TALI FEINBERG
The scare at the home started when a woman contracted the virus and died on 2 May. Thereafter, the number of infections went up to 46 by 27 May, with 14 residents and 32 staff members contracting the virus.
However, the home managed to contain the virus and against all expectations, turned the situation around.
“We identified cases in the home early on, and took a systematic approach to care,” says Dr Leon Geffen, who was appointed by the home to oversee the crisis. “It would be irresponsible to say there wasn’t a lot of good luck and chance involved.”
Geffen is overseeing the situation at Highlands House voluntarily. He has been on the panel of the World Health Organization infection and prevention control guidance for long-term care facilities, and is working with the Western Cape health department to develop an action plan for older people during the COVID-19 pandemic.
“We’ve been monitoring symptoms among residents who were tested positive daily, and keeping a close eye on their oxygen levels,” Geffen says. “After the index patient [who passed away] was identified and an initial outbreak was indicated, we identified 12 positive residents during the initial screening of 187 residents in early May.
“Subsequently, we conducted a further 12 tests on residents [some were retested], including two tests on residents who passed away [neither of which were positive]. Of the 12 tests, one came back positive. A resident became symptomatic, and was referred directly to hospital, where their positive status was confirmed. That resident has subsequently recovered, and is back at Highlands House. That brings the total number of positive cases among residents to 14 to date.
“The reason we know what happened is that we tested widely and we’re keeping a close eye on anyone who may be symptomatic,” Geffen says. “We have a low threshold of testing anyone who may be symptomatic, and early on, we implemented a very strict PPE [personal protective equipment] policy. We believe isolating residents in their rooms could also have curbed the spread.”
As to whether he believes they have curtailed the outbreak at Highlands House, he says, “We are managing it to the best of our ability. We are assessing staff well-being, tracking staff absenteeism, and noting staff symptoms. Staff have been provided with PPE. We have adequate stock of hand sanitisers, masks, and aprons throughout the facility to protect residents and staff.”
In regard to the health of the home’s staff, Geffen says, “We conducted a total of 279 tests on staff, and 32 returned positive results. Subsequently, some were tested at community health clinics in early May.”
One staff member reported symptoms on 25 May, tested positive, and hasn’t returned to work. “All residents this person cared for have been screened by the doctor on duty, and continue to be screened daily. None of them is symptomatic. Nine of the staff member’s colleagues were also screened, one of whom reported mild symptoms on 2 June, and was asked not to come on-site.
“Of the 32 staff initially identified as positive, 31 returned to work after isolating at home for the appropriate amount of time and showing no further symptoms. The other staff member will return next week,” Geffen says. “We continue to screen our staff, and they are more vigilant about their symptoms. We are tracking symptoms and absenteeism. But most importantly, the staff has full access to all PPE, and we are meeting the necessary hygiene requirements.”
Testing is now done on a “case-by-case basis”, Geffen says. From now on, they test those who they suspect may be infected, or anyone whose well-being is significantly declining.
“We know we’re still at an early stage of the disease in the province,” says Geffen. “We expect exponential positive cases outside of the home. We will maintain strict vigilance.”
However, he is aware of the impact this has on residents. “We would also like to see our residents resuming a semblance of life before lockdown,” he says.
“There’s been a slow relaxation of strict isolation and quarantine procedures. Small groups are taking part in activities daily. Shul activities have recommenced under strict physical distancing conditions. We would like to start to allow communal meals with physical distancing, and resume other activities.
“Over the next few weeks, as the country moves through new stages of lockdown, we will consider how best we can allow family members to visit. We will look at how we can make use of online platforms like Zoom or Skype for family to make contact with residents. However, the logistics, capacity, and resources involved are overwhelming.”
Resident David Myers, who tested positive for COVID-19 in the first round of testing, remained asymptomatic, and has now made a complete recovery. “Testing positive affected me mentally, as did being in isolation,” he says. “But physically, I wasn’t affected.”
He believes that the high number of recoveries is “testament to fantastic job by Geffen, Highlands House Deputy Director Delia Kaplan, and the entire Highlands House team who worked tirelessly and acted quickly and decisively. Some residents may feel that it’s been too strict, but deep down, I think they all understand the need to be cautious.”
Myers says that since he tested positive, he has been checked by a doctor once a day, and regularly by nursing staff. “If my temperature or oxygen levels changed, they were ready for action,” he says.
Myers is now allowed out of his room, but is mostly restricted to his floor. He has been allowed to go outside, but movement around the home isn’t encouraged. “Being outside and meeting others who tested positive, I would say we all feel similar – everyone is relieved that so many of us have recovered.”
He says there has been a fundamental shift in the way residents see each other. “Prior to the outbreak, there was always some bickering amongst residents. I understand there’s not a lot of interaction now, but I sense a much more supportive attitude.
“I was in the library last week watching an exercise class. One of the residents who had been positive, and was quite ill at one stage, entered the room. She has fully recovered. All those in the exercise class stopped and clapped when they saw her. It was very touching.”
