COVID-19: Doctors On The Frontlines Tell Their Stories

Some African doctors on the frontlines of the COVID-19 pandemic in Africa, United Kingdom and the United States, enabled by technology, gathered to share ideas about best practices in saving lives while safeguarding themselves from the virus.

Some 20 doctors of African descent gathered across three continents via Zoom to discuss best practices in safeguarding health workers at the frontlines of the COVID-19 pandemic.

The doctors from Nigeria, Ghana and Cameroon mostly working in the Diaspora discussed the need to establish hospital protocol for COVID-19 management; TELE-Medicine as an alternative to face-to-face medical practice; personal protection routine doctors should adopt to avoid getting infected; integrity of tests; and use of face masks among others.

The presence of a Nephrologist based in Bronx, New York in the group sharing how he got infected with COVID-19 underscored the gravity of risks healthcare workers face in saving the lives of others.

Coughing heavily as he spoke, the Nigerian-born doctor (name withheld) said he contracted COVID-19 as a result of an unguarded examination of an asymptomatic patient using a face mask he had used more than once.

He warned health workers to be circumspect about their protection routine.

“When I came in contact with the patient I was wearing a surgical mask, gloves, apron. I had used the face mask about two to three days. I was careful not to touch the surface. I cannot remember if I washed my face after seeing the patient; I don’t know if it contributed to how I got the infection. I want to advise doctors to prepare ahead. Work with your family as if you are already exposed.

“You can have all the PPE there is; if you are taking it off and you don’t do it appropriately, you will run into trouble. Avoid touching surfaces; wash your hands; wash your face,” he said.

All the doctors agreed there was a need to establish and follow personal protection protocol to avoid endangering their lives, families and patients.

Convener of the meeting, Dr. Ona Utuama, a hospitalist and public health researcher practising in Florida, U.S., said she had stopped wearing jewellery and personal clothes to work.

“I wear scrubs, get a long pair of socks, no jewellery, rubber shoes; I cover my hair. When I get home I ensure all my clothes come out in the garage and straight into the laundry; wash my hands and have my bath before meeting my family,” she said.

Dr. Sola Irinoye, who runs a primary care private practice in South Africa, also said he had dedicated work clothes and had prepared a part of his home for his sole use while the pandemic lasts.

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Dr. Anthony Nebor, a Pulmonology and critical care, in Detroit Michigan advised doctors to limit their exposure while treating patients by going to them only when necessary as the virus spends substantial time in the air.

“Studies have shown that this virus can be in the air for up to three hours. For the dreaded Tuberculosis, it is about 30 minutes. If you don’t have adequate protection, you should not see patients,” he said.

Dr. Patricia Wodi, a Paediatrician in the UK, called for a policy that requires all patients to have face masks on when visiting the hospital. She also warned doctors not to hang around the hospital longer than necessary and limit discussion with co-workers.

“The Italians had substantial transmission among his workers. Protect yourself; be wary of patients and other health workers. Every human being is a potential carrier,” she said.

As important as using PPE, the doctors also stressed the need to wash before and after removing them. Dr. Benson Okwara, Team Lead for COVID-19 response at the University of Benin Teaching Hospital (UBTH), said he supervised the wearing and removal of PPE for frontline workers at the hospital.

With the global shortage of PPE being an issue, the best practice on their safe usage was discussed.

A doctor from Ghana, Gertrude Acquah-Hagan, said doctors were being told to use home-made PPE.

Dr. Irinoye said he manages his PPE supply by re-using his N-95 masks (three or four times) and suits after sterilising them in an Ultra-Violet sterilizer.

However, the doctors did not agree that sterilising PPE for re-use was good enough to protect health workers.

Dr. Utuama urged doctors to demand PPE from hospital authorities rather than manage what inadequate equipment they are given.

“Ask your hospital to provide. If you are a health worker you need the best type of protection you can get,” she said.

Nebor added: “I stand for use of PPE once and discard. I am still a bit sceptical about disinfection.”

The group generally agreed that Telemedicine was a way hospitals could use to reduce face-to-face meetings with patients.

Dr Ufuoma Okotete, an Abuja-based Physician, said TELE-Medicine was the way to go. “Sixty percent of hospital visits are not necessary,” she said.

However, Dr. Adegoke said hospitals have to work out how to bill patients for Tele-medicine which may not require the patient to be physically present at the hospital.

Dr. Utuama said she uses TELE-Medicine to attend to patients at the hospital.

“We started with using the phone; now we use an iPad to interact with the patients,” she said.

The doctors generally praised Nigeria’s management of the pandemic so far. They, however, warned that the numbers be kept under control and expressed concerns about inadequate testing. They underscored the need for proper planning and leadership.

Dr. Utuama said beyond building isolation centres, planning, and adequate testing were key to successful management of the pandemic.

“Nigeria keeps building isolation centres which are good but need those who are on the frontlines to guide them through the fine details. It’s the testing, protocols, management processes that those in hard-hit areas are doing that will help them and avoid the mistakes we made. We pray our cases don’t increase quickly,” she said.

Private hospitals in Nigeria are not allowed to manage COVID-19 cases except they are accredited. However, with some of the COVID-19 patients being asymptomatic, they are likely to spread the infection unknowingly wherever they go.

Underscoring the need to be prepared, the doctors said hospitals should have a protocol in place for managing patients even before they start getting cases.

Dr. Adeleke Adegoke, a family medicine ER Expert and hospitalist in Texas, said the plan should include the number of entry and exit points access to the hospital, to what happens should a patient CPR which is likely to generate aerosol that would further spread the virus.

“Most hospitals in the U.S. did not plan ahead of time. For folks in Nigeria, it is best to start planning now. Have a plan for what will happen if there is a surge; entry and exits to the hospital; decision to intubate; there should be protocol on everything so everyone does not just do what they like,” he said.

Dr. Cynthia Yohanna, a UK-based doctor, said her hospital has divided the ER (Emergency Room) into two and code-named them to refer to COVID and non-COVID areas. COVID areas have health workers in full PPE. Non- COVID-19 area takes precautions to prevent infection.

“We have split the practice into two – hot zone and cold zone. Once you have a cough or temperature you don’t get seen with others; you are seen in the quarantine zone,” she said.

The doctors noted other hospitals had similar arrangements and named the Quarantine area hot zone, red ER, Dirty area etc.

In Anambra State, Special Adviser to the Anambra State Governor on Health, Dr Simeon Onyemachi said private hospitals had been directed to set up mini-isolation areas in their hospitals should they get suspected cases then escalate to the relevant government agencies to pick up such patients to isolation centres.

He said the state may get up to 7,000 cases based on its Mathematical model, adding that the government had prepared a 300-plus bed isolation centre for COVID-19 cases in the Anambra State NYSC Camp.

“We are preparing for the worst-case scenario. If we look at the modelling, we will get 7,000 people. We have built a 328-bed isolation centre in the new NYSC camp.

We set up a protocol for hospitals to follow. When they get suspected cases, they should use a part of the hospital as mini-isolation centre; the numbers to call are in the bulk SMS we sent to the hospitals,” he said.f

Regarding the use of face masks by the public, the doctors agreed that it should become a general policy.

Dr. Utuama advised Nigerians to make masks at home to reduce the cost of buying readymade ones which are presently scarce.

“We don’t have masks here; we are telling people to make. In Nigeria, let tailors make cheap face masks and give or sell to those around them. It took us five weeks to make that decision – too late. So for Nigeria, make that decision now,” she said.

After agreeing that the deliberations were fruitful, the doctors decided to make the meeting weekly to continue sharing their COVID-19 experience.

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