Working the Frontline…

As the numbers continue to rise and our country, province and district head deeper into the eye of the Covid-19 storm, we take a moment to chat to three people who are amongst the thousands putting their lives on the line to ensure our safety every day.

What exactly is a ‘frontline’ worker? Well, in times of disaster, these are the people who end up working directly in the line of the danger. The ‘frontline’, so to speak, varies depending on the disaster (in this instance a global health pandemic) and depending on the job they do.
North Coast frontline workers, specialist physician and pulmonologist Dr Leon Naidoo, advanced life support paramedic Janus van Schalkwyk and SAPS warrant officer detective Deepa Naidoo all play vital roles in ensuring our day-to-day safety and well-being … and even more so in these times.

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DETECTIVE WARRANT OFFICER DEEPA NAIDOO

This month warrant officer Deepa Naidoo will have completed 30 years of service in the South African Police Services. Originally from East London, officer Naidoo joined the SAPS straight after school. She was posted in East London for two years before being transferred to the SAPS training college in Chatsworth as an instructor. In 1994 she transferred to the Umhlali SAPS detectives and, in 2008, she joined the FCS (Family Violence, Child Protections and Sexual Offences) unit. As a detective warrant officer and investigator in the FCS officer Naidoo’s duties include attending to and investigating cases of sexual abuse within the Umhali policing area.

1. How has your job evolved over the past three months as a frontline worker during the pandemic?
   Like everyone, during this pandemic we have had to take many precautions throughout lockdown, which brought about changes in our workplace and the manner in which we work. In my line of work we have to come into direct contact with many people every day. This means having to sanitize my office or vehicle after each interaction. It’s tedious, but is absolutely necessary in these times. The lockdown has also unfortunately caused a major backlog with investigations and our court cases.
2. How you are coping on both a professional and personal level in the midst of this pandemic?
   The pandemic seems to have brought about panic to some people and yet there are otherswho don’t take any precautions to protect themselves. On a personal level I have tried to be particularly careful as I have my parents living with me and they are very vulnerable. My greatest fear is bringing the virus home to my family. At work social distancing amongst colleagues can be difficult as we sometimes work in teams when we have serious cases to attend, like the recent murder case of a 6-year-old child.
3. What are some of the most common misconceptions people have about the work you do? People often have preconceived ideas about policing and police members. The work I do is emotionally draining and I deal with trauma every single day. We all find our own coping mechanisms, but some days are more difficult than others. I have a very supportive family and they are always there to cheer me up on bad days. I love my job and I try to make a difference to each victim that I assist. I always ensure that they know help and counselling is available when they need it.

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SPECIALIST PULMONOLOGIST – DR LEON NAIDOO

With private practices at both the Netcare Alberlito and Mediclinic Victoria Hospitals, Dr Leon Naidoo is also the only specialist pulmonologist/critical care physician on the North Coast and currently the lead physician for the joint operational committee for Covid-19 at the above-mentioned hospitals. He is also part of the rapid response team for Covid-19 in KZN. “As a specialist physician, I am trained to diagnose, treat and follow up a wide array of clinical illnesses in every field of medicine. My expertise extends to a sub or super-speciality, viz Pulmonology and Critical Care medicine. This means that I was trained to be an expert in illnesses affecting the entire respiratory system.” Diseases commonly evaluated and treated by pulmonologists include asthma, chronic obstructive lung disease (COPD/emphysema), lung cancer, interstitial and occupational lung diseases, complex lung and pleural infections including tuberculosis, pulmonary hypertension, and cystic fibrosis

1. Tell us a bit about your role as a primary specialist involved in COVID-19 cases? My role as a primary specialist for COVID-19 begins with firstly diagnosing a positive case, assessing the severity of the illness and then rapidly implementing the best management plan. We use local and international guidelines to assess patients as having mild, moderate or severe disease. The mild or asymptomatic cases are quarantined at home (or now available government facilities) with no specific treatment, and asked to contact their doctors should they feel worse. The moderate to severe cases are where the situation becomes extremely challenging. These are the patients that we have to decide on conservative management versus life support/mechanical ventilation. As you may well know, to date there is NO specific treatment or vaccine for the disease. We hear in the media about breakthrough drugs that cure patients; but currently there is no medication that works universally or is guaranteed to clear the disease. The management of the severe cases is a gargantuan task; involving medical expertise, bravery and a lot of faith.
2. How you are coping on both a professional and personal level in the midst of this pandemic?
   On a professional level, the changes that have occurred at the various facilities regarding screening, admitting practices, theatre, isolation, etc have changed the way we practice medicine. We have had to adapt to this new ‘normal’. Health care professionals all have to wear PPE (Personal Protective Equipment) when reviewing every patient. There are different levels of PPE depending on the risk of patient we see. Hand hygiene and masks are the very bare essentials nowadays. I can honestly say that I have never had so many showers per day in my life. Of course, the economic ramifications that we have all had to face during the pandemic, and particularly the lockdown period has reached almost every health care professional as well. We have seen a significant drop in patient numbers, both as outpatients and inpatients and many practices have had to temporarily shut down as staff cannot be paid. From a personal standpoint, the sheer mammoth task of comprehending a global respiratory pandemic; and knowing that as a respiratory specialist you will be at the forefront and responsible for so many more lives, is massively daunting to say the least.
3. With such limited resources, how do you weigh the worth of one life versus another? How do you decide who gets a ventilator and who does not? The most difficult personal issue though is, ‘how do I adequately treat my patients, yet not infect my family when I get home?’ I still remove my clothing outdoors and disinfect before I run into a shower, before my child can see me. There are days that I cannot go home at all due to the exposure I have had at the hospital. This is our new ‘normal’ and puts a massive strain on our personal lives.

