Many HIV-positive patients in the Eastern Cape survive Covid-19, webinar told

4 Aug 2020

Doctors working in an Eastern Cape hospital where there are high rates of HIV infections have said during a webinar that they have not lost a single patient to Covid-19 who was HIV-positive only — but all who were HIV-positive with added comorbidities such as diabetes and high blood pressure died after testing positive for the virus. Ten patients died at the hospital over one weekend after the oxygen supply ran out.

A webinar on Covid-19 in the Eastern Cape, organised by the World Health Organisation, the African Forum for Primary Healthcare and the World Organisation for Family Doctors was moderated by Professor Shabir Moosa, a family physician in the Department of Family Medicine at Wits University.

Moosa said while globally there had been a number of excess deaths, it is still unknown whether these patients were unreported Covid-19 cases or if their deaths were from a different cause.

Dr Ramprahash Kaswa, a family physician at Walter Sisulu University and acting CEO of Mthatha Regional Hospital said most of the patients they received were already very sick when they arrived at the hospital.

He explained that as their patients come from the OR Tambo district, where a high percentage of the population had tested positive for HIV infections, they were worried initially. Kaswa said between the last week in March and the second week of July they had tested 1,849 patients with a 21.2% positivity rate. There were 114 deaths, 130 patients were discharged and 130 health workers were infected.

Kaswa said more than 80% of the health workers had recovered and had returned to duty, but one had died.

He said in March and April, until the testing criteria were changed, fearful communities overran them to be tested. This, he explained, resulted in a large percentage of negative cases, but by July they had refined their criteria. Now, every third test is positive for the coronavirus.

The OR Tambo district had been highlighted by the Eastern Cape Government as one that was highly vulnerable — 12,214 people tested positive for coronavirus infections in the district and 247 died. The average number of deaths per 100,000 of the population is around 17.

As with most other hospitals in the country, Kaswa said their statistics also show that older people are at a higher risk of death due to Covid-19. He said the majority of their patients who died had both diabetes and hypertension.

“We have noticed a low rate of morbidity in people with HIV,” he added. “But those who had all three co-morbidities, diabetes, high blood pressure and HIV, all died of Covid-19.”

Kawa said the hospital lost 10 patients in one day when they ran out of oxygen.

“We were dependent on oxygen. We lost 10 people when we ran out of oxygen,” he said. “We are currently using 100 cylinders in a weekend.”

Of those who die, about a third die in the emergency room or on their way to the hospital or within an hour of arrival, Kawa said.

“It was really difficult when we ran out of oxygen. The staff was very traumatised. Everyone had to go for counselling.”

A possible shortage of oxygen at the province’s hospitals was identified by a team of experts sent to the province by Minister of Health Zweli Mkhize as a problem in fighting the pandemic. After the team presented their report to premier Oscar Mabuyane, he appointed a project management team to lead the province’s Covid-19 response.

At the end of July, the head of this unit, Dr Sibongile Zungu, presented a plan to Parliament to deal with the oxygen problem. This included installing bulk oxygen tanks at a number of hospitals, including Mthatha Regional Hospital and Dora Nginza Hospital in Nelson Mandela Bay.

Dr Vincent Adeniyi, a family physician at Cecilia Makiwane Hospital and a senior lecturer at Walter Sisulu University, said that at the start of the pandemic the hospital organised two doctors who were able to tell patients on the phone that they had tested positive for Covid-19.

Dr Ben Gaunt, the clinical manager of the Zithulele Hospital and lecturer at Walter Sisulu University, said it was a challenge for them to get their head around the pandemic.

“Unions and junior staff are important. The politicisation of this pandemic was quite noticeable. We had a good stock of personal protective equipment. Our core value is to put the patient first, but the level of fear was such that for a large number of staff they were not able to see their patients until they felt safe themselves. “They almost completely forgot about their theoretical patient,” Gaunt said.

He said some of the lessons learnt from the pandemic was that one should not underestimate how terrified people were.

“They won’t think straight.”

He said they introduced a system where patients were triaged at the gate — this was very important even though “a little boring”.

“I also found we had to be proactive with our nursing plan and how nurses are allocated to avoid stigma and discrimination,” Gaunt said.

“Covid-19 is everyone’s problem. Many people felt that if we can wall it off, it can become someone else’s problem.”

Gaunt added that as far as clinical care went, they found that focusing on the basics would bring the most benefit and this included a clear admissions criteria, ensuring that oxygen was available and giving steroids to those needing oxygen as well as Clexane (to stop clotting) and making sure that patients were put in the right position.

He said differential diagnoses remained important as patients were still presenting with TB, pneumonia and fungal pneumonia.

“We took quite a beating in some ways, but I hope we will grow from this experience together,” he added. “This storm will pass,” said Gaunt.

Dr Vincent Adeniyi, a family physician at Cecilia Makiwane Hospital and a senior lecturer at Walter Sisulu University, said that at the start of the pandemic the hospital organised two doctors who were able to tell patients on the phone that they had tested positive for Covid-19.

He said they were already seeing clusters of disease where many members of a family fell ill or clusters of death where family members all died.

“This will cause fear and anxiety,” he said. “It can also cause a sense of guilt.”

Adeniyi said many patients were very anxious and hospital doctors were also affected by stress.

He said when doctors phoned to break the news to their patients they frequently could not, as the patient was at the mall, at a funeral or driving, even though they were meant to be isolating at home.

Adeniyi said a new electronic results system implemented by the Department of Health, that makes it possible for patients to receive their results by text message, made matters easier. DM/MC

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