Harare’s COVID-19 alarm: No ICU staff, testing limitations

Unprepared: An April 1, 2020, picture showing one of Wilkins Hospitals' hurriedly upgraded wards. XINHUA

The capital’s main COVID-19 treatment centre does not have intensive care unit (ICU) personnel to manage critically ill patients, a City of Harare epidemiology report has revealed.

Harare’s 12 active coronavirus cases are the most of any province in the country, with four patients admitted in council-run isolation centres. A situation report prepared by the Harare city council’s health department on April 26 showed the capital was nowhere near ready to handle any escalation of the pandemic, which has so far led to four deaths from 32 confirmed cases in the country.

“We have set up ICU facilities at WIDH (Wilkins Infectious Disease Hospital) without ICU staff and the MOHCC (Ministry of Health and Child Care) needs to urgently address this,” the report says.

The treatment facilities also have no blood for patients who might require transfusion, it adds. 

“There are inadequate staffing levels for the teams that are managing COVID19 response. This is the case management (doctors, nurses, cleaners e.t.c), the surveillance team. The city of Harare has approached the MOHCC on staff issues and so far no assistance has been offered.”

The report adds that some health workers were reluctant to work on COVID-19 cases, while others were unhappy about low pay.

“Allowance issues are bringing disharmony and disengagement amongst staff, indications are that the allowances being proposed are too little for a disease that is killing health care workers worldwide. Other staff are unwilling to work in COVID-19 outbreak,” says the report.

The City of Harare also complains about limited testing capacity. Nationally, the government has increased testing through the use of rapid testing since mid April, but with 6834 tests having been conducted as of April 27, the country is still some way off the government’s target of 40,000 tests by the end of the month.

“We need urgently to have decentralization of testing sites in Harare. We also need to have more of the testing equipment to be readily available on a day to day basis, at times we are receiving only 10-15 viral culture transport media per day which limits the number of tests we can do,” the report adds.

Viral culture transport media refers to clinical specimens containing viruses, including COVID-19, preserved and stored in a plastic, screw cap tube.

Council also complained about people being referred to its facilities without adequate screening.

“Central hospitals and private practitioners (are) referring clients for COVID-19 screening and testing without observing the case definition,” the council said.

Here are some highlights from the council report:

The Good:

  • No local transmission reported in Harare between the onset of the lockdown, and April 26, the day of the report. All new cases recorded until the report date were imported.
  • Wilkins renovations almost complete, with capacity to admit critical patients in ICU
  • Zimbabwe has joined the World Health Organisation’s Solidarity trial, joining over 100 countries which are currently trying out four treatment options – Remdesivir, Lopinavir/Ritonavir, Interferon beta-1a and chloroquine/hydroxychloroquine.
  • Tracing of 548 contacts for Harare’s 17 confirmed cases has been done. Most of these have gone through 21 days of follow ups with no symptoms developing.
  • Protective suits, surgical masks, waterproof coats and goggles received from the government, for distribution to the council’s clinics.
  • 558 community health workers and 12 district AIDS coordinators have been trained to help with  risk communication and community engagement.

The Bad:

  • No ICU personnel in place at Wilkins, a major COVID-19 treatment facility.
  • Limited testing capacity.
  • Screening area operates during the day only and there is no adequate staff allocated specifically for screening. 
  • No blood stocks for patients who might require transfusion.
  • Personal Protective Equipment is still short despite recent improvement.
  • Lack of psychosocial support for patients.
  • Low staff morale.