Provinces hard hit by COVID-19 rush to fast-track the diagnosing of health workers as South Africa’s cases surge
Eastern Cape healthcare workers are waiting nearly a month for their coronavirus test results from public sector laboratories, prompting workers to fear that they may be exposing patients and colleagues to the infection.
Earlier this month, testing backlogs prompted the Western Cape health department to announce that it would restrict testing for the new coronavirus to those with symptoms who were over the age of 55 or had underlying health conditions, as well as healthcare workers or patients in hospital or old-age homes.
A backlog of more than 21 000 tests for the new virus in the Eastern Cape has led to calls for the province to adopt a similarly restrictive criteria for coronavirus testing. Meanwhile, healthcare workers in the province say they’re scared that if they develop COVID-19, they won’t be diagnosed in time to get care or protect others from catching it. Gauteng and KwaZulu-Natal are already rushing health worker tests to private laboratories.
As of 9 June, the National Health Laboratory Service (NHLS) had about 70 000 unprocessed tests for the new coronavirus, SARS-Cov-2, NHLS chief executive officer Kamy Chetty told Parliament on 10 June. SARS-Cov-2 causes COVID-19 disease.
Chetty said international shortages in testing kits and supplies meant South Africa receives fewer kits than it needs, fuelling backlogs. The national laboratory service will start prioritising processing tests for healthcare workers as well as those who are at a high risk of dying from COVID-19 as part of a new system, Chetty said. Tests such as these will be done before those coming in as part of community screening efforts.
She explained: “We don’t have enough tests in the world.”
‘I’ve resigned myself to the inevitable outcome but others are scared’
In the Eastern Cape, tests for frontline workers including healthcare staff and other essential services such as security guards are already marked “urgent” and moved to the front of the NHLS’ queue, in theory, to try to speed up results for these groups.
But that has done little to clear backlogs. By 11 June, 2117 urgent tests were still unprocessed in the Eastern Cape, says NHLS spokesperson Mzimasi Gcukumana.
In correspondence between the NHLS to healthcare workers in the province seen by Bhekisisa, the national laboratory service says broken equipment, unnecessary testing, and a lack of the chemicals needed to run the tests have exacerbated delays.
In early June, healthcare workers say they were told there was “no reasonable prospect” of even a test marked “urgent” being processed within 14 days.
One worker in the Eastern Cape, who spoke to Bhekisisa on condition of anonymity, had seen waiting times of up to two weeks for coworkers’ COVID-19 results. “One of my colleagues was tested two weeks ago through the health department and still has not received her results.”
He explains: “I’ve resigned myself to the inevitable outcome, but others who have underlying conditions are scared, and rightly so.”
Results from more rural parts of the province can take up to a month, warned some healthcare workers.
People with diabetes and high blood pressure are more likely to die from COVID-19 than others, according to preliminary data from the Western Cape. As of 28 May, 2 000 healthcare workers in the public and private sectors had already tested positive for COVID-19, according to statements by Health Minister Zweli Mkhize.
Private, academic labs join the fight against the backlogs
Communication sent to healthcare workers and seen by Bhekisisa suggests the Eastern Cape health department is considering using private laboratories, the NHLS did not confirm this. Gcukumana says the government laboratory service is making use of spare test kits from private and academic laboratories.
The province will also be recruiting 38 new staff including a pathologist, scientist, technologists and clerks, according to Chetty’s presentation.
“We need quick movement on results so that people can be taken to isolation or treatment, and so that health workers can decide in which wards to put them or whether to send them home,“ Mhkize told journalists at a press conference.
New equipment is also heading to NHLS labs in East London and Port Elizabeth.
In Gauteng and KwaZulu-Natal, the NHLS has also added additional workers, equipment and testing sites, Chetty told Parliament. Both provinces have struck deal with private sector labs to deal with almost 40 000 unprocessed tests between the two provinces.
Academic laboratories in KwaZulu-Natal are expected to begin processing SARS-Cov-2 tests by the end of this week and research laboratories in the Western Cape are preparing to do the same.
But Chetty warns that turning to the academic and private sectors is no silver bullet: “The problems we’re facing in the NHLS are exactly the same as what the private and academic labs are struggling with.”
Western Cape: New policy reduces waiting times for some
The Western Cape accounts for nearly two-thirds of all reported COVID-19 cases in South Africa since the country’s outbreak began. Doctors there say that the province’s plan to test fewer people has cut waiting times for healthcare worker test results significantly. The province has also made use of private labs to process some essential worker tests.
“The turnaround time for health worker tests is between one and two days,” says James Porter, a specialist family physician at the public sector Symphony Way Community Day Centre in Delft outside Cape Town.
Tests results for patients already in hospital usually come back within a day, Chetty told Parliament.
The outcomes of tests for patients who aren’t in hospital, however, are still backlogged. Porter says he recently received a test result of a sample he took a month ago.
“That turnaround time of 30 days makes the original test completely pointless. Those results are useless to us on the ground,” he told Bhekisisa.
As a result of the backlog, Porter and his colleagues at other primary health care facilities only test people who are well enough to be sent home to self-isolate. People who can’t isolate at home are sent to government isolation facilities.
He explains: “If there’s a patient who is very sick, we send them to hospital because they’ve got much faster testing times there.” — Additional reporting by Laura Lopez Gonzalez