We asked specialist physician and pulmonologist Dr Leon Naidoo to share some of the most common misconceptions people have about Covid-19.

1. Spraying alcohol on the skin kills viruses inside the body:
   Alcohol based-hand sanitisers are effective against most micro-organisms on your skin and other surfaces. However, these are not meant to be ingested or applied to mucous membranes. These products cannot kill viruses within the body; and will most likely cause severe harm to you if used improperly.

2. Only older adults and young people are at risk
   SARS-CoV-2, like other coronaviruses, can infect people of any age. However, older adults and individuals with pre-existing health conditions, such as diabetes or asthma, are more likely to become severely ill. It is important to note that cigarette smokers are also classified as extremely high risk – so now would be a great time to quite smoking.

3. Children cannot get COVID-19
   All age groups can contract SARS-CoV-2. So far, most cases have been in adults, but children are not immune. In fact, preliminary evidence suggests that children are just as likely to contract it, but their symptoms tend to be less severe.

4. COVID-19 is just like the flu
   SARS-CoV-2 causes an illness that does have flu-like symptoms, such as aches, a fever, and a cough. Similarly, both COVID-19 and the flu can be mild, severe, or, in rare cases, fatal. Both can also lead to pneumonia. However, the overall profile of COVID-19 is more serious. Different countries have reported different mortality rates. Although scientists are still working out the exact mortality rate, it is likely to be many times higher than that of seasonal flu.

5. Everyone with COVID-19 dies
   This statement is untrue. The WHO also report that around eighty percent of people will experience a relatively mild form of the disease, which will not require specialist treatment in a hospital. Mild symptoms may include a fever, a cough, a sore throat, tiredness, and shortness of breath.

6. Cats and dogs spread Coronavirus
   Currently, there is little evidence to suggest that SARS-CoV-2 can infect cats and dogs.

7. Face masks always protect against Coronavirus
   Healthcare workers use professional face masks, which fit tightly around the face, to protect themselves from infection – proper surgical masks have 3 layers of protection; and protects the patient more than the user. An N95 (or higher) mask is designed to filter out 95% of micro-particulates from the environment; and this protects the user. These types of masks have generally been reserved for health care workers, or other individuals at extremely high risk.This is extremely important to note: Disposable and cloth masks can protect against droplets, but neither can protect against aerosolized particles. We use these masks in public places to minimise the chances of the user spreading the virus to others via aerosol generating actions such as talking, sneezing, coughing. These types of masks will not work if they are worn incorrectly (for example if the mouth is covered, but the  nose is not). This type of mask will not protect you against the virus in a hight risk setting, example being in a household with a positive contact.

   The Centre for Disease Control and Prevention (CDC) and NICD recommend that all people wear cloth face masks in public places where it is difficult to maintain a 2m distance from others. This will help slow the spread of the virus from asymptomatic people and those who do not know that they have contracted it. When wearing a mask, it is essential to continue with other precautions, such as not touching the face and practicing physical distancing. Instructions for making masks at home are available here https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

8. Hand dryers kill coronavirus
   Hand dryers do not kill coronavirus. The best way to protect oneself and others from the virus is to wash the hands with soap and water or an alcohol-based hand rub.

9. SARS-CoV-2 is just a mutated form of the common cold.
   Coronaviruses are a large family of viruses, all of which have spiky proteins on their surface (CORONA = Latin for ‘crown’)  Some of these viruses use humans as their primary host and cause the common cold. Other coronaviruses, such as SARS-CoV-2, primarily infect animals. Both Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) began in animals and passed into humans – both of these are strains of the coronavirus. This global pandemic is due to another, more severe strain of coronavirus  SARS-CoV-2, dubbed COVID-19

10. You have to be with someone for 10 minutes to catch the virus
    The longer someone is with a person who has it, the more likely they are to catch the virus themselves, but it is still possible to catch it in under 10 minutes.

