How COVID-19 spread through St. Augustine’s hospital in KZN

Netcare welcomed the release of the report into how one case of COVID‐19 at its St. Augustine’s Hospital in KwaZulu Natal led to the spread of 119 cases in 21 days.

The investigation found that between 9 March and 30 April 2020, there were 119 confirmed cases identified at St. Augustine’s Hospital (39 patients and 80 staff). Fifteen of the 39 patients died.

According to the report, the most plausible explanation for the outbreak is that there was a single introduction of the severe acute respiratory syndrome-related coronavirus 2 (SARS‐CoV‐2) to the hospital in early March, most likely through transmission from a patient being assessed for COVID-19 in the emergency department to another patient being admitted at the same time with a suspected stroke.

The virus then spread widely through the hospital, involving patients and health care workers on at least five different wards.

The report was initiated by the National Department of Health under the auspices of the Ministerial Advisory Committee (MAC) on COVID-19 in the country, 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).

The investigation was led by Dr. Richard Lessells, Professor Yunus Moosa and Professor Tulio de Oliveira, bringing together expertise in infectious diseases, epidemiology and viral genomics.

The Investigation methods included medical record reviews, ward visits, and interviews with health care workers and management.

Dr. Lessells explained: “Through detailed analysis of the timelines – which wards patients were on when their symptoms started when they tested positive for SARS-CoV-2 – we were able to build a hypothesis of the most likely chain of events and understand how the virus spread around the hospital. Our genetic analysis supported this hypothesis and gave us confidence that our explanation was correct. To us, our findings highlighted how easily and quickly this virus can spread through a hospital. The initial spread of the virus was not recognised at the time, because the first patient who we think was infected in the emergency department was not initially suspected of having COVID-19. She did not have any of the typical risk factors and only presented with a single episode of fever without cough or other respiratory symptoms. By the time she was diagnosed with COVID-19 and the hospital began responding to the outbreak, several other patients and health care workers had already been infected.”

Investigations into the outbreak at the hospital began on 4 April after the identification of 13 confirmed COVID‐19 cases and three deaths at the hospital.

Netcare’s Regional Director, Craig Murphy emphasized that 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.

“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.

“We continue to learn more about the virus and are responding to new research with further precautionary measures. We wish to reiterate our sincere gratitude to all our healthcare workers, nurses and doctors, and their families for their incredible efforts under these trying and challenging circumstances,” said Murphy.

 

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