Adventures of a virus in a hospital in South Africa

A hospital in South Africa recently published a remarkable account of how a single patient in the emergency department (ED) introduced Covid-19 to the hospital which then managed to spread to 119 confirmed cases by 30th April.

The first patient, P1, appeared at the ED for a Covid-19 test on March 9 after recently returning from Europe and coming down with symptoms. They quickly whisked him off to a separate room but in the short time he was there he managed to infect another patient, P3, who was in the ED at the same time but for a separate issue. P1 and P3 were in close proximity to each other and were seen by the same medical officer. The map below shows the location of P1 and P3. P1 was in the triage area and P3 was opposite this room on a trolley (outlined in green in the map below).

ed
Source: https://www.krisp.org.za/manuscripts/StAugustinesHospitalOutbreakInvestigation_FinalReport_15may2020_comp.pdf

P3 was admitted to the cardiac intensive care unit later that same day where she stayed for 4 nights. On the 13th March, she developed a fever. It did not occur to anyone that it might be Covid-19 related at this time because there was no Covid-19 in the hospital, or so they thought. The fever subsided and the patient was discharged on the 16th March. Her condition deteriorated on the 19th March and she was readmitted with suspected Covid-19.

The first staff case was on the 17th March in a nurse who cared for P3 on the night shift of 12 March – 13 March. From here the infection spread throughout the hospital infecting 39 patients and 80 staff in different wards and departments. They think the virus was transmitted by staff, patients, and medical equipment such as stethoscopes and thermometers.

They did a very thorough investigation and made a number of recommendations including early isolation of suspect Covid-19 patients, equipping health care workers with appropriate PPE, and regular cleaning and disinfection of surfaces and equipment. It’s not exactly rocket science but it shows how easily the virus transmits when we don’t follow these basic ideas.

12 Replies to “Adventures of a virus in a hospital in South Africa”

  1. Very interesting and a strong reminder not to to get complaisant. But a slightly autistic part of me demands to know: what about P2?

    1. Good question! I believe P2 was an outpatient who had travelled in from Europe with the virus. They came to the hospital for a test and tested positive so they are counted as one of the positive cases but they didn’t catch the virus in the hospital or transmit it to anyone else so that path stopped with them.

  2. There was an article in the paper with Neil Ferguson (I think) explaining that a major reason we have struggled to contain the infection rate is that we didn’t get the infections in hospitals and care homes sorted out early on, and still haven’t. So they are kind of factories churning out virus back into the population, mainly through members of staff.
    It makes sense because I can’t understand why there is so much infection still going on – you assume that if people are doing sensible things and staying away from each other it would die back. But the general population doing sensible things where there is little infection can’t counteract the levels of spread you describe.

    1. I saw that article. There were several mistakes early on including discharging elderly patients from hospitals back to care homes where they seeded the virus. At that point, there was a worry that hospitals would become overwhelmed and so they were trying to free up as many beds as possible. But in the end, hospitals were never overwhelmed and this strategy created the tragedy that unfolded in care homes.

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