11. Rinsing the nose with saline protects against coronavirus
    There is no evidence to suggest that a saline nose rinse protects against respiratory infections. Some research suggests that this technique might reduce the symptoms of acute upper respiratory tract infections, but scientists have not found that it can reduce the risk of infection.

12. You can protect yourself by gargling bleach
    People should never put bleach in their mouths. There are no circumstances in which gargling bleach might benefit a person’s health. Bleach is corrosive and can cause serious damage.

13. Antibiotics kill coronavirus
    Antibiotics only kill bacteria. They do not kill viruses. To date, there is no effective medication against the virus.

14. Thermal scanners can diagnose coronavirus
    Thermal scanners can detect whether or not someone has a fever. However, other conditions, such as seasonal flu, can also produce a fever. In addition, symptoms of COVID-19 can appear two to 14 days after infection, which means that someone who has the virus could have a normal temperature for a few days before a fever begins. Also, a person can be infected and display NO fever or any other symptoms.

15. Garlic protects against coronaviruses
    Some research suggests that garlic might slow the growth of some species of bacteria. However, COVID-19 is caused by a virus, and there is no evidence to suggest that garlic can protect people against COVID-19.

16. Home remedies can cure and protect against COVID-19
    No home remedies can protect against COVID-19. This goes for vitamin C, essential oils, silver colloid, sesame oil, garlic, fish tank cleaner, burning sage, and sipping water every 15 minutes. The best approach is to adopt a good hand-washing regimen and to avoid places where there may be sick people. We have noted that numerous pharmacies and other institutions are selling medications that claim to boost your immune system and protect you against the virus – there is no such thing unfortunately. A healthy immune system starts with a proper diet, exercise and lifestyle modification,  example limiting alcohol intake, smoking cessation etc.

17. You can catch coronavirus from urine and faeces
    It is unlikely that this is true, but the jury is currently out. According to Prof. John Edmunds, from the London School of Hygiene & Tropical Medicine in the U.K.:“It isn’t a very pleasant thought, but every time you swallow, you swallow mucus from your upper respiratory tract. In fact, this is an important defensive mechanism. This sweeps viruses and bacteria down into our gut where they are denatured in the acid conditions of our stomachs.”“With modern, very highly sensitive detection mechanisms, we can detect these viruses in faeces. Usually, viruses we can detect in this way are not infectious to others, as they have been destroyed by our guts.” However, it is worth noting that some research concludes that viruses similar to SARS-CoV-2 might persist in faeces. A recent research letter in JAMA also concludes that SARS-CoV-2 is present in faeces.

18. The virus will die off when temperatures rise in the spring
    Some viruses, such as cold and flu viruses, do spread more easily in the colder months, but that does not mean that they stop entirely when conditions become milder.As it stands, scientists do not know how temperature changes will influence the behaviour of SARS-CoV-2.

19. Coronavirus is the deadliest virus known to humans
    Although SARS-CoV-2 does appear to be more serious than influenza, it is not the deadliest virus that people have faced. Others, such as Ebola, have higher mortality rates.

20. Flu and pneumonia vaccines can protect against COVID-19
    As SARS-CoV-2 is different than other viruses, no existing vaccines protect against infection.

21. The virus originated in a laboratory in China
    Despite internet rumors, there is no evidence to suggest that this is the case. In fact, a recent study demonstrates that the virus is a natural product of evolution. Some researchers believe that SARS-CoV-2 may have jumped from pangolins to humans. Others think that it might have passed to us from bats, which was the case for SARS.

22. The outbreak began because people ate bat soup
    Although scientists are confident that the virus started in animals, there is no evidence to suggest that it came from soup of any kind.

23. 5G helps SARS-CoV-2 spread
    As the world becomes more connected, some regions are rolling out 5G mobile technology. A raft of conspiracy theories appear wherever this technology sets foot. One of the most recent theories to emerge is that 5G is responsible for the swift spread of SARS-CoV-2 across the globe. Some people claim that 5G helps viruses communicate, often citing a paper from 2011. In this study, the authors conclude that bacteria can communicate via electromagnetic signals. However, experts dispute this theory, and SARS-CoV-2 is a virus, not a bacterium.Wuhan was one of the first cities to trial 5G in China, which helps explain the origin of some of these theories. However, Beijing, Shanghai, and Guangzhou also rolled out 5G at a similar time.

    It is also worth noting that COVID-19 has significantly impacted countries with very little 5G coverage, such as Iran.

