NHLS strategy to deal with Covid-19 test results and backlogs; Life Healthcare Group & Netcare on state of readiness for Covid-19
10 June 2020
Meeting Summary
Video: JM: PC on Health and Select Committee on Health and Social Services, 10 JUNE 2020
Audio: NHLS strategy to deal with Covid-19 test results and backlogs; Life Healthcare Group & Netcare on state of readiness for Covid-19
Documents:
National Health Laboratory Services presentation
Life Healthcare COVID-19 presentation
Presentation on readiness of Netcare hospitals for COVID-19 pandemic (awaited)
The National Health Laboratory Service (NHLS) has conducted 492 704 tests so far. There was a massive increase in the number of tests being performed during the month of May, where the figures more than doubled between April and May. There are 70 219 unprocessed specimens that still need to be tested and that the specimens from the hotspot areas are prioritised. The NHLS assured the Committees that the specimens were stored under specific conditions to avoid contamination. While the NHLS has the capacity to 35 000 tests a day, but the global shortage of test kits allows for only 10 000 tests to be done every day. South Africa has the capacity to produce its own testing kits, but it is a time-consuming process. The Department of Science and Technology (DSI) is working with SMMEs to produce test kits and materials. The NHLS are committed to delivering quality testing and to ensure support for the targeted testing strategy.
Members expressed concern that the backlog of tests has undermined our ability to effectively fight this pandemic because people are not able to get their test results back in time. The Committees enquired about the legitimacy and the costs of testing returned from the NHLS and were concerned about the high number of unprocessed specimens that still need to undergo testing and being at risk for contamination. Members enquired about the criteria used to distribute testing machines across the country.
The NHLS responded that one COVID-19 test costs R 507 to conduct. Every person who gets tested must get tested if they match the COVID-19 case definition of being symptomatic or being in contact with someone who are COVID-19 positive. Individuals who are tested are advised to go into quarantine or to self- isolate for 14 days. This is the established practice to ensure that individuals are not spreading the disease during the time that they are waiting for their test results to be delivered. The Committee was reassured that the specimens were stored under specific conditions to avoid contamination. The NHLS has been conducting an average of 15 000 tests a day, but the daily number is dependent on the availability of test kits and materials. The NHLS has focused on the provinces with the highest positivity rates, but there are provincial action plans for every province. The NHLS has a quality monitoring system to generate reliable data relating to the outcome of test results.
The Life Healthcare Group (LHG) has 66 healthcare facilities with a national capacity of 4 593 adult beds, 373 adult high care beds, 599 adult ICU beds, 547 ventilators, 280 anaesthetic machines, bulk oxygen tanks, and PPEs. LHG’s hospitals have surge plans in place with a regional plan in place to assist any individual hospital if the need arises. The LHG has implemented its risk reduction strategy which includes mandatory masks and screening for all persons on the premises, the regular monitoring of doctors and staff members, and adherence to social distancing rules.
Netcare has 51 acute hospitals in South Africa with a current national capacity is 6 040 critical care beds (of which 3 780 are in the private sector), 1 048 ventilators, and 392 anaesthetic machines. Netcare has 1 024 beds for COVID-19 patients, and a further 821 beds for patients who are awaiting diagnosis. 3 000 beds can be used to provide forms of oxygen support. Netcare provides full support and when a staff member is exposed to COVID-19, Netcare pays in full for the testing and isolation costs and provides special leave to the staff member. Healthcare practitioners are provided with a healthy and safe environment to practice and care for patients.
Meeting report
Dr S Dhlomo (ANC), Portfolio Committee Chairperson, opened the virtual meeting and said that the Committees would receive a briefing from the NHLS on COVID-19 test backlogs and results of tests followed by the Life Healthcare Group and Netcare on their state of readiness to receive and treat patients during the pandemic. He noted the Select Committee Chairperson is unable to attend the meeting.
National Health Laboratory Service on test results and backlogs
Dr Kamy Chetty, CEO of the NHLS, stated that so far there have been 492 704 tests conducted by the NHLS. The NHLS has increased the number of tests done each month with a massive increase in the number of tests being performed during the month of May, where the figures more than doubled between April and May. Most tests have been conducted in the Western Cape and Gauteng as these are the hotspot areas for infection. The Western Cape has a 18.56% positivity rate, and 114 381 tests were done by 8 June, with 21 232 positive cases and 814 inconclusive cases.
