomatic and were positive are now ready to come back to work as per the guidelines. Staff who had been symptomatic and have recovered will be coming back to work within the next few days.”

Geffen says they are still actively monitoring staff and residents for symptoms. The elderly are still not allowed to leave the home and special arrangements have been made with GPs to do consultations on-site.

The elderly and those with underlying health conditions are at higher risk from the coronavirus. Geffen says there isn’t enough science to fully explain why the elderly are vulnerable but says the virus can affect heart, lung and kidney function and can cause an inflammatory response.

“That could cause a cytokine storm,” said Geffen, a phenomenon where the body starts to attack its own cells and tissues rather than just fighting off the virus.

“It can reduce oxygen transport in the blood which has an impact on all the organ systems in the body. So, do older people have less reserve than younger people do? Do they have a different inflammatory response to the virus than younger people? These are questions that I think, over time, will be answered.”

Geffen acknowledged that Highlands House is financially well-resourced and replicating its response elsewhere would be difficult. On testing alone, it spent more than R400,000. Each test costs R850. He lamented the challenges facing lesser-resourced old age homes servicing low-income communities.

“These facilities don’t have the ability to provide effective PPE [personal protective equipment], hand sanitisers and masks because they don’t have the funds available.”

He said it was incumbent on the Department of Social Development to provide these facilities with resources. He was also concerned at the lack of education being given to care workers to demystify Covid-19. A particular concern was what the shortage of PPE meant for care workers who often use public transport and may be carriers of the virus.

“They need to be provided with PPE and it’s incumbent upon the Department of Social Development to take responsibility.”

According to Geffen, the best way to protect care homes from the coronavirus is to do testing en masse, where there’s a quick turnaround time for results, preferably a day or a few hours.

“I think it’s important for us to try and keep our older people as well as possible.”  DM

This article was amended on Tuesday, 26 May, 2020, for clarity.