COVID-19: Under-testing, PPE shortage endanger patients, medical personnel at LUTH

…hospital’s system leaves no room for spread – CMD

The Lagos University Teaching Hospital (LUTH) risks spreading the deadly COVID- 19 to staff and patients as manpower and equipment shortages impede its fight against the disease in Nigeria’s largest city, a source within LUTH’S system confided in Businessday.

According to the source, who spoke on condition of anonymity because of the sensitivity of the matter, over-stretched doctors, inadequate testing capacity and shortage of personal protective equipment (PPE) are mainly responsible for this development.

At the biggest hospital in

Lagos, supposedly noncoronavirus patients seeking care at its gate could, in fact, slip into harm’s way because doctors are unable to test all patients to distinguish those with the novel coronavirus before admission, the source said.

“We are using probability to allow people into the hospital. The people who are given priority for protection are those who are treating COVID-19 patients and those who are the first contact in triage, deciding whether a patient should enter or not,” the source told Businessday.

Under the current circumstances, where the method of determining which patient should be isolated is predicated largely on assumption or probability due to insufficiency of testing kits, there are multiple layers of danger unfolding.

Although the Nigeria Centre for Disease Control (NCDC) had conducted 38,231 tests as at May 20, the Nigeria Medical Association (NMA) has raised a red flag against the deficit in the smart testing technique adopted by the centre, arguing it has failed to capture the real incidence of the COVID-19 in Nigeria.

Consequently, doctors screening patients at the largest tertiary hospital in Nigeria’s commercial capital are in the dark, a gaping loophole through which coronavirus patients could fall through into the wards other than its 60-bed isolation centre.

Unfortunately, health workers in the accident and emergency ward of LUTH are not given the standard of protection that workers in the COVID-19 isolation centres enjoy based on the faulty assumption that they work with low-risk patients, the source said.

Businessday understands that it is not rare for doctors to buy surgical masks and gloves out-ofpocket since the outbreak of the pandemic. As doctors, nurses and porters among others work with poor knowledge of the status of the patients, there is a risk the virus will accidentally spread from patients to health workers, from health workers to other patients and their relatives who come daily to care for them.

At the end of each day, these unprotected workers could take the virus home, exposing their family, friends, relatives and other members of society they interact with on the false assumption that they only treat non-coronavirus patients. Health workers at the forefront of the pandemic, on the other hand, are housed in the hospital’s residences and guest lodges during this period.

“The risk of LUTH becoming a super-spreader is very high because of the lack of very strict testing,” the source at LUTH said. “If you use the NCDC criteria, most of the patients should be tested because they mostly have a fever, cough, and tiredness. Our criteria for testing are more robust. We are constrained and can only test so many. We have tried to have a scoring system based on symptoms but it is not working because COVID-19 patients can start masquerading.”

But Chris Bode, LUTH’S chief medical director (CMD), when contacted said the hospital’s system didn’t leave room for spread of the virus.

Bode said no doctor at the tertiary health facility has been infected amid effort to manage the crisis. He did not, however, respond to the question about the challenge poor provision of PPE or lack of testing facing LUTH’S frontline workers.

Across the country, the number of infected doctors has increased as a full-blown community transmission of COVID-19 is now responsible for most infections, though initially it was recent arrivals to Nigeria.

Saliu Oseni, NMA chairman, Lagos chapter, estimates nearly 500 healthcare workers had been infected in Lagos as of May 19 – the distress and demoralisation among medical professionals, especially doctors, is palpable.

Also, the combination of these challenges implies a critical part of the Nigeria healthcare chain is weakened when mass testing, well-equipped hospitals and fully protected health workers are a must if the pandemic is to be contained. Since the race began to contain the virus in Nigeria, LUTH has had to part with two of five blocks available for managing patients.

Initially, an entire block that handles about 120 beds was yanked off and converted to a full COVID-19 isolation centre of 60 beds. Following that, another block close to it was added for coronavirus treatment, decimating the operating capacity of the poorly equipped and short-staffed hospital further by 40 percent.

What it means is that non-emergency cases and procedures including elective surgeries have not only been shuttered, patients who are, in fact, in need of urgent medical attention are being turned away due to the overstretched capacity.

“This has been useful to reserve safety equipment for healthcare workers managing COVID-19,” AbdulRasaq Lawal, a consultant surgeon at LUTH, told Businessday earlier. “We are focusing on services that are meant to preserve lives like emergencies. Emergencies cannot wait until after COVID-19. We have to treat them right away.”

Before COVID-19, LUTH was already at breaking point – barely 20 from about 65 patients seeking care daily got admitted to an A&E ward with less than 35 bed spaces. The system relied on transferring, discharging or death to make bed spaces available. On good days, a doctor could see about 13 patients. One doctor can attend to 20 patients on bad days which are frequent.

The coronavirus outbreak has further reduced that attention but neither the number of patients with illnesses or requiring emergencies has stopped.

“My main fear now is lack of testing, lack of manpower and lack of protection,” the source told Businessday. “I also fear the complete collapse of the health sector. We are not far. Politics is still going on in the way we are responding to the pandemic. Today we are trying to give an impression that we are in control and on top of the situation.”