Testing strategy to reduce backlogs:
She outlined the process for testing using molecular tests: First, the NHLS obtains a specimen or swab of the individual being tested. Second, the RNA is extracted from the specimen converted to DNA, which is then amplified by PCR with specific primers for recognising COVID-19. Lastly, the results are interpreted to indicate whether the presence of viral RNA indicates an active infection. As of 9 June 2020, there are 70 219 unprocessed specimens that still need to be tested and that the specimens from the hotspot areas are prioritised. She specified that unprocessed specimens are those that have been at a laboratory for longer than three days after it has been registered. The breakdown of unprocessed specimens per province are as follow: Western Cape (7 266), Gauteng (23 000), Eastern Cape (21 953), and KwaZulu- Natal (18 000). A reasonable time to clear a specimen through the laboratory is 48 to 72 hours. She assured the Committees that the specimens were stored under specific conditions to avoid contamination.
Tests are prioritised using a colour coding system which makes provision for five key categories: Category 1 is for priority testing for individuals in dire medical need and for clinical diagnosis, Category 2 is for testing high risk individuals, Category 3 is for testing frontline healthcare workers and essential service personnel, Category 4 for surveillance, and Category 5 for screening in targeted hotspot areas. The NHSL uses this system to fast-track test results where it is needed the most. The NHLS outlined its strategy to upscale the number of tests they conduct, which includes increasing the number of extraction and PCR equipment, exploring alternative extraction methods, advocating for a better supply of test kits, and utilising more targeted, focused testing that allows for the better use of the limited resources available to fight the COVID- 19 pandemic. The NHLS has the capacity to do 35 000 tests a day, but the global shortage of test kits hampers this. As a result, 10 000 tests can be conducted in a day by the NHLS. The number of daily tests that can be conducted depends on the supply of test kits and can be increased to 30 000 a day if more test kits are provided. South Africa has the capacity to produce its own testing kits, but it is a time- consuming process. The DSI are working with SMMEs to produce test kits and materials.
Provincial action plans:
The NHLS has prepared a provincial action plan that will address the key problems experienced by the four provinces mostly affected by the COVID-19 pandemic.
In the Western Cape, targeted testing is conducted on prioritised specimens from in-hospital or high risk- patients. A large share of high through-put test kits is allocated to the Western Cape, additional extractors will be provided for the Tygerberg and Green Point laboratories, and additional PCR machines provided for each of the NHLS testing sites. The Green Point laboratory was recently added as an additional testing site, in collaboration with private laboratories.
In the Eastern Cape, 38 additional staff members were recruited which consisted out of 1 pathologist, 1 scientist, 18 technologists, and 20 clerks. The East London and Port Elizabeth testing sites were quipped with new extractors and PCR equipment. A stream-lined process to allow for the categorisation of specimens is being implemented. The feasibility of concluding partnerships with private laboratories are being explored.
In the Gauteng, 46 additional staff members were recruited to increase capacity. Separate registration facilities were created and in Braamfontein 15 new clerks were employed. Additional extraction and PCR equipment was provided, and some testing capabilities were decentralised to the Chris Hani Baragwanath Hospital, Helen Joseph Hospital, and the Tambo Memorial Hospital.
In KwaZulu-Natal, 73 staff members are already employed and NHLS is still recruiting new technologists. The laboratories in Edendale, Ngwelezane, and Madadeni are currently being validated.
Dr Chetty concluded by stating that the backlog is unlikely to affect people’s behaviour as every person who is tested is advised to self-isolate for 14 days to prevent spreading of the disease. The NHLS upscaled its testing capacity on a national level in a short space of time to provide significant numbers of test results on a weekly basis. Outputs are increased to reduce the backlog of test results. The NHLS remain committed to delivering quality testing and all attempts will be made to ensure support for the targeted testing strategy.
Discussion:
Ms P Dyantyi (ANC) thanked the NHLS for the presentation. The Committees appreciate that the NHLS is working on reducing the backlog. However, the two provinces (Western Cape and Gauteng) are having a surge of infections first, and the NHLS must prioritise employing more staff members in these provinces to avoid having testing machines and materials available but no staff to operate them.
