SARS-CoV-2 infection prevalence in healthcare workers and administrative and support staff: The first-wave experience at three academic hospitals in the Tshwane district of Gauteng Province, South Africa

Background. The availability of well and functional healthcare workers (HCWs) and support staff is pivotal to a country's ability to manage the COVID-19 pandemic effectively. While HCWs have been identified as being at increased risk for acquisition of SARS-CoV-2 infection, there is a paucity of data pertaining to South African (SA) HCW-related infection rates. Global and provincial disparities in these numbers necessitate local data in order to mitigate risks. Objectives. To ascertain the overall SARS-CoV-2 infection rates and outcomes among all hospital staff at three hospitals in the Tshwane district of Gauteng Province, SA, and further determine associations with the development of severe COVID-19 disease. Methods. This retrospective audit was conducted across three academic hospitals in the Tshwane district for the period 1 June - 31 August 2020. Deidentified data from occupational health and safety departments at each hospital were used to calculate infection rates. A more detailed analysis at one of the three hospitals included evaluation of demographics, work description, possible source of SARS-CoV-2 exposure (community or hospital), comorbidities and outcomes. Results. The period prevalence of SARS-CoV-2 infections ranged from 6.1% to 15.4% between the three hospitals, with the average period prevalence being 11.1%. The highest incidence of SARS-CoV-2 infections was observed among administrative staff (2.8 cases per 1 000 staff days), followed by nursing staff (2.7 cases per 1 000 staff days). Medical doctors had the lowest incidence of 1.1 cases per 1 000 staff days. SARS-CoV-2 infections were categorised as either possibly community or possibly healthcare facility acquired for 26.6% and 73.4% of the infections, respectively. The administrative group had the highest proportion of possible community-acquired infections (41.8%), while doctors had the lowest (6.1%). The mean age of individuals with mild and severe disease was 41 years and 46.1 years, respectively (p=0.004). The presence of comorbidities was significantly associated with severity of disease (p=0.002). Conclusions. This study highlights that hospital staff, including administrative staff, are clearly at high risk for acquisition of SARS-CoV-2 infection during a surge.

The effect of restructuring of health care services on caesarean section rates

Objective: To examine the anticipated changes in caesarean section (CS) rates following the restructuring of maternity health care services from regional to district level. Hypothesis: A change in provision of maternity services from regional to district level results in a decrease in CS rates. Method: A retrospective audit was undertaken of CS rates 3 months before (1 April-30 June 2001) and 3 months after (1 August-31 October 2001) the 'down-scaling' of obstetric services from regional to district level at Addington Hospital; Durban; South Africa. In addition; the booking status of patients; indication for CS; appropriateness of CS decision; and perinatal outcome were evaluated. Results: The total number of deliveries before and after the restructuring of health care services decreased 2070 to 1409. Despite this 32 reduction in the total number of deliveries; the CS rate was essentially unchanged following the restructuring of the obstetric service (24.6 vs. 22.9). The proportion of CS for complicated high-risk cases decreased from 9.62 to 4. The perinatal mortality rate decreased from 84.5/1000 to 59.4/1000 deliveries. An inappropriate decision for CS was made in one-third of the cases. Conclusion: The restructuring of the health service and decrease in the number of high-risk patients seen should have resulted in a decrease in CS rate. Lack of change in the latter may suggest possible influence of the skill of health care providers