A journey through Covid-19 as patient and carer

AMID the Covid-19 pandemic, I had begun to believe that my family and I would not contract the virus.

After all, I had looked after hundreds of patients with Covid-19, successfully treated a large number (although losing some), worked with the KwaZulu-Natal Department of Health and the National Department of Health from the onset of the pandemic, and despite my husband and I working in two of the most highrisk exposure professions (Ear Nose and Throat surgery and Medicine), we weathered the first two waves of the pandemic without becoming sick from Sars-CoV-2.

I concluded that we had correctly executed all the relevant precautions. My experience in the management of the HIV pandemic made me feel well equipped to contribute to developing strategies to respond to Covid-19.

The KwaZulu-Natal Department of Health developed and repurposed several facilities for the management of Covid-19. In the eThekwini Municipality, the Clairwood hospital was the largest hospital repurposed for the management of the disease. Such repurposing intended to transform the hospital from what used to be a convalescent and rehabilitation hospital into one that could manage patients presenting with acute disease.

The hi-tech infrastructure had to be matched with staff appropriately skilled to manage patients presenting with acute and often complicated diseases. This is because Covid-19 presents in accompaniment with other diseases whose management has a bearing on outcomes of management of Covid-19 itself. Moreover, equipment necessary to manage varying degrees of disease severity, accompanying diseases and complications also had to be procured. Despite such hurdles, training to use this equipment was accomplished in a hospital equipped with state-of-theart infection prevention and control infrastructure for the management of highly contagious diseases.

Furthermore, the space at the facility allows for quarantine for those who are under investigation for Covid-19 while awaiting results, and isolation of those who have been confirmed to have the disease. Isolation within the facility is designed for those with mild to no symptoms, which helps with accessing care promptly if the disease progresses and complications develop, particularly because the early presentation is key to achieving optimal outcomes.

An additional advantage to such space in the facility is its ability to limit the spread of infection to members of the family and other people in the community. Moreover, the facility has recognised that Covid-19 also has a real psychological impact on its victims and it has prioritised providing its patients with space to rest.

However, when the opportunity to vaccinate opened, I was reluctant. My rationale was that I had worked closely with patients with Covid-19, including resuscitation of many patients and had felt breaths of patients on my face and remained without infection. I concluded that the protection worn in the wards was enough to keep me safe.

I weighed up the uncertainty of unwanted effects from the vaccines that are unknown against the reality that I had remained protected within the hospital. My family and I were adhering to all Covid-19 protocols and we had remained safe. The balance of these probabilities left me feeling reluctant to take the vaccine. Ultimately, I allowed my husband to take a decision for the family and took the vaccine. I thought I had experienced the worst blow dealt by Covid-19 at the height of the second wave of the pandemic, until the experience over two weeks last month at my facility.

Patients were arriving in numbers, critically ill, and we lost the largest number in the shortest period of our experience. Amid such challenges, I tested positive for Covid-19 despite all the precautions that had kept me safe in the past. It is impossible to make out whether I took the infection home or whether we picked up the infection in the community and infected each other at home.

My symptoms have been very different from all that I have been teaching about and all that my patients have presented with. When I needed to be hospitalised, I turned to my hospital. I feel proud of team Clairwood hospital, not just as a staff member but as a patient of the team, too. My experience has emphasised that in responding to the Covid-19 pandemic, it is important to include community-level responses to provide for those that do not have appropriate resources.

Lockdown restrictions should consider appropriate interventions for those who are homeless. The pandemic should serve as a hard lesson to deal decisively with poverty, education, housing and food security.

The relevance of physical distancing interventions where most citizens live in informal settlements or congested settings requires urgent review. Timeous contact tracing and optimal testing, institutional quarantine and isolation must be promoted while the definitive interventions are under review.

This strategy should enable the reduction of the spread of infection in communities and the reduction of disease complications and death, thus reducing the impact of potential future pandemic waves.