Mr A Shaik Emam (NFP) raised the concern that the delay in test results, especially at the Tygerberg facility, and that people are sent back to work with the requirement that should they pick up any COVID-19 symptoms they should return to the NHLS. The period between the day the test is done and the day the result is available is too long and poses a risk.
Mr P van Staden (FF+) refereed to the 1171 inconclusive tests which refers to when a test was done, and it cannot be clarified whether the result was positive or negative. What is the reason for receiving a test result as inconclusive? What is the cost of conducting one test in the NHLS’s laboratories? Are unprocessed specimens still used and how is specimens disposed of after the tests have been conducted?
Ms A Gela (ANC) asked for clarity on why the NHLS have excluded the Northern Cape in the distribution of PCR equipment. How does the NHLS’s strategy to prioritise who gets tested relate to their efforts to upscale the number of tests being done?
Dr K Jacobs (ANC) stated that 114 381 tests were done in the Western Cape, whereas 150 954 tests were done in Gauteng. The positivity rates between the provinces are quite dissimilar. How will the NHLS correct this type of testing considering that there are not enough test reagents and kits? On the prioritising of who gets tested, this should be uniform to all provinces. He emphasised the point made by Mr van Staden about unprocessed specimens by enquiring what the value is in still doing test on specimens that have been in storage for a lengthy amount of time. The NHLS’s priority is to identify people who are COVID-19 positive and is actively suffering from the disease for everyone to understand the extent of the COVID-19 pandemic in South Africa.
Ms E Wilson (DA) stated that there is a significant risk of unprocessed specimens being contaminated if there is a backlog in test results. During the lockdown and responding to the pandemic, the government has been regulating the movement and behaviour of the people. Has there been any Regulations which govern the conducting of tests? Why are there discrepancies in the figures received from the provinces? For example, in one area of Limpopo there were two cases reported, but the number of cases returned to zero two days later, and then once again returned to two cases after that. It is very alarming to people who are following the statistics and data of COVID-19 infections as it calls the accuracy of the figures into question. The court case challenging the national tobacco ban is underway and being heard during the week. Are there any statistics on how many of the COVID-19 infections involved smokers?
Ms S Gwarube (DA) reminded the NHLS that at the beginning of the pandemic the Committees advised the entity that its testing capacity needs to be ramped up significantly. The Department of Health (DoH) set a target of testing between 15 000 and 30 000 tests per day. The backlog of tests has undermined our ability to effectively fight this pandemic because people are not able to get their test results back in time. What kind of strategies have been employed to target the deficit of testing reagents and kits when it comes to developing our local and domestic capacity? The GeneXpert machines require cartridges to operate which is also one of the testing materials we are lacking. What are the criteria used to distribute testing machines across the country and how many more are allocated to each province?
Ms H Ismail (DA) restated the problematic nature of having backlogs in test results. people are being tested and placed in self-isolation for 14 days. However, by the time they come out of self-isolation they have not yet received their test-results and they return to their places of work. This puts a lot of people at risk for infection that could be avoided by timely delivery of test results. What is the cost of conducting one test in the NHLS’s laboratories? Are there any national guidelines on the pricing of tests, because there are major differences in what laboratories are charging. There are also issues with patients who are being tested and told that their medical aids only pay for the cost of the test should they test positive. If they test negative, the patient must bear the burden of paying for the price of testing. She then requested data to indicate how many of the COVID-19 infections involved smokers and how many COVID-19 patients that are on ventilators are smokers.
Mr M Sokatsha (ANC) noted inconsistencies on the provincial information provided. He asked for clarity on why the NHLS have excluded the Northern Cape in the distribution of PCR equipment. There are four provinces who have not been included under the breakdown of unprocessed specimens. Why are there such inconsistencies when information relating to provinces are presented? What is the current situation with the shortage of test kits so far?
Ms N Chirwa (EFF) requested clarity on the rationale behind procuring laboratory materials from Western countries and not procuring them locally? What is the ratio of materials used from our domestic engineers compared to international suppliers? What is the current capacity of the NHLS to conduct tests daily and are these tests legitimate? There has been significant amounts of concerns and grievances from people whose next of kin has passed away due to different illnesses, but their death certificates state that they passed away from COVID-19. What is the legitimacy of the tests conducted and the data shared by the DoH surrounding the COVID-19 pandemic? People who are COVID-19 patients must be treated as such from the start, and those who are not ill should be prioritised because they are more at risk of spreading the disease. The Committees have also been receiving complaints about the NHLS for calling people and asking payments of R1 800 for tests conducted in public hospitals. She criticised the umbrella approach of the NHLS and restated that the Committees has advised them to follow a region-based operation according to the priorities of each region, because the national approach is insufficient.
