After doctors blame administration for COVID-19 clusters at hospitals, Health Ministry circulates new procedures in internal memo
 
 
New Qasr al-Aini Teaching Hospital; Courtesy: VINCI construction website
 

Clusters of COVID-19 infections have broken out in three hospitals across Egypt over the last week. The Doctors Syndicate and medical staff who have spoken to Mada Masr have laid the blame for the spread at the feet of hospital administrators, whom they say have refused to take proper measures to limit infections. 

The spate of infections has affected medical staff at Alexandria’s Agamy Hospital, Cairo’s New Qasr al-Aini Teaching Hospital and Fayoum General Hospital, with the index case for the latter two hospitals being unknown, according to accounts medical staff have provided to Mada Masr and a statement from the Doctors Syndicate issued on Sunday.

In response to the spread, the Health Ministry’s Curative Care Department circulated an internal memo, a copy of which Mada Masr obtained, that sets out new procedures for medical staff in quarantine hospitals. The new procedures address some of the main criticism medical staff leveled at hospital administrations, including that exposed staff were denied testing.

At the New Qasr al-Aini Teaching Hospital, which is affiliated with Cairo University, medical faculty dean Hala Salah Eddin announced on Sunday that 17 members of the staff had contracted COVID-19, three of whom are nurses and the rest of whom are hospital administrators. According to local media, two administrative officials affiliated with the hospital have been placed on ventilators.

According to Salah Eddin, the index case for the cluster remains unknown, but she stated that those who had contracted the virus do not deal with patients in the hospital, and that they have been transferred to quarantine hospitals over the past two weeks.

Salah Eddin’s statement is an about-face for the university and the hospital, from which patients were evacuated last Thursday. 

Explaining the evacuation decision in a statement issued on Saturday, Cairo University spokesperson Mahmoud Alam Eddin said that the evacuation followed from a decision to convert Qasr al-Aini into a quarantine hospital for the university’s students and faculty members.

The Cabinet also published a statement on Saturday morning, denying accounts that the hospital was being evacuated due to a spike in coronavirus infections among staff and patients. The statement reiterated that the evacuation was to prepare the hospital to become a quarantine site.

Mada Masr reached out to Alam Eddin following his statement on Saturday. He stressed that there had been no positive cases among patients, but he declined to comment on whether any medical or administrative staff had contracted the virus, saying that it was always a “possibility.” 

“There is no news scoop here,” Alam Eddin told Mada Masr. 

The spokesperson confirmed that all patients had received a medical examination in the last two days in order to ensure they had not contracted COVID-19. 

Alam Eddin had said earlier that all patients were being transferred to other hospitals affiliated with Cairo University, including the Old Qasr al-Aini Teaching Hospital and Manial University Hospital, while dialysis patients were transferred to the King Fahad Unit at the university’s faculty of medicine.

However, a Qasr al-Aini nursing supervisor, who spoke to Mada Masr on condition of anonymity, confirmed that several medical and administrative staff had contracted the virus, including the hospital’s chief nurse, who had been sent to Agouza Hospital to be quarantined along with her son, who had also contracted the virus.

Two doctors working in the emergency room and three nurses, who have since been admitted to quarantine hospitals, also contracted the virus, in addition to a number of administrative workers, the nursing supervisor added. 

A CT scan conducted on one member of the administrative staff who was exhibiting COVID-19 symptoms showed damage and scarring in his lungs, according to the nursing supervisor. He was given a PCR test but continued to come into work without wearing any protective gear until the results of his test came back positive. 

When the decision to begin transferring patients out of the hospital was made last Thursday, Qasr al-Aini was providing care to about 200 patients and employed more than 5,000 doctors, nurses and administrative staff. 

The nursing supervisor told Mada Masr the working conditions at Qasr al-Aini are difficult, with shifts extending to 24 hours, and many of the “staff cannot bear to wear masks” for the entire shift.

While patients suspected of having contracted COVID-19 are admitted into the hospital through the emergency room, they are then transferred to one of the hospital’s internal departments while they await the results of the PCR tests. If they test positive, they are transferred to a quarantine hospital. 

However, in some instances, patients awaiting their results died in the hospital. Their bodies were then transferred out of the hospital using the patient elevator, according to the nursing supervisor, who added that several departments in the hospital closed after coronavirus cases began to appear. 

Medical staff filed a complaint with the administration, demanding that the hospital be sterilized, the nursing supervisor said. 

The administration, however, responded by randomly testing 56 members of staff — mostly doctors and nurses from the intensive care unit — the nursing supervisor added. 

Alam Eddin stated on Saturday in televised statements that the university has conducted 10,000 PCR tests.

The administration at the Agamy Quarantine Hospital are also facing accusations of negligence for withholding testing among medical staff, a decision that staff at the hospital say resulted in an outbreak of COVID-19 among staff. 

