Over half of healthcare professionals in South Africa feel that they do not have adequate PPE, putting them at risk of contracting the coronavirus.  Half of them are also not confident that they have enough knowledge about COVID-19 while only 1 in 2 are trained in treatment guidelines and 1 in 4 in declaring patients as recovered. These are some of the findings of a report by the Human Sciences Research Council (HSRC), in partnership with the University of KwaZulu-Natal’s Nelson R. Mandela School of Medicine based on a survey looking at the impact of COVID-19 on healthcare workers in the country.

The  results of the survey of at least 7607 healthcare workers over the age of 18 years in all nine provinces were released as the Department of Health announced that more than 24 000 healthcare workers in the country have contracted the virus so far of whom more than 180 have died.

The survey looked at issues such as:
•    Training received to respond to COVID-19
•    Levels of knowledge, awareness and attitudes to COVID 19
•    The use and access to Personal Protective Equipment in the workplace
•    Perceptions of risk in the workplace
•    Concerns in relation to COVID-19
•    Health and psychosocial wellbeing of the respondent

Half of the participants worked in the public health sector and a third in the private sector while the others worked either in the NGO, civil society or academic sector.  Most of them were female with nurse practitioners comprising two out of five of the participants.

PPE concerns

Overall, over two thirds of the participants expressed the need for all forms of PPE  and expressed low confidence in the availability and accessibility of PPE while the data suggest that there is not enough knowledge of the use of PPE in some clinical situations, e.g. N95 mask for use in triaging patients, use of surgical mask in critical and intensive care of COVID-19 patients. Four out of five expressed the need for environmental controls, eye shields/goggles, gloves and N95 masks while the self-perceived risk of contracting COVID-19 was high when confidence in the correct use of PPE was low.

Knowledge of COVID-19

While most doctors expressed confidence in their knowledge about COVID-19, nurses indicated that their awareness of the virus was inadequate. Two in five participants did not know the correct COVID-19 incubation period while only one in two were trained in treatment guidelines and one in four in declaring patients as recovered. The survey also found that there is a large difference in training received between medical vs nurse practitioners on treatment guidelines, case definitions as well as tests that should be done to confirm diagnosis. Those who were not confident in their overall knowledge about COVID-19 reported a higher self-perceived risk.

Risk perception was the lowest in the provinces with the highest proportions of health professionals working in urban formal settings – 84% in Gauteng and 78% in the Western Cape. The risk perception was the highest in the Free State and in North West.

Concerns over health and wellbeing

Nurses reported the lowest general health and wellbeing compared to medical practitioners and other healthcare professionals. Nearly half of nurse practitioners were extremely concerned about family members and personal health while 2 in 5 health professionals have extreme concern for their family wellbeing, whilst one in five health professionals have extreme concern for their own personal wellbeing. Three in five nurse practitioners were concerned about passing infection to family members. A quarter of nurse practitioners experienced severe psychological distress with health professionals working in the public sector experiencing higher psychological distress than those working in the private sector. Health professionals who reported high psychological distress reported low levels of general health and well-being whilst health professionals who reported high general well-being reported low levels of psychological distress.

Recommendations

In its recommendations, the report stressed the importance of putting interventions in place to address the knowledge gaps and that communication of information must be cascaded at all levels as it emerges from trusted sources while responsiveness to new evidence as it emerges is critical.

The health system improvement strategy should be to:

  • Train health professionals to become more knowledgeable and self-efficacious in outbreaks such as COVID-19 by sending streamlined communications that are targeted, tailored and sensitive to avoid the negative consequences of fear, stigma and denial. Provide comprehensive training in all the fields that will be required in their jobs and have practical training and application so that health professionals feel confident in them.
  • Ensure safer work environments through adequate structural measures and PPE provision.
  • Information should be shared between facilities across provinces / districts on COVID-19 management and experiences to place risk into realistic contexts. The researchers note that risk perception may be heightened or exaggerated and differ from the actual or real risk. Keeping the personal risk in perspective will help prevent anxiety, panic and counterproductive coping strategies.

Health facilities need to:

  • Provide sufficient infrastructure/spaces and protocols for screening, referral, testing, managing and isolating patients, ventilation and environmental controls, adequate PPE for all staff in accordance with IPC guidelines.
  • Encourage and enforce preventive behaviours (mask wearing, distancing) among South Africans. Create public awareness of health systems’ burden. Build social buy-in among the public to value the contributions of health professionals/ front-line workers e.g. “We stay here for you, please stay home for us” campaigns and “Clap for our Carers” hour.
  • Strategic allocation of procedures for health professionals with underlying health conditions, to minimise their risk.
  • Comprehensive training and application of correct use of PPE, including doffing and donning. • Adequate provision of all required PPE for all levels of staff
  • Instruction on the correct types of PPE to be used in each COVID-19 management procedure.
  • Greater emphasis should be put on the broader infection prevention and control including environmental measures.

Supporting the health and wellbeing of healthcare professionals

  • During outbreaks such as COVID-19 a proactive health and wellbeing framework for supporting health professionals should be implemented. The framework should contain a core curriculum which can be adjusted to the specific requirements of the outbreak.
  • The framework needs to be tailored and targeted for all levels of health professionals, i.e. from primary healthcare workers to ICU nurses, doctors etc.
  • A mechanism for acute situational counselling and debriefing sessions, coping strategies for all levels of health professionals should be implemented by a multi-disciplinary support team.
  • Particular attention should be paid to the shielding of those health professionals with underlying health conditions and / or family members who have COVID-19 risk factors.

The full report is available on: http://www.hsrc.ac.za/en/media-briefs/general/hcw-survey-launch