Dr Sodzi Sodzi-Tettey writes: Before we got the blood, she was dead!
Behind the brave smiles of our clinicians squarely facing the Covid-19 crises are dark frustrations and deep stresses! Take the current anxieties about delayed test results for suspected cases of Covid-19 I heard last week in an Accra-based hospital for starters!
A patient came with respiratory symptoms and a relevant travel history. Covid-19 was suspected and a laboratory test was requested. Being in mild respiratory distress, the patient was admitted, started on medication and provided oxygen support as needed. By day six of admission, patient was doing great and discharged home, all symptoms abated. On day seven, Covid-19 test results came in positive!
Fortunately, health workers in this instance assumed that the patient was positive until otherwise proven and took all the necessary precautions. While these personal protective precautions are laudable, what may escape many are the attendant ethical, safety and efficiency dilemma it highlights for the health worker. Dr. Kofi Effah, Director of Catholic Hospital, Battor’s Cervical Cancer programme immediately gets it.
“For us at Battor, it takes three days to over a week to get results. Staff are apprehensive to work on clients whose Covid-19 status they are unsure of. Why use all your PPEs allocated for a week for a suspected Covid-19 case only for the result to come in as negative? If you don’t use the PPEs too and the test comes as positive, you would have exposed your health workers. So many institutions are sending their suspected cases home for ‘self-isolation’ putting all of us at risk,” explained Dr. Effah.
The reality is that there is a significant backlog in samples waiting to be tested at the three main centers with dire implications for effective Covid-19 case management and containment. If the idea is still to flatten the curve through quick diagnosis of patients and their contacts, quick isolation of cases and quick disruption of transmission, then the testing bottlenecks need to be unraveled as a matter of urgency. In this regard, attempts to retool over 170 Genexpert machines originally procured for Tuberculosis diagnosis for Covid-19 testing cannot come fast enough.
Additionally, hospitals like Catholic Hospital, Battor are uniquely positioned to conduct 94 Covid-19 tests every two hours or approximately 1000 tests in a day. To successfully run these SARS-CoV-2 viral tests however, their current Amp Fire HPV machine originally secured for cervical cancer testing, needs to be retooled with the right reagents, swabs, detection kits, autoclave, freezer and sensor etc. in addition to renovating a specialized location for Covid-19 tests all at a total cost not exceeding USD 65,000.
Even more profoundly, the apprehension of clinicians to handle clients of unknown Covid-19 status is not trivial, with fatal implications at times even. Dr. Kofi Effah learnt this the hard way. Most of his surgeries on patients with cancer are now on hold. To worsen matters, he recently lost his last patient who had surgery for Ovarian cancer to bleeding complications.
In Effah’s words, “The patient had five units of blood donated for her before surgery. The surgery was more difficult than anticipated and ended up with resection of parts of her small bowel. She received six units of blood in theatre, but we needed more blood for her in the morning. There was none. Our ambulance was dispatched to the District Hospital in Sogakope where the medical superintendent had arranged for two extra units of blood. Sadly, she died before the ambulance reached Sogakope!”
Apparently, the Battor blood bank is regularly replenished by patients scheduled for uterine fibroid surgeries as a safety measure in the event of excessive blood loss. With Covid-19, these surgeries have also been put on hold with the unintended consequence of depleting the hospital’s blood bank.
Put bluntly, the fortunes of patients with non Covid-19 conditions are now dire and without a concerted effort to maintain essential health services while combating the Covid-19 epidemic, many will die that could and should have lived! To quote WHO, “When health systems are overwhelmed, both direct mortality from an outbreak and indirect mortality from vaccine-preventable and treatable conditions increase dramatically.” We do need to keep a sharp eye on the fast emerging double impact, lest the deleterious unintended consequences of Covid-19 also prove overwhelming.
The author is the Executive Director, Africa at Institute for Healthcare Improvement – IHI