By Zahirah Dzahir - 9/20/2020 11:40:00 PG


Pakat do kecoh sangat tentang 'kluster sungai'..makanya jom kita baca..


“Doctor, why is it that I feel I have lost any sense of taste tonight?” uttered our in house staff nurse to the casualty officer who was on the night shift. She was febrile but she wasn’t complaining of any respiratory symptoms. When the casualty officer relayed her story to me as I was the consultant physician on call on the same night, it struck me that we might be dealing with something sinister.

Nevertheless, when I ordered for the Covid antigen test, I was quite nonchalant about it. It would never be positive I thought. After all, the precautions that we had undertaken was up to the mark. I helmed the infection control committee and let me attest to you that the weekly meeting we had since the outbreak was truly grueling. We wanted to make sure no stones unturned to protect our shores.

We ensured all admissions, symptomatic or asymptomatic to undergo the antigen nasal swab. We chose this modality as the result could be back within a mere 1 hour. Patients would need to wait no farther than the casualty area until the result was back. If there would be any suspicion the patient might be harboring the virus, he would continue to be isolated despite the antigen being negative. We would then proceed to the confirmatory PCR swab test. Our think- tank had quickly crafted a sturdy swab test bay that would streamline the patients to undergo these tests within a nick of time. This bay was also designed to protect the health care workers who conducted the tests.

In fact, there had been an air of discontentment among the patients suggesting that we had been too strict. Why wouldn’t them, as we allowed only one accompanying person into our premises. A face mask was their passport provided that their entrance was approved by our border officers consisting of a body of people including our triage nurses and security officers. We blacklisted anyone with a fever and our temperature scanners had been running wild to detect the suspects.

We had been conducting the mandatory antibody testing for all admissions too. We wanted to evaluate if the patients could have any recent exposure. We had been collecting the data ever since the outbreak. I felt we had enough data to write a scientific evaluation on this. One thing for sure the number of positive IGM had been on the rise like a storm surging to turn into a tornado anytime. We knew that Covid 19 had been pervasive in our community. A bomb was ticking and we had to ensure no outsiders would be allowed into our compound to detonate it.

But that night, our perspective had changed completely. It was not the outsider after all….

The antigen test came back as heavily positive! We had diagnosed our first health care worker to carry this nasty virus. The irony was, it wasn’t even a transmission from any of our patients as no way any of them could penetrate our fortress. I was standing on a shaky ground when I found out that she came from the operation theatre community. The last thing any hospital would want to hear was an outbreak emanating from the operation theatre.

As I tried to gain some composure to declutter my mind, the casualty officer gave me the “by-the-way” kind of a remark that there was another staff nurse that had just left with a fever. They felt that there was nothing to shout about as she just had some dry cough and a temperature. She was given some outpatient treatment and a medical leave to rest at home. The only difference was she also came from the operation theatre community.

Our hospital was undoubtedly poising for a nightmare, when we had also confirmed a second case within the same night. We summoned the nurse and her antigen swab test was also heavily positive! By then, it was just after midnight, about the same time when the Titanic collided with the iceberg. All hands on deck, alarm bells began to ring.

Meanwhile, everybody was already awake at that crucial moment. Our MD, Dato’ Dr. Kamarulzaman didn’t waste any time to establish his chains of commands. All operation theaters were clamped down with immediate effect, only allowing the emergency theater to run. He had steered the hospital to a screeching halt. As dawn set in, we had already arranged a set up to screen for PCR to all the operation theatre personnel. We assembled everyone including all anesthetists in an open space behind our hospital. Our doctors assigned to this task were already donned in their full Personal Protective Equipment, and we rounded all of them. By then my infection control committee team had already established a list of people who could have come into contact with the positive nurses. They had no sleep at all.

Eventually, we had quarantined all operation theater personnel as we braced for the results. The PCR test would take another day, all fingers crossed. Yet, as we were trying to breathe some air, our roller coaster took another steep plunge. Another OT personnel who just came back from a short holiday crashed into our casualty department with a raging fever. He was not in the list this morning as he was still on leave. His antigen was also very positive. This was totally turning to be a high drama.

My head was spinning. I wasn’t sure how to shuffle the deck now, what went wrong I kept asking? Obviously the virus that we were at war with knew no mercy the moment it breached us. I was almost going into a convulsion when the report came back, out of 49 OT personnel screened, 18 of them turned out to be positive! I was speechless, dumbfounded, looking straight ahead at the wrecking ball that was coming for us. We had become an epicenter of a health care worker outbreak that was so unprecedented totally putting us on the map overnight.

If not for Dato’ Dr. Kamarulzaman who kept the wits about him, we would have lost our compass. His firm yet calm demeanor has kept us together. We didn’t waste any time to embark on a next herculean task of getting everybody, all and sundry that had got to do with our hospital to undergo the PCR tests. From the top posts, consultants, nurses, allied health care workers to the cleaners and food handlers. All patients that were still remaining in the ward were also subjected. We didn’t spare another dozens of our dialysis patients and their family members too. Our backyard was like a scene of a Hollywood blockbuster movie containing a contagion.