Ms M Hlengwa (IFP) enquired whether there is any policy in place to reduce the backlog of testing. She raised her concern that there are instances where machines are available, but no staff to operate it.
Ms A Maleka (ANC, Mpumalanga) enquired whether the NHLS has the capacity to monitor whether the tests done in its laboratories are legitimate. How much has been spent on private laboratories because of the shortage of test reagents and kits? There have been complains on a lack of response from the NHLS. What are the reasons for this and what is being done to correct it?
Mr M Bara (DA, Gauteng) stated that there has been a report that some specimens are being ferried by road from the Eastern Cape to Gauteng. If this is the case, does it not have a bearing on the inconclusiveness of some tests being conducted? To what extent does the backlog contribute to further infections?
Ms D Christians (DA, Northern Cape) enquired about the 67 mobile vans procured and deployed to provinces. Considering the shortage of test kits and reagents, the NHLS is requested to provide clarity on what the responsibility of these mobile vans are. Are they adequately capacitated to fulfill their functions and to which provinces were these mobile vans deployed to? How can the community members access these vans should they need to undergo testing? She asked why the NHLS have excluded the Northern Cape in their presentation and requested updated data to ascertain the true situation in that province.
NHLS response
Dr Chetty responded that the NHLS is prioritising some provinces and as outlined in the provincial action plan, there are more staff members being recruited in hotspot provinces and more equipment are allocated. The call centres that the NHLS established was done rapidly and massive numbers of nurses have been recruited to work in shifts. Doctors have been recruited for the Doctors’ Hotline, and the NHLS has also established a Results hotline where employees have also been recruited. All the mobile vans and labs are staffed with two nurses and a driver.
The issue around the Tygerberg facility, the backlog as been cleared at that facility. Every person who gets tested must get tested if they match the COVID-19 case definition of being symptomatic or being in contact with someone who are COVID-19 positive. Individuals who are tested are advised to go into quarantine or to self-isolate for 14 days. This is the established practice to ensure that individuals are not spreading the disease during the time that they are waiting for their test results to be delivered. The backlog is unlikely to affect people’s behaviour as every person who is tested is advised to self- isolate for 14 days to prevent spreading of the disease. They are also encouraged to practice safe and hygienic behaviours. The inconclusive results occur when the machine itself could not clearly determine whether the gene is positive or negative for COVID-19. The laboratories then contact the individuals or the clinician to determine that the test needs to be repeated as an inconclusive result was achieved. The number of inconclusive tests is not high and occurs with a lot of machines because the specimen used was not adequate or enough. The NHLS estimates that the cost to conduct one test is R 507 per person.
Biological samples may deteriorate over time, but it does not affect the integrity of the specimen. The NHLS is conducting an experiment to investigate how long the RNA can be detectable in these samples and whether the specimens are still viable for testing. The Committee will be informed of the outcome of the experiment as soon as the results are finalised. She assured the Committees that the specimens were stored under specific conditions to avoid contamination.
Dr Chetty clarified that the Northern Cape has not been excluded, but it is true to say that the current platforms used by the NHLS, except for the GeneXpert, must be signed off by a biologist. The biologist looks at the different patterns because they are testing for different genes and then signs off on whether it was a positive or negative test result. The tests can only be conducted in laboratories staffed with a biologist. There are not laboratories with biologists in the Northern Cape and the NHLS is exploring a plan of appointing one to support the province. The Northern Cape does get test kits and materials from the GeneXpert, which allows the province to conduct some of its own testing. The NHLS is in discussion with the DoH to establish the firm priorities of its testing strategy to create a national policy.
Until recently, most of the provinces were conducting testing using the same case definition and proportionally the Western Cape is going more tests as it is the epicentre of the COVID-19 pandemic in South Africa. There are no specific Regulations relating to testing of potential COVID-19 patients. The statistics and data presented are obtained from the National Institute for Communicable Diseases (NICD) and includes data from the private sector. The issue on statistics of smokers are not kept at the NHLS, as only test results are stored and not the patients’ clinical history.
