Whilst much work has been undertaken to try to ensure all measures necessary are in place to prevent an outbreak of COVID-19 occurring on Ascension, a number of steps have also been taken to prepare for the challenge that an outbreak on Ascension would present. In doing so, Georgetown Hospital will be as prepared as it can be in the event it needs to manage a COVID-19 outbreak within the community and provide crucial care to those who need it.
Change to the clinic service
One of the first actions taken has been to implement an appointment system to space out visitors to the hospital and ensure some form of distancing can be observed. This process includes hand washing on arrival for all, and the closure of the waiting room. It is pleasing to report that the new system has worked extremely well, thanks to everyone recognising the importance of these measures and cooperating appropriately.
The most immediate challenge identified was the need to quickly increase and improve the Hospital equipment inventory to prepare for a possible influx of very ill patients. As many will no doubt be aware, at its worst, COVID-19 is a very severe pneumonia. This represents a significant challenge to Ascension. Georgetown Hospital is primarily set up as a community-based service. As such it was important to rapidly organise and prepare to provide high-level critical care if needed.
Hospital staff moved swiftly and were fortunate to acquire a new sophisticated multi-mode ventilator from South Africa to supplement the equipment the Hospital already had. This machine can be used to support both spontaneous breathing as well as manual ventilation in several modes. As things presently stand three ventilators are available for use, with the potential to also adapt an anaesthetic ventilator if needed to provide additional capacity.
In addition to this, the AIG also:
Everyone will have heard much about Personal Protective Equipment (PPE) in the news. PPE is vital to allow staff to safely treat COVID-19 patients if they are admitted to hospital. In addition to stock held from the Ebola threat a few years ago, the Hospital nursing and pharmacy team were able to place several orders with different suppliers, and with the help of the Foreign and Commonwealth Office (FCO) and Public Health England (PHE), an initial shipment of hand sanitiser, masks, gloves and gowns has been received. Although more is being sourced, this places the Hospital on a good footing to allow staff to deal with COVID-19 patients safely.
Stocks of essential drugs, including the more specialised medicines needed to treat COVID-19, have also been increased. The uncertainty around COVID-19 and the intense competition for scarce supplies has presented a real challenge for the Hospital team, meaning securing these essential supplies has been logistically extremely difficult. The success in sourcing these vital goods has taken much dedication and hard work from the staff there.
Over the past several months the AIG Operations and Facilities Directorate has been working with Georgetown Hospital to develop a design for a new, purpose built hospital in the future. However, as this will be several years away a number of areas where the current building requires urgent upgrading in view of COVID-19 have been identified. As a result, a series of projects, including the upgrade of a ward and one of the bathrooms, have now been completed.
The Hospital has the capacity to treat up to 10 patients within its current location. In view of this an additional building in Georgetown has been identified to serve both as safe accommodation for staff that are caring for COVID-19 patients, as well as possible overflow accommodation for lower risk patients who require some level of monitoring or nursing care.
Whilst the challenge of managing a COVID-19 outbreak itself is significant, the Hospital must at the same time still be able to continue normal services to the community. As such, preparations are being made to establish at least three separate medical teams, two of which will rotate in and out of quarantine/isolation as they treat COVID-19 cases. In addition a reserve body of staff is required in case of staff illness.
Several steps are being taken to ensure this can be achieved. Firstly, the Hospital is able to call on its current reserve of medically trained professional staff not currently employed at the Hospital. Secondly, work is underway to recruit and train a small team of community volunteers to assist at the Hospital, mainly in providing logistical support and “non-COVID” care. Thirdly, an additional doctor and nurse (both with significant anaesthetic and ICU experience) have been recruited from South Africa, who will be transported to Ascension at the first available opportunity.
Further training of current staff is also vital. Dr Bianca van den Berg is heading up this project and is facilitating formal teaching sessions on a weekly basis.
Finally, there is the critical issue of being able to rapidly, and in real time, test for the presence of this virus in individuals. For Ascension, the strategy will be to promptly isolate, test, quarantine and contact trace all of those with suspected COVID-19.
Fortunately, thanks to our colleagues in the militaries it is presently possible to conduct some testing through the sending of samples to the USA or the UK. However, the AIG has nonetheless taken the step of purchasing a “closed system” platform which will provide the ability on island to test for the virus and get a result within 45 minutes. Unlike the much talked-about antibody tests in the news, this is a powerful molecular test for the virus which, up to now, has only been available in virology laboratories. This is the key element in the strategy to combat COVID-19 on Ascension. The unit is expected to arrive within the next few weeks, and work to secure a suitable number of test cartridges is also underway.
Although all of these steps have been taken, many of which will benefit the health and wellbeing of the community for years to come, everyone is aware that there is still more to be done. As such, the Hospital staff will continue to work tirelessly and liaise closely with authorities to ensure the island and its medical facilities are as prepared as can be for a possible outbreak of COVID-19 on Ascension.
In the next COVID-19 update some of the current scientific and medical thinking about COVID-19, and how it might relate to Ascension, will be discussed.
In the meantime all members of the public should remember the following: