Amid the COVID-19 pandemic, I had begun to believe that my family and I would not contract the virus. After all, I had looked after hundreds of patients with COVID-19, successfully treated a large number (although losing some in the process), worked with the KwaZulu-Natal Department of Health and the National Department of Health from the onset of the pandemic, and – despite my husband and I working in two of the most high risk exposure professions (Ear, Nose and Throat Surgery, and Medicine) – we had weathered the first two waves of the pandemic without becoming infected by SARS-CoV-2.
I simply concluded that we had taken all the relevant precautions correctly. My experience in the management of the HIV epidemic made me feel well equipped to contribute to developing strategies to respond to the pandemic.
In the provincial context, the KwaZulu-Natal Department of Health developed and repurposed several facilities for the specific management of COVID-19. In the eThekwini Municipality’s area, the Clairwood Hospital was the largest hospital repurposed for the management of the disease. The aim of such repurposing was to transform the hospital from what used to be a convalescent and rehabilitation centre for the province into a hospital that could manage patients presenting with acute diseases. During this repurposing, the high-tech infrastructure had to be matched with staff appropriately skilled to manage patients presenting with acute and often complicated diseases. This is because COVID-19 presents in accompaniment with other diseases whose appropriate management has a bearing on the outcomes of the management of COVID-19 itself.
As such, it is essential that staff are skilled in the appropriate management of diseases that accompany COVID-19. Moreover, equipment necessary to manage varying degrees of disease severity, accompanying diseases and complications also had to be procured. Despite such hurdles, appropriate training to use this equipment was done in a hospital well equipped with state-of-the-art infection prevention and control infrastructure for the management of highly contagious diseases such as COVID-19.
Furthermore, the space available at the facility has quarantine facilities for those under investigation for the disease while awaiting results, and isolation for confirmed cases. Isolation within the facility is designed for those with mild to no symptoms, which helps with accessing care promptly if the disease progresses and complications develop, particularly because early presentation is key to achieving optimal outcomes. Disease severity is assessed by conducting a full clinical examination to assess the impact of the virus on all organ systems, including assessment of other underlying diseases in order to provide prompt management of these underlying diseases and associated complications.
Services are provided around the clock and a digital health technology platform is used for triage purposes with the appropriate facility where necessary. An additional advantage to such space in the facility is its ability to limit the spread of infection to members of the patient’s family without infection as well as other people in their community. Moreover, the facility recognised COVID-19 also has a real psychological impact on its victims (despite such topics receiving little attention) and as such it has prioritised providing patients with space to rest while receiving care and monitoring.
However, when the opportunity to vaccinate arose, I was reluctant. My rationale was that I had worked very closely with patients who had the disease, and had done resuscitation of many patients and had actually felt their breath on my face. I concluded that the protection worn in the wards was enough to keep me safe. I weighed up the uncertainty of unwanted effects from the vaccines that are unknown against the reality that I had remained protected within the hospital. My family and I were adhering strictly to all COVID-19 protocols and we had remained safe. The balance of these probabilities left me feeling reluctant to take the vaccine.
Ultimately, however, I allowed my husband to take the decision for the family and we decided to get vaccinated.
I thought I had experienced the worst at the height of the second wave of the pandemic until my experience of the last two weeks of July this year at my facility. Critically ill patients were arriving in large numbers and we lost the largest number in the shortest period since we had been treating patients.
Then, amidst all this, I tested positive for COVID-19 despite all the precautions that had kept me safe. It is impossible to decide whether I took the infection home or contracted it in the community – it is difficult to pinpoint the source of infection. However, the most important point is I took my husband’s advice and got vaccinated.
My symptoms have been very different from all that I have been teaching about and those my patients have had. When I needed to be hospitalised, I turned to my hospital, Clairwood. I am proud of team Clairwood Hospital, not just as a staff member but as a patient of the team too. Every member of the team executes their role with distinction, from the team member who comes in to clean up and serve meals, to the nurses who regularly check vital signs of patients and look into any complaints they might have, to the doctors who examine, make clinical decisions, and provide support. I enjoyed extra special support from my team who provided treats and home-cooked special meals for me while I was in hospital. The support received from my community to see my family through a very difficult time was immeasurable.
My experience has demonstrated clearly that in responding to the COVID-19 pandemic, it is important to include community-level responses to provide for those without appropriate resources. Lockdown restrictions should take into account appropriate interventions for the homeless.
The pandemic has shown that it is vital to deal decisively with issues such as poverty, education, housing and food security.
The regulations for social distancing in areas where the majority of citizens live in informal settlements or congested settings require urgent review and in the meantime timeous contact tracing and optimal testing, institutional quarantine and isolation need to be promoted. This strategy will help ensure that those infected are identified early, examined to assess any complications or other diseases that might accompany COVID-19, and get treated early.
This strategy should help reduce the spread of infection in communities and the reduction of disease complications and death, thus reducing impacts of potential future waves of the pandemic.
• This article was originally published in the Daily News on 26 August, 2021
Professor Nombulelo Magula is the Head of Internal Medicine at UKZN and leads the Clinical Team at Clairwood Hospital.
*The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of KwaZulu-Natal.