On the testing capacity of the NHLS, 30 000 is the available throughput of tests for the equipment available. During the last week, the NHLS has been conducting an average of 15 000 tests a day, but the daily number is dependent on the availability of test kits and materials. South Africa has the capacity to produce its own testing kits, but it is a time-consuming process. The NHLS has focused on the provinces with the highest positivity rates, but there are provincial action plans for every province. The NHLS has a quality monitoring system to generate reliable data relating to the outcome of test results.
Dr Chetty condemned the possibility of call centre agents asking for payment for tests from the patients and requested information in relation to be turned over to the NHLS for investigation of abuse of the system. On the possibility of the backlogs resulting in more infections, it is the duty of clinicians and healthcare workers to manage their patients in a safe way to avoid spreading of the disease until the test results have been returned. The DoH decide where the mobile vans operate.
Prof Eric Buch, NHLS Board Chairperson, stated that the NHLS Board has been tracking the upscaling of testing capacity from the beginning of the year. The big challenge is to procure and source the test kits and materials, but the suppliers have been unable to provide. The NHLS constantly engages with the DoH to source more test kits and materials. The NHLS does not charge patients or individuals directly for the costs of the tests. The provinces are billed for the number of tests they have ordered according to a Schedule approved by the Minister of Health. The hospitals or clinics of the private patients are billed directly for COVID-19 tests.
The Chairperson requested the NHLS respond to the questions they have not answered in writing.
Life Healthcare Group (LHG) on readiness for COVID-19
Ms Ansuyiah Padayachee, LHG Manager of Corporate Social Investment, stated that LHG has 66 healthcare facilities in South Africa and Botswana. She introduced the LHG delegation that will inform the Committees on the measures in place to manage suspected and confirmed cases, actions to control virus transmission, and challenges that have emerged during LHG’s response to the pandemic.
Mr Matthew Prior, LHG Funder Relations and Health Policy Executive, explained that their preparedness is grounded on three pillars: the community, employees and hospitals, and government. In terms of the first pillar, community, LGH prioritises the creation of a safe environment for patients and visitors, to discourage unnecessary visits to the doctor or to the hospital, and to reduce morbidity and
mortality. In terms of the second pillar, employees, and hospitals, it is paramount to ensure that hospitals are prepared to manage the surge of patients, to promote the emotional and physical well-being of employees and doctors, and to retain capacity to manage non-COVID-19 patients. The last pillar, government, focuses on collaborating with national and provincial responses to manage the pandemic, to report data, and to provide bed capacity where available. The global fee per day charged for LHG’s services is R16 156 for a critical care bed, R2 972 for an acute care bed, and R990 for palliative care.
Dr Trevor Frankish, LHG Clinical Directorate, emphasised the importance of the protection of healthcare workers and that it is vital to maintain the mental and physical health of our staff while providing them with the adequate Personal Protective Equipment (PPE). Surfaces and hospital environments are disinfected regularly and that there are protocols in place should employees be exposed to COVID-19. Since 22 March 2020, 313 staff members and doctors have been infected. Two staff members in the Eastern Cape have passed away because of their exposure, 13 are currently hospitalised, 68 have fully recovered, and 239 staff members are currently in self-isolation. LHG has implemented its risk reduction strategy which includes mandatory masks and screening for all persons on the premises, the regular monitoring of doctors and staff members, and adherence to social distancing rules.
Mr André Joseph, LHG General Manager of Funder Relations, stated that all LHG hospitals have surge plans which are verified by experienced persons independent of local management. There is a regional plan in place to assist any individual hospital if the need arises.
He provided a breakdown of the capacity of LHG hospitals in the four most affected provinces, including KwaZulu-Natal, Gauteng, Eastern Cape, and Western Cape. LHG’s current national capacity is 4 593 adult beds, 373 adult high care beds, 599 adult ICU beds, 547 ventilators, 280 anaesthetic machines, bulk oxygen tanks, and PPE.
