How to protect health workers during Covid-19 era

Our country faces an unprecedented public health emergency that threatens to overwhelm our health care system.

The Ministry of Health has made commendable progress in early detection of the first cases through surveillance, limiting the spread of the disease by the index cases, developing interim guidelines on case management and infection prevention for healthcare workers and communicating with the public.

Current models estimate that without the implementation of effective interventions, 10,000 Kenyans will be infected by May 2020, with up to 20 per cent requiring hospitalisation and at least five per cent requiring ICU support.

With the current national inpatient and ICU capacity at about 80,000 beds and 600 beds respectively, the virus will overwhelm our existing health system in a matter of months.

The management of Covid-19 disease in regions of the world that have been hardest hit showcase the examples of successes and failures from which we must learn and adapt.

Given the spread of the SARS-CoV-2 virus among health care workers, we recommend that all front-line health care workers in clinics and emergency departments, wear a surgical mask while on clinical duty.

Additionally, we recommend the use of an N-95 mask and eye protection device whenever dealing with a suspected or confirmed case with Covid-19 disease who has excessive coughing or is undergoing an aerosol-generating procedure.

Unnecessary invasive procedures should be avoided in suspected and confirmed cases where the presumptive diagnosis may suffice.

Furthermore, it is important to use appropriate personal protective equipment (PPE) whenever conducting invasive non-respiratory procedures on a patient with Covid-19 disease as there may be a risk of transmission from non-respiratory sources.

Extra care should be taken during the removal of PPE as the risk of contamination is high during the removal procedure.

In the health care setting, surgical masks should be replaced as soon as they get damp and can be used for up to four hours, while the N-95 masks may be used for up to eight hours.

Masks should not be reused in Kenya as no guidelines are yet in place for disinfection.

However, there is an urgent need to develop local guidelines on extended use of masks and re-use of N-95 masks following disinfection.

Prof Lule is a member of the Infectious Diseases Society of Kenya's Covid-19 working group.