Yet, the good leadership has kept everyone calm and composed. We knew the tenet of war was to identify the enemy. We needed the reconnaissance to determine the scale of the damage. We let everyone home while waiting for the result and we volunteered to close the hospital. We laid our strategies at our command center. This was the backbone behind the scenes comprising of all the leaders that handled everything from the spring cleaning of the hospital, handling everyone’s welfare, addressing the press up till getting a psychiatrist to handle the stress. Undoubtedly within our command centre we observed social distancing, wore our masks and banned anyone who had any contacts with our enemy. We couldn’t wait for the PCR result to come back as time was not on our side. No one with symptoms was allowed to gain entrance into our command centre.

Perhaps we didn’t realize enough that we were at war with a very witty entity. The virus seemed to know that we were the next target as when the results started to come back overnight, one of our generals was confirmed positive. He was all along in our meeting. It was already within us, stealthy yet weaponized with the state of the art of espionage skills. This entity had managed to get the upper hand of us and knew victory would be granted if you eliminate the enemy’s command centre.

Blow after blow, the war raged upon us. Our command centre, instead of being the vanguard for our people became an index of suspicion. We were slapped with the pink tags, a humiliating indication that we couldn’t leave anywhere except our little room at home. We were subjected to more rigorous PCR testing one after another. Every time we underwent the test we would go into the vortex of doom waiting eagerly for the results. I knew what the strategy the virus was playing up on us. It was stealing us away from focusing to exterminate it. Our chief in command also knew it and told us to persevere.

We gathered back our spirits that was thrown into pieces. Our enemy didn’t realize that it came too late, way beyond the era that we could establish impressive online technological communications. Our homes became the next command centre now. Everyday our chief in command would gather us on online meetings, grilling us with grueling tasks. We were not daunted at all because we were a great team. We were almost wired to our phones addressing any issues for the sake of our patients, our staff and our friends. It was as if we didn’t care whatever our PCR result would turn out to be because we sincerely wanted to be back with a vengeance. Ultimately it has made my relationship with my hospital members much closer than before that we were now one big united family.

It sort of evoked my memory of the Normandy Landings in France during the World War II. In the beginning they felt that they were losing the battle, so did we. However because we persevered, we managed to turn the tables. Finally all the PCR results came back indicating the outbreak was only contained just within the operation theatre community. Except for one of our generals probably because he might have a contact with the OT cluster but wasn’t aware of it, the rest of the staff were proven negative. None from the wards, management floor, cafeteria, and casualty area even none came from the patients. Our dialysis patients, nurses and families were also negative. It was the element of time that we managed to make the full use of it. Sincerely, we didn’t waste any of it at the start.

Eventually we managed to weather the storm. The command centre team welcomed with open arms in gratitude as all their tests including mine were negative. By then, we managed to handle all the bare bones to reopen our hospital. We completed the terminal cleaning, took surface swabs everywhere, ensured the welfare of our staff was taken care of and medications delivered by courier to the patients. Our colleagues and their families being admitted into the hospital were getting better. We raised our hats to the excellent service given by our general hospital team and their infectious disease consultants for the good job of taking care of our brothers and sisters. The public health team was ever very supportive.

We had ridden the wave. Now it was the time to recollect and decipher what we could learn from all this. I couldn’t emphasize more than to ensure we all wear masks at all times and observe the social distancing framework. Of all the other standard of procedures these two would be our best bet until the vaccine becomes our savior. We saw it with our own eyes, even when we had a positive exposure in our meeting room, none got it, because all of us wore the masks as opposed to those who contracted the virus. Everyone in our cluster who contracted it, admitted that they had been socializing at work without the masks thinking the enemy was not among themselves.

Another most important learning point really was to shift more focus to our health care workers. Our SOP towards the patients were already well in place but we could have underplayed the attention to our own health care workers. They must be sincere in admitting their symptoms at the earliest possible time. Be it, even if there is only some lingering sore throat they must be evaluated. We had already seen enough repercussions if they didn’t. We must have a lower threshold to screen health care workers with the PCR swabs. Social distancing is imperative. We might want to label our outbreak as the pantry outbreak or better still to name this as the pantry cluster. That place was the probably the starting point of all this.

Lastly I also learned that I was blessed with a great leadership at our hospital. Team work was also the key element in this conundrum. This episode did not make us a loser but made use someone even better. Our learning curve had catapulted.

As we opened up our hospital again, we put forward a prayer so that we would always be protected by the almighty. I entered my hospital again with a renewed sense of enthusiasm. We were one and always would be.
I would continue to uphold my hospital motto, we care and take care!


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