Less than two weeks after Egypt’s Doctors Syndicate paid tribute to a prominent pathologist in Port Said who passed away after having been infected with the Covid-19, the syndicate this week made a strong appeal to the authorities to adopt all necessary measures to protect medical teams after some medics tested positive for the virus in several leading hospitals.
The biggest scare of the week was when the spread of the new coronavirus was found to have reached one of the most important health institutions in the country, the National Cancer Institute (NCI) which provides diagnosis, surgery, treatment and medicine to thousands of patients for free on a daily basis.
News confirming that a nurse at the NCI children’s ward had tested positive for Covid-19 prompted a lot of unease. “The parents of many of my patients were calling me, hoping that I would deny the news. Unfortunately, I could not reassure them, as I knew that it was true,” said one NCI pediatric oncologist.
Doctors working at the NCI said on condition of anonymity that they had not been oblivious to talk of a nurse showing possible symptoms of the new coronavirus. They also said that they had been aware of growing unease among other medics.
“We were worrying for ourselves and for our patients. We asked for an early internal investigation of the matter and were told that we were panicking for no reason,” said another doctor at the NCI.
What really happened to allow the number of infected medics at the NCI to reach over 25, including four doctors, varies in the details. One narrative says that it was an infected child admitted for chemotherapy in one of the NCI facilities who passed the infection to a nurse who then passed it to other nurses and doctors on the wards.
Another narrative says that a nurse who worked shifts in private hospitals got the infection in a private hospital, later shutdown, and passed it on to medics at the NCI. Both narratives agree substantially on what happened next: the nurses asked for time off and screening, which was denied.
According to another NCI doctor, “as it was becoming clear that we are possibly stuck with a huge problem, we sent letters to the Ministry of Health, the Ministry of Higher Education [the NCI is a university hospital], and the Doctors Syndicate.”
When there was no reply and with growing indications that things did not look good, some decided to break the silence by pursuing screening and going public about the situation. Attempts by the administration to hush things up did not work, and there was an instruction that all workers and patients who had been in contact with the infected medics should be tested.
Work at the NCI main building in Cairo has been temporarily suspended for sanitisation, but not at all the auxiliary facilities.
“It is a very tough situation. Cancer patients cannot be left unattended for more than a few days, and some operations can be rescheduled for a few days but not for more. Work has to resume as soon as possible,” said Medhat Khafagi, a consultant surgeon at the NCI.
According to Khafagi, the sanitisation and testing of medics should be conducted in parallel to allow at least a core group of medics to resume work as soon as possible.
A source close to the minister of higher education said that the plan was to get back to work as early as next week, while excluding medics who had been in contact with infected staff or patients and only allowing those who test negative to go back to work “while keeping everybody under tight surveillance.”
On Monday, Mahmoud Alameddin, a spokesman for Cairo University to which the NCI is affiliated, said that outpatient clinics would be operating starting on 7 April while the sanitisation of all NCI facilities continued.
Meanwhile, the source said that the office of the prime minister was directly following the investigation being conducted to reveal the true story about what had happened at the NCI. “Those who allowed for a possibly contained situation to get out of hand should be legally punished,” he said.
The hospitals of universities in Egypt are under the auspices of the Ministry of Higher Education, but they are not exempted from the regulations and surveillance of the Ministry of Health.
“The public, patients, and NCI staff members who got infected due to the mistakes of some officials will see these officials pay a price,” he said.
Meanwhile, the Ministry of Health has issued directives that require the daily screening of medics, tighter infection-control measures, and the allocation of special divisions for the treatment of all suspected cases of Covid-19.
However, doctors at the NCI said they were not very confident about how things would work. One concern relates to the difficulty of making sure that everyone who has been in touch with the infected staff, especially patients from remote areas who might not be following the news, are tested.
Another concern is that there is no guarantee that no more infections will occur, given what four of six doctors who spoke to Al-Ahram Weekly on condition of anonymity said there was a “severe shortage of protective equipment and prompt testing.
“I could test negative today and start working, but a few weeks down the road I could get infected. At that point I would need to stop instantly without worrying about being reprimanded and I would need to be promptly tested again,” one said.
OTHER INFECTIONS: However, the story does not end there, as news has emerged of infections among medics in other leading public and university hospitals.
In one case, a training physician at the gynecology and obstetrics section of the Al-Demerdash Hospital at Ain Shams University in Cairo said he had to come to work after having taken his father for a coronavirus screening because the supervising resident doctor would not allow him a day off.
The training physician tested positive, just like his father. This caused the closing of a unit at the gynaecology and obstetrics department at the hospital.
According to Ahmed Rashed, professor of gynaecology and obstetrics at Ain Shams University, it was not necessary or possible to shut down the other five units in the department at the hospital.
“This is one of the busiest departments at Al-Demerdash Hospital. Closing down hospital wards is a decision that has to be taken only if there are very serious reasons as we are talking about thousands of women who need to come to give birth and to have a whole range of medical services,” Rashed said.
“It was absolutely unnecessary on the part of the resident doctor to insist on the attendance of the junior physician. Regulations on attendance need to take into consideration the fact that the country is trying to stop a pandemic,” he added.
“What hospitals need today are efficient doctors and sufficient protection equipment, not a full attendance sheet for a training physician,” Rashed said.
Meanwhile, the administration of the Al-Demerdash Hospital issued a statement to assure the public that all medics who had been in contact with the physicians concerned were being tested. Even those who test negative would not be allowed to resume their duties before two weeks to make sure that they do not develop symptoms, with their return being dependent on a second screening, it said.
Medics who have been tested at the NCI, the Al-Demerdash Hospital, and other health facilities in several governorates this week numbered in the hundreds, according to medical sources. Most, the same sources added, had tested negative on the first and second screenings.
Mona Mina, a member of the Doctors Syndicate, said the syndicate did not have official figures for positive cases of Covid-19 among medics. While the percentage of infection among medics was low, any infections could be “really consequential” given the contact they have with dozens of patients and medical staff every day and the shortage of medical staff in many hospitals.
“What we know is that doctors and other medical staff are at a much greater risk of infection and that they need to be fully protected and promptly screened for their sake and for the sake of the patients they treat and the families involved,” Mina said.
Infection-control protocols need to be firmly observed, as specified by the World Health Organisation (WHO), she said, adding that unfortunately this has not always been the case.
She added that a follow-up mechanism that brings together the relevant government bodies, essentially the ministries of health and higher education, along with the Doctors Syndicate needed to be assembled to make sure that any complaints were properly and promptly investigated.
“If we really want to win the battle against Covid-19, we cannot be leaving our doctors and our medical teams in harm’s way. The developments of this week should be enough of an alarm bell,” Mina stated.
*A version of this article appears in print in the 9 April, 2020 edition of Al-Ahram Weekly