Wednesday, 8 April 2020

NEW CORONAVIRUS TESTING GUIDELINES


Zimbabweans showing symptoms of a potential Covid-19 infection will now immediately be referred to the rapid response team for testing as Government adopts new and broader testing guidelines approved by the World Health Organisation.

This followed the second Covid-19 death in Bulawayo where testing was delayed by his private practitioner until the patient was close to death.

At the same time private doctors are being trained through their own association to order tests to be done early in suspected cases. 

Some private doctors skipped the initial training on how to respond to patients with potential Covid-19 symptoms and there is now a call for private practitioners to be brought up to the same levels as their public sector colleagues.

Previously, the WHO guidelines considered history of travel or contact with a confirmed case in addition to the symptoms before deciding on a test, and that was the Zimbabwean procedure which has now been updated to concentrate on the symptoms, rather than the travel and contact history.

Zimbabwe’s 11th confirmed case, and second death, was initially diagnosed with pneumonia by a private doctor in his home city since the 79-year-old Bulawayo man had not travelled before showing symptoms more than a week before hospitalisation and his test towards the end of last week, and had no known contact with an infected person although he had been visiting a Hwange tourist resort in mid-March.

Responding to emailed questions on circumstances surrounding the detection, management and subsequent death of the country’s eleventh case of Covid-19, WHO country representative Dr Alex Gasasira said it was important for all clinicians and health workers in Zimbabwe to have increased sense of suspicion when attending to patients with febrile illnesses accompanied with respiratory symptoms. 

He said ongoing efforts to train all health care workers in the country on how to screen and manage patients who present with signs and symptoms of Covid-19 should be accelerated.

“Government of Zimbabwe through the Ministry of Health and Child Care has taken a decision to expand the range of patients who will be tested,” said Dr Gasasira. “WHO supports this decision.

“WHO was grateful to all for making resources available for expanded testing to be implemented. These included the Government and the ministry, and the international partners who have provided the required human resources, laboratory equipment and consumables.”

Dr Gasasira said the WHO was encouraged by ongoing efforts by Government and different stakeholders in responding to the outbreak that has so far claimed two lives in Zimbabwe with nine others confirmed as infected although recovering.

Zimbabwe Hospital Doctors for Human Rights urged Government to popularise the case definition among private practitioners, arguing that current awareness efforts were skewed towards practitioners in public health facilities who know when to order tests.

“In an outbreak of this nature, we would expect active surveillance, screening and testing of all symptomatic cases. In this case (the Bulawayo death), we are of the view that the testing was rather too late, exposing health workers, communities and delaying active case management for the patient. 

“We also think; the ministry should do more in terms of popularising the case definition among private practitioners. Focus has been among those responding within council and Government facilities but we have seen that the first port of call for most cases are private general practitioners,” said ZHDHR chairperson Dr Fortune Nyamande.

Zimbabwe Medical Association secretary general, Dr Sacrifice Chirisa urged practitioners to follow laid down protocols when attending to patients.

He said through ZIMA, some practitioners were trained on managing suspected cases but admitted some had failed to attend the training.

He said because of the Bulawayo case, ZIMA was now in the process of organising another training session to be conducted virtually so that all practitioners are conscientised on how to deal with suspected cases.

“Most facilities are now screening all patients and any suspected cases are immediately referred to a Covid-19 centre and this is what our practitioners should be doing,” said Dr Chirisa.

“Covid-19 is real, it is here, people know the protocol. It should just be followed.”

According to the Ministry of Health and Child Care’s daily update, the country’s eleventh case involved a 79-year old patient who initially presented to a general practitioner on March 23 with a history of cough, difficulty in breathing, sore throat and fever.

When he failed to improve on antibiotics prescribed, he reported to a private hospital, where he was admitted. Although the patient, now deceased, had no history of travel, he had indicated that he had been to a tourist resort in Hwange. 

His condition deteriorated, the rapid response team was called in to assess and take samples. While awaiting results, the patient died in hospital although by this late stage he was being treated for both pneumonia and for Covid-19.

His results later came back positive for Covid-19. Herald

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