By: Vahnu Manikchand

As Guyana was grappling with the impasse of the March 2, 2020 elections, the country was thrown into an unprecedented situation after detecting its first novel coronavirus 2019 (COVID-19) case on March 11 – exactly one year ago today – forcing the country, its people and its institutions, particularly the healthcare system, to adopt extreme emergency measures against the virus that has caused a global epidemic.

The country’s first COVID-19 case – referred to as ‘patient zero’ – was discovered following the death of 52-year-old Ratna Baboolall, who was deemed an imported case. The woman had returned from New York, United States, days before falling ill and eventually dying from complications at the Georgetown Public Hospital (GPHC). Several of her family members subsequently tested positive, and as the cases grew, authorities shut down Guyana’s borders, including air, land and sea.

Now, one year later, Guyana’s COVID-19 death toll is 205, with some 8928 confirmed cases of which 8211 persons have recovered.

The local healthcare system had started putting systems in place against the novel coronavirus since January 2020 when it was declared a public health emergency of international concern by the World Health Organization (WHO).

However, the same day Guyana recorded its first case, the same day WHO declared COVID-19 a pandemic. With Guyana’s epicentre being Region Four (Demerara-Mahaica), the Georgetown Public Hospital became the response centre and had to undergo massive transformations – both physical and systematic – in response.

We spoke with GPH’s Director of Medical and Professional Services, Dr. Fawcett Jeffrey, about some of those transformations that were done to the facility in preparation for COVID-19 and then to manage the outbreak.

He posited, “We knew that it would get to Guyana at some point, so we had started our preparation”.

Transformation at GPH

“When we started off, there used to be a big tent out there. We used to call it ‘our tent hospital’, and that tent was loaned to us by the Police [Force]. We got a loan of the tent from Rent-a-Tent also. So, the private entities and other entities were also helpful in our fight against COVID initially. But the tent ended up being not the most comfortable place to house the patients.”

Dr Jeffery noted that the Ministry of Health had to isolate one of the rooms in the hospital and turn it into a transition area for suspected COVID patients.

Additional works were started to establish an isolation area in the new In-Patient Building, which eventually became the COVID-19 Intensive Care Unit (ICU) until November 2020, when the refurbishing of the Ocean View facility at Liliendaal, Greater Georgetown was completed and the building was ready for occupancy.

However, after the detection of patient zero, the Georgetown Hospital imposed measures and accelerated its efforts.

“All our entrances became screening points. We started off with tents. We had no other resources, so we put a tent in the street over at New Market Street and we had small areas in the institution where we started screening persons. We had nursing staff, medical staff, and at that time we didn’t have a lot of knowledge of COVID, so we were using medical staff – young doctors – to be part of the screening process.

Then we realised (that) screening alone would not help us, we needed triage areas. So, we built two triage areas,” Dr Jeffery explained.

One of those is on Newmarket Street and the other on East Street, where doctors are stationed in a structure to manage patients who may have symptoms and needed to be evaluated more thoroughly before a decision is taken on their treatment process.

“So, we established triage areas at East Street and at Middle Street, both of which are still functional even though we’ve now sent almost all of our COVID activities to the Ocean View facility. But, of course, patients would still come to the Georgetown Hospital with symptoms, so we have to be ready for those patients. So, we still triage them and we still screen them, and if they need to be swabbed or if they are symptomatic, then they go to the emergency room.”

According to the Medical and Professional Services Director, that Emergency section is no longer what it used to be.

“We ended up building an isolation area for the respiratory-ill, critically-ill patients, so that we can have them there and treat them there until we define where they’re going, and until they get their swabs and then a decision is made… That’s for patients coming in with any manifestations that could possibly be COVID-related… That is on the northern side [of the Emergency entrance].

“Then we further continued construction and we developed another [area] on the southern side of the Emergency entrance. We put patients there who have milder manifestations, but we don’t want them to mix with everybody else. So that’s transformation there.”

Additionally, an isolation area was also created over at the Maternity Wing for mothers who tested positive for the novel coronavirus.
There is also another area for suspected patients to be placed until their results are available.

However, Dr Jeffery pointed out that while it was never an easy job, they are a long way from where they started in terms of their response and preparedness to fight the pandemic.

Patient Zero

At the time when patient zero was taken in, protocols were in place and the staff had undergone training. But nothing could prepare them for that Wednesday afternoon on March 11, 2020.

Emergency Medicine Specialist at the Georgetown Hospital, Dr Tracey Bovell, said, “The protocols were in place at that time because, since January, we had training in relation to PPEs (personal protective equipment) and how you wear your PPEs and how you go about protecting yourself. So, that was already in place, and as time went by, we started increasing the amount of protocols and policies as we learnt more about COVID-19.

“We used the knowledge that was gained not only from our own experience, but from the experiences of other countries, so that we can create more policies and more protocols that are directly related to COVID.”

Dr Bovell recalled that patient zero came in on March 10 as a referral from a private hospital.

“She came to the Accident and Emergency Department. She was very ill – this was in the night [of March 10] – and eventually she was diagnosed with pneumonia among other things…and she had a cardiac arrest. Her heart stopped, and after resuscitation failed, she was pronounced clinically dead. A swab sample was taken from her after an examination of her history of travel primarily, and her symptoms. It was sent to the National Reference Lab.

“That day we waited. Everybody waited with their fingers crossed and probably with their feet as well, to see what that result would be. We got that result later that afternoon. We called the staff together and explained [the results] to them, we explained to the family. We had a discussion with family members even before we took the swab, so that they will go home and be quarantined until further notice.”

According to the Emergency Medicine Specialist, there were a lot of mixed emotions from staff members.

“There was fear – fear of the unknown, fear of a new illness that we were not taught in medical school. There was also that fear of not knowing how much you are protected, because at that time there was not much information out in relation to COVID-19. People were very fearful and very scared. Although we had training before, they also had a lot of questions about going home to their family, seeing their kids and so on…,” the doctor explained.

Dr Bovell revealed that they eventually realised that not everyone who came into contact with patient zero was wearing their PPEs, and then there was also a lot of mixed information at that time.

“So, what we did, we actually quarantined the staff that were directly related to that case, that were directly treating that patient. Physicians, nurses, attendants, specialists, residents, registrars. If the cleaner was in that area, we quarantined him or her too. So all of the staff members that were directly related to that case, they were quarantined.”

Luckily, not one of them contracted the virus.

However, Dr Bovell noted that now the GPH staff are more comfortable and even willing to work with COVID-19 patients, having learnt more about the virus since then.

“Initially, what you were getting was that people didn’t even want to work at all, because they had the fear of the COVID-positive patient coming in. But now you have people willing to work with patients knowing that they are positive with COVID-19. I think this change in attitude came about with information-sharing, education, and letting people know what is the information out here from countries with more cases…providing them with PPEs. At no point in time were we having difficulties providing the PPEs, for the persons were actually seeing COVID-19 patients. Now with this knowledge