In a letter sent to the Cabinet on Sunday, which Mada Masr obtained a copy of, the Doctors Syndicate conveyed the complaints of Agamy Quarantine Hospital.

In the letter, the syndicate said it had received a number of complaints from doctors at the hospital that revealed “dangerous indicators.” 

The syndicate cited an incident in which a hospital manager refused to conduct a PCR test on a doctor who had just been assigned a 15-day shift at the quarantine hospital, despite the fact that the doctor stated that he had interacted with a COVID-19 patient. According to the syndicate’s letter, the doctor repeatedly asked to undergo the test before returning to work with his colleagues, but the hospital administered disregarded his request for 48 hours, during which time he continued to work alongside colleagues.

As per standard procedure at quarantine hospitals, medical staff are rotated every 15 days to another team, although those who wish to stay on a rotation are allowed to remain.

When the doctor was administered a PCR test, he tested positive. However, hospital administration insisted he take a second test, which came back negative. After the second test, the administration insisted the doctor should resume work. It was only after the doctor requested a third test, which came back positive, that he was sent to a quarantine facility. 

According to the Doctors Syndicate, the known protocol does not require a second test to confirm positive cases.

The syndicate also raised an issue regarding accommodation for staff at Agamy Hospital. Doctors assigned to the new 15-day rota are currently housed with other doctors who have been in direct contact with patients, the syndicate stated. One doctor contracted the virus from doctors she was living with who had yet to test positive.

Finally, the syndicate specified that the hospital administration had assigned doctors who were not specialized in respiratory diseases — their specializations ranged from obstetrics and gynaecology to psychology and surgery — to the quarantine hospital without providing them adequate training. 

The syndicate also renewed its request to the Health Ministry to publish information on the technical and administrative protocols, infection control and standard treatment in isolation and quarantine hospitals.

At Fayoum General Hospital, at least 20 hospital workers have tested positive for COVID-19 since April 15, according to Walid Nasr, a member of the Fayoum Doctors Syndicate Council, who spoke to Mada Masr on Sunday. 

This figure includes three doctors, 15 nurses and two other workers in the hospital, according to Nasr, who added that one of the doctors had also transmitted the infection to his parents. All of the confirmed cases have been taken to the quarantine hospital in Malawi, Minya.

Nasr told Mada Masr that the first people to test positive at the hospital were a gynecologist, a surgeon, and a hospital worker, each of whom were unsure how or where they had contracted the virus.

Other cases continued to show up over the following days, and those who had interacted with the infected cases were tested. One hundred and twenty-seven of the nursing staff were moved into dormitories at Fayoum University to be tested. According to Nasr, even though they tested negative, a Health Ministry official ordered they remain in quarantine for another 14 days before retaking the test. 

Nasr explained that about 90 percent of the hospital is currently closed, and that no new patients are being admitted.

He added that children in the hospital’s nurseries have been transferred to other hospitals, and that the administration is also trying to transfer patients in intensive care to other hospitals. The kidney disease department, which is currently treating 350 patients, is the only one currently working. However, the hospital was disinfected on Monday, according to local media, in preparation for the closed departments to reopen.

In light of the spate of infections, the Curative Care Department in the Health Ministry circulated an internal memo outlining new health procedures for medical staff at quarantine hospitals. 

The memo petitioned the heads of health directorates and quarantine hospitals to send the names of all medical staff who had contracted COVID-19, so that the Health Ministry can pay out financial dues quickly and determine how long infected hospital workers would need for treatment and recovery. 

The memo also mandated that all staff at quarantine hospitals be administered a rapid test for coronavirus upon arrival and before departing for their 15-day shift. All those who test positive in the rapid test will subsequently be administered a PCR and quarantined until the PCR results return. 

Hospital administrators previously came under scrutiny at the start of April for their handling of an outbreak at the National Cancer Institute, where 20 health workers and six family members contracted the virus. To trace the COVID-19 outbreak at the institute, Mada Masr interviewed four nurses who contracted the virus, including a head nurse and the nurse whom the Cairo University dean accused of spreading the disease to his fellow workers. All four spoke to Mada Masr by phone from quarantine hospitals in Cairo, Alexandria and Qalyubiya, describing how they were exposed to the virus and how they took it upon themselves to get tested to prevent a further outbreak while the institute refused to take any action.

Following the incident at the cancer institute, the Health Ministry sent out a memo to health officials and doctors on April 6 to impose measures to prevent further outbreaks. Among other measures, the Health Ministry mandated that all hospital staff be screened before clocking in for shifts, that personal protective equipment should be available at all times, and that an “observer” from the hospital’s disease control team should be appointed to ensure medical staff follow standard procedures for putting on and taking off PPE.

As of Monday night, 3,333 people have contracted COVID-19 in Egypt, and 250 people have died, according to a statement from the Health Ministry.

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