24. Drinking alcohol reduces the risk of infection
    In response to a series of myths surrounding alcohol and COVID-19, the WHO released a statement. In it, they explain that although alcohol can disinfect the skin, it does not work the same way inside the body.They explain that “consuming any alcohol poses health risks, but consuming high-strength ethyl alcohol (ethanol), particularly if it has been adulterated with methanol, can result in severe health consequences, including death.”In a fact sheet on the subject, they write that, “Alcohol use, especially heavy use, weakens the immune system and thus reduces the ability to cope with infectious diseases.” Because alcohol is associated with a number of diseases, it may make people more vulnerable to COVID-19.

25. You can catch coronavirus in swimming pools
    According to the CDC there is no evidence to suggest that SARS-CoV-2 spreads between people through the water in swimming pools, hot tubs, or water playgrounds. If these facilities disinfect their water with chlorine or bromine, this should inactivate the virus. That said, as with all public areas, people can still catch the virus from others who attend these facilities. The virus can spread through inhaling respiratory droplets in the air and coming into contact with surfaces. The CDC say that people should continue to protect themselves both in and out of the water by staying 6 feet (2 meters) away from others and wearing cloth face coverings when not in the water.

 

What should we do?

The CDC and NICD recommend these simple measures to reduce the spread of SARS-CoV-2:

• avoiding close contact with people who appear to be sick
• trying not to touch the eyes, nose, or mouth
• staying at home if sick
• sneezing into a tissue, then throwing it in the trash, or sneezing into the crook of the elbow
• using standard cleaning sprays and wipes to disinfect frequently touched objects and surfaces
• washing the handswith soap regularly, for at least 20 seconds
• wearing a cloth face covering in stores, pharmacies, and other public settings

Source and credit – WHO, CDC and NICD

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ADVANCED LIFE SUPPORT PARAMEDIC – JANUS VAN SCHALKWYK

Self-confessed ocean addict and advanced life support paramedic, Janus van Schalkwyk is currently the clinical governance manager for IPSS Medical Rescue as well as the Cardiac and Stroke Network manager for Lenmed Ethekwini Hospital and Heart Centre. The 34-year-old qualified as a lifeguard at the age of 17 and was a working as a rescue swimmer on the old John Rolf Surf Rescue helicopter by the time he was 19 years old. “It was during this time that I met several paramedics who exposed me to pre-hospital emergency care. I was completely hooked from the first day I worked as a volunteer on an ambulance.” Janus has a bachelor’s degree in emergency medical care and has worked on both land based and offshore oil rigs across several African countries. He is currently completing his Master’s degree in Emergency Medicine.

1. Tell us about how your job has evolved over the past three months as a frontline emergency worker during the pandemic.
   Pre-COVID-19 I spent a lot of time going out to communities, doctors, retirement homes and even other paramedical services conducting training and education talks on identifying risk factors, signs and symptoms and available interventions for cardiac diseases and strokes. Over the last four months, our primary focus has shifted towards preparing our staff, our road and aero-medical operations, and our support services for the pandemic. Unlike most other industries that focus on preventing their employees from coming into contact with suspected COVID-19 patients, our employees will be required to treat and manage both high risk and confirmed COVID-19 patients. Patient safety and the health of our staff is our primary concern. We have had to change the way we operate our services on a daily basis without compromising patient care. Everyone knows how uncomfortable masks are and how difficult they are to breath in. Now imagine carrying a heavy patient out of a forest or doing CPR for 40 minutes while wearing the mask. How do you explain to a patient that has sustained multiple fractures that they have to wear a mask? These are just some of the challenges we face daily and that we have had to adapt to.
2. How are you are coping on both a professional and personal level in the midst of this pandemic? I have been in this industry for a long time. The nature of the industry requires you to put yourself in very stressful and difficult situations. Coping with the stress is challenging initially but the more senior crews will always be there to debrief, talk to and support junior crews. We have developed our own coping mechanisms over time, and must use them now more than ever. Having a partner who understands the industry makes a big difference as the stress does place a large burden on your relationship.
3. What are some of the most common misconceptions people have about the work you do? A common misconception that many people still have about paramedics is that they are just ambulance drivers. In developed countries, patients are quickly loaded into an ambulance and rushed off to a nearby hospital to an awaiting team of specialists. In South Africa, access to healthcare is in ongoing challenge. Patients that are critically ill or injured often have to be transported for prolonged periods of time before arriving at a hospital that is able to provide definitive care. This means that paramedics sometimes spend hours treating patients before arriving at hospital. Out of necessity, South Africa has developed an extensive tertiary paramedical program to deal with this challenge. We now have access to advanced life support paramedics that can offer the same level of care, medications and equipment in the pre-hospital environment as what you would see in an emergency department at most hospitals.

Text: Leah Shone