Experts warn of high risks for frontline healthcare workers

Healthcare workers are among those at greatest risk of contracting Ebola, with at least four of Kenya’s eight confirmed cases being health workers.

The healthcare workers are those who attended the first patient.

Principal Secretary for Public Health Mary Muthoni said the eight cases include the imported index patient, who died, four of his relatives and four healthcare workers.

“We are currently managing eight confirmed cases of Ebola Bundibugyo virus disease,” said Muthoni.

“It is critical to note that we had the deceased, then his cousin, who was case number two, the mother, who is case number three, and a male relative, who is case number four. Then we had cases five, six, seven and eight, who are our healthcare workers,” added the PS.

This raises concerns over the protection of frontline workers, amid Ebola response and preparedness.

Scientists have said that health workers can acquire the virus while caring for infected patients, particularly when handling bodily fluids.

With these risks, they call for strict adherence to infection prevention measures, like the supply of quality Personal Protective Equipment (PPE).

“Ebola outbreaks usually affect healthcare workers more than the larger population,” said Dr Moses Masika, a virologist.

“That is why they need training and protective gear,” he added.

Protecting healthcare workers is not only a concern for their safety, but also for the general public.

Prof Julius Oyugi, a virologist, said healthcare workers who handled the index case were at risk of infection because of their direct contact with the patient and potentially infectious bodily fluids.

“Current infection trends show health workers who handled the patient in hospitals,” said Oyugi, Professor of Virology in the Department of Medical Microbiology, College of Health Sciences, University of Nairobi.

The expert highlighted that normally, handling sick patients or anything that contains fluids from the patient requires a very high level of care.

This also entails adhering to the use of personal protective equipment (PPE) and infection prevention and control measures.

Prof Oyugi cited the 2014 Ebola outbreak in West Africa, where healthcare workers were infected with the disease.

During the outbreak, an American citizen contracted the virus in Liberia and travelled to the U.S., where he was admitted to an isolation facility.

Two nurses who cared for him subsequently became infected.

The researcher said the incident demonstrated the risks healthcare workers face when caring for Ebola patients, even in settings with isolation facilities.

“Healthcare workers are often the first group exposed when an infected person seeks treatment, putting them at risk before the disease is identified and appropriate precautions are taken,” he added.

The expert maintained that infection prevention standards are critical.

However, he said fatigue and the demands of caring for sick patients could make it difficult for workers to remain consistently vigilant.

At the same time, he said that whereas training and preparedness efforts often focus on doctors, nurses, pharmacists and laboratory personnel, there is a need to include other workers who operate in hospital spaces.

Among people at high risk, he said, are cleaners and those who handle laundry.

Concerning the current trend of Ebola in the country, the researcher applauded the ministry’s efforts in containing the disease that remains among quarantined individuals.

Currently, the country is reporting local transmission from the index case.

Though there is no spill of cases to the community, Oyugi called for continued vigilance and tighter contact tracing.

Surveillance, he said, should also be tightened at the borders and ports of entry to identify any new infections quickly.

“Based on the numbers, the Ministry of Health has done well in terms of trying to control the spread of Ebola. So far, none of the people who have tested positive is from community spread. All are contacts of the index case,” he said.

Further, he called for continued monitoring of people who had been exposed and prompt isolation of anyone who develops symptoms.

“We have no walls at the borders, and we therefore need to tighten checks to avoid a spill of the virus in the country,” he added.

Director General of Health Dr Patrick Amoth said the contacts in quarantine, among them four healthcare workers, were identified through epidemiological investigations and a further review of the index patient's exposure history.

“Of the 130 line-listed contacts, eight additional contacts were recently identified, comprising eight healthcare workers who attended to the index case and one family member who visited the patient in hospital,” he said.

Dr Amoth said contact tracing was a continuous process, with additional people identified as investigators reviewed healthcare records, conducted interviews and gathered new information about possible exposures.

None of the additional contacts identified had signs or symptoms of Ebola at the time they were placed in quarantine.

According to the DG, all contacts are undergoing daily symptom monitoring, with arrangements for immediate isolation and clinical assessment should any develop symptoms suggestive of Ebola.

The Ministry is also verifying whether the healthcare workers continued attending to patients after their exposure to the index case.

Dr Amoth said the risk of onward transmission from exposed healthcare workers remained negligible provided they were asymptomatic, noting that Ebola is not transmitted before symptoms develop.

“Therefore, even if the healthcare workers continued providing clinical services following exposure, they would not be expected to have transmitted the virus while asymptomatic,” he said.

However, the Ministry will conduct a comprehensive risk assessment to identify anyone who may have come into contact with the newly confirmed healthcare workers from the onset of their symptoms until they were isolated.

Any additional contacts identified will be listed, traced, assessed and quarantined where necessary.

Dr Amoth said the 21-day follow-up period for the newly identified contacts would begin from their last exposure to a symptomatic case, rather than from the date of their exposure to the original index case.

Daily monitoring will continue, with immediate isolation and clinical assessment for any contact who develops symptoms, as the Ministry seeks to identify and interrupt any potential chains of transmission.

AT the same time, with the cases, doctors are demanding the inclusion of healthcare workers in the Ebola task force and the provision of quality PPE.

Through their union, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), it is worrying that no cadre is part of the task force, and they remain in the dark on Ebola preparedness.

KMPDU Secretary General Dennis Miskellah said they will assess PPE supplied, including isolation units and quarantine facilities, before they are deployed for use.

“Even if they exclude us, our members will always report to us if they are given substandard PPE,” he said.

Miskellah warned that doctors would down their tools if they were supplied with substandard protective equipment or exposed to unsafe working conditions.

“If anything substandard is issued to our members, this time round, we shall call them to down tools,” he said.

He added: “The moment a healthcare worker dons PPE, they assume someone has cared for their safety. As KMPDU, we want to see those PPEs. We shall check them.”

The union official said Kenya should learn from the Covid-19 pandemic, when healthcare workers faced significant risks while responding to the outbreak.

“This time round, we shall not burn ourselves,” he said, insisting that healthcare workers must not be expected to risk their lives without adequate protection.