Discussion:
Chairperson Dhlomo thanked LHG for the presentation. The Portfolio Committee conducted an oversight visit in the Eastern Cape last week and was shanked by an official at one of LHG hospitals. The Committee received an apology from Ms Padayachee, but it was not explained why the official behaved the way he did. It was unbecoming behaviour when an oversight visit has been agreed on in one of LHG’s facilities and they are not willing to share access and the relevant and needed information with Members.
Mr Sokatsha enquired on the service level agreement (SLA) between LHG and the government. Are there any costs involved in terms of the SLA for provinces? What happens when a family member of a COVID-19 positive employee is also found to be exposed and infected with the disease? Will those family members be admitted to the quarantine sites of LHG?
Ms Dyantyi thanked the Chairperson for raising the disappointment the Portfolio Committee experienced at St. Mary’s Hospital, which forms part of LHG hospitals. She requested LHG share the report of the incident with the Committee. She expressed concern at the high number of COVID-19 infections and deaths reported in frail care wards of LHG. She requested clarity on whether the number of deaths reported are all related to COVID-19 or if it includes other causes of death as well.
Mr Shaik Emam asked a critical question by requesting LHG to inform the Committees on what criteria they use to accept or reject patients that are waiting to be admitted to their facilities. Are there any discussions with the DoH underway to engage on this? If there are no criteria in place, LHG must tell the Committees how they will implement a relevant plan. He enquired why LHG is experiencing a shortage of PPE, as a great percentage thereof is locally manufactured.
Ms Gwarube said that her understanding is that the provinces with higher numbers of positive cases would also be the provinces with higher numbers of deaths. The Eastern Cape has the second most positive COVID-19 cases, but only 63 deaths. Why is this the case and does it link to inadequate monitoring or reporting of data? At what costs are the critical care and ICU beds being contracted out to the government should we be heading towards the peak of the pandemic?
Ms Maleka enquired about the collaboration of LHG with other private healthcare providers to tackle the COVID-19 pandemic. How many healthcare professionals has tested positive for COVID-19 at LHG and how many have recovered?
Mr Bara highlighted the challenges of Life Esidimeni regarding mental health patients. What is the strategy that LHG employs to ensure that those establishments adhere to the safety and hygiene protocols put in place in fighting the COVID-19 pandemic? The peak of the pandemic is projected to be around August or September. What is the level of readiness of LHG in keeping up with the peak of infections and incoming patients when the situation worsens?
Ms Christians asked whether there is an agreement between the private sector (including LHG) and the government during the COVID-19 outbreak. Are there any compensation arrangements in place? Have the ICU beds been contracted out on an already negotiated price or are the discussions still ongoing? She stated her appreciation for the provision of mental health and wellbeing services that are provided to LHG staff and healthcare practitioners. She emphasised Mr Bara’s question by asking whether LHG is ready for when the peak of the COVID-19 pandemic arise.
LHG response
Mr Adam Pyle, CEO of LHG, apologised to Chairperson Dhlomo and the Portfolio Committee for their negative experience at the St. Mary’s Hospital. LHG did not intend to waste the Members’ time or show any disrespect. LHG will investigate the incident when the relevant hospital manager who was involved is back from his mandatory self-isolation period after being exposed to a COVID-19 positive nurse.
Mr Prior stated that the Regulations of the Disaster Management Act granted a specific exemption for the private hospital industry to discuss pricing as an industry. The industry must be given specific dispensation by either the Minister of Finance or the Minister of Health to discuss pricing. The industry received dispensation to discuss other issues, such as the coordination of capacity and ensuring that the private sector hospitals can report data through the DoH and the NICD. The industry was not granted dispensation to discuss pricing, and LHG submitted a proposal to the DoH. Subsequently, the DoH held a public briefing and the Minister of Health announced that they were going to recommend the specific prices as in the presentation. The VAT-inclusive costs charged for LHG’s services is R16 156 for a critical care bed, R2 972 for an acute care bed, and R990 for palliative care. The costs outlined are below LHG’s cost recovery level and is not a sustainable rate. LHG’s financial statements are in the public domain and the Committees can scrutinise its profitability levels. The next step is to establish an service level agreement (SLA) and a Memorandum of Understanding that will be used as the basis of engagement between the provinces and the government. There will be a managed care process where patients from the public sector will be referred to the private sector hospitals through a process by the provincial departments and the DoH before patients are admitted.
Dr Frankish stated that while LHG is open to such an arrangement, there has been no request from employees who test positive after exposure to COVID-19 to have their families admitted to quarantine facilities. LHG quarantines any staff member who test positive to avoid further infection to their family. The situation in the Eastern Cape can be attributed to the burden of comorbidities when someone is exposed to COVID-19. The information from the NICD are informative and publicly available. The effect of comorbidities must be kept in mind when interpreting the number of deaths of frail care patients. The risk of asymptomatic people spreading the disease is between 30% and 40% and is an unmanageable risk.
Mr Pyle added that LHG has tried to source locally manufactured PPEs and have engaged with the suppliers to develop their capacity to provide enough PPE. Every LHG hospital has surge plans in place to deal with a surge in COVID-19 infections and patients. The major challenges include a limited staff and bed capacity. Staff members can be moved between provinces depending on where the surges occur. LHG does not have the capacity to admit patients who do not need to be hospitalised. Doctors and staff are restricted from moving between hospitals outside LHG.
Chairperson Dhlomo stated that the moonlighting of healthcare professionals is an issue as doctors and nurses move between various hospitals which increases the risk of spreading the disease. He requested the Life Healthcare Group to respond to the questions they have not answered in writing.
Netcare on readiness for COVID-19
Dr Richard Friedland, Netcare Group CEO, outlined Netcare’s pandemic framework which includes preparation by heightening awareness and risk mitigation, containment by employing further strategies to limit transmission, decreasing community transmission through enhanced tracking and tracing, and preparing for a surge in infections by implementing a structured approach to increased capacity demands.
To protect its healthcare workers, Netcare provides training on the application and removal of PPEs, increases awareness of infection prevention control measures, endorses proactive and supportive communication, and provides flu vaccines for all staff. When a staff member is exposed to COVID-19, Netcare pays in full for the testing and isolation costs and provides special leave to the staff member. Healthcare practitioners are provided with a healthy and safe environment to practice and care for patients.
There are 51 Netcare acute hospitals in South Africa. Netcare’s current national capacity is 6 040 critical care beds (of which 3 780 are in the private sector), 1 048 ventilators, and 392 anaesthetic machines. Netcare has 1 024 beds for COVID-19 patients, and a further 821 beds for patients who are awaiting diagnosis. 3 000 beds can be used to provide forms of oxygen support.
Netcare categorises patients in three zones based on their COVID-19 status. Patients who are infected with COVID-19 are allocated to the red zone that are prioritised and handled as critical. Patients whose status is unclear whether they are COVID-19 positive or negative are allocated to the yellow group for ‘people under investigation’. Patients who are negative for COVID-19 are allocated to the green group.
He concluded by stating that Netcare applauds the decisive stewardship of the Minister of Health and the DoH in tackling the pandemic. Netcare stands ready to play its part in fighting the pandemic and reiterated its pledge to treat all patients with dignity, compassion, and outstanding care.
Discussion:
Ms Wilson thanked Netcare for their presentation. There was a newspaper article about the Milpark hospital where complaints were received that COVID-19 positive patients were placed in wards with patients who did not test positive for the disease. This is quite alarming as we know that some people are asymptomatic patients and it may take a few days for them to develop symptoms and become aware that they have been infected. What has Netcare done to stop this type of situation from happening again? It is predicted that there will be tens of thousands of positive cases of COVID-19 shortly. Will the bed capacity of Netcare be able to handle a surge in patients? Is South Africa sufficiently equipped to deal with the pandemic as it escalates considering the number of ventilators and the equipment available?
Mr Shaik Emam asked how Netcare will differentiate between patients coming from the public or the private health sector to decide which patients to admit. There is an innovation that allows a ventilator to provide oxygen to three or four patients at a time. Is Netcare aware of this innovation and exploring it as a solution to the oxygen shortage? He expressed concern about the protection of healthcare employees. Does Netcare provide additional benefits to their next of kin should they pass away due to exposure to and COVID-19 infection?
Ms M Sukers (ACDP) commended Netcare for their contribution in fighting the COVID-19 pandemic. What was the root cause of the COVID-19 outbreaks at the Kingsway and St. Augustine hospitals and how has the situation been handled? Have any additional protocols been put into place to avoid a recurrence of such outbreaks? South Africa’s health system has been under severe strain which is likely to increase in the upcoming weeks. What contingency or surge plans does Netcare have in place to handle a sharp rise in COVID-19 infections and patients?
Ms Chirwa requested an update on St. Augustine hospital and what Netcare is doing to avoid similar outbreaks at other facilities that are open to the public. How will the tariffs of private doctors be amended when public hospital patients start utilising their facilities? How often does Netcare conduct tests on its healthcare professionals to determine their COVID-19 status?
Ms Gwarube asked clarity on the extent that Netcare upscaled its capacity by requesting the number of available ICU beds and ventilators that were available before the pandemic and how many are available now. From where does Netcare procure the additional equipment considering there is a global shortage? How does Netcare deal with people whose COVID-19 status is unknown considering the backlog in test results at the NHLS and the increase in admissions and foot traffic in the facilities?
Ms Gela said that Netcare did not state the challenges it is experiencing in its presentation. Where does Netcare procure the PPE used in their facilities? Does Netcare have the capacity to procure more beds for patients when the peak of the pandemic comes around?
Ms Hlengwa asked what Netcare’s role is in helping and uplifting the neighbouring public hospitals in various areas to increase their capacities in fighting the COVID-19 pandemic.
Mr Sokatsha stated that the Northern Cape was excluded and requested Netcare to inform the Committees on its capacity to take patients within that province. A detailed update on the recovery of costs between Netcare and the government is required.
Ms Ndongeni stated that a large number of healthcare professions has tested positive for COVID-19. How many doctors, nurses, and staff members have been tested positive at Netcare facilities?
Netcare response
Dr Friedland stated that the Milpark issue was about a patient who claimed she was in the green zone and was in the same ward as someone who had tested positive for COVID-19. All patients that enter Netcare facilities are pre-tested and only people who are negative for COVID-19 will be admitted to the green zone, but asymptomatic patients and the test results that show false negatives make this process significantly harder. Strict isolation measures are adhered to and all staff members must use PPEs. Patients whose status is unclear whether they are COVID-19 positive or negative are allocated to the yellow group for ‘people under investigation’, which includes patients admitted in emergency situations.
One of the advantages in South Africa is that we have come into this pandemic later than other countries and we have been able to benefit from their learnings about treatment, such as using the innovative versions of ventilators. Not all patients need to be put on ventilators and alternative forms of oxygen therapy are being explored considering the insufficient number of ventilators available. Inadequate supplies of oxygen will be a grave challenge when the pandemic reaches its peak. Since the start of the pandemic, Netcare has been upscaling its capacity by purchasing an additional 100 ventilators and 270 nasal ventilation devices, collectively costing over R1m to procure.
Netcare cannot differentiate between patients from public and private sectors as it is not possible in a state of disaster to differentiate people based on whether they can afford healthcare or not. If the DoH wishes to transfer patients to Netcare facilities based on the agreed protocols, those patients will be admitted on a first-come first-serve basis. Patients will be treated based on their immediate healthcare needs. Netcare support local PPE manufacturers but had to import materials as well at expensive rates. Netcare has spent R900m in the last three months to ensure the protection of its staff and healthcare professionals.
When a staff member is exposed to COVID-19, Netcare pays in full for the testing and isolation costs and provides special leave to the staff member, while they are subjected to continuous risk assessments.
Healthcare practitioners are provided with a healthy and safe environment to practice and care for patients. No staff member or healthcare professional at Netcare is prejudiced against based on their income or ability to protect themselves from the COVID-19 disease. They are provided with PPE while they are at the hospital and additional safety and hygienic measures when they are travelling. Netcare pays for their accommodation should they need to self-isolate or be put into quarantine and staff are provided with free flu vaccines. The most significant challenge with staff on the frontline is anxiety and stigmatisation. Staff are provided with free in-house counselling and wellness programmes to be used as needed.
On the situation at the St. Augustine hospital, it was an extraordinary lesson for Netcare, and an independent investigation was conducted by leading epidemiologists. Netcare implemented the recommendations made by the team of epidemiologists, which including the closing down of social areas and canteens. It strengthened the health and safety protocols in place which have been expanded to all other Netcare facilities to avoid similar outbreaks.
Chairperson Dhlomo requested Netcare to respond to the questions they have not answered in writing.
The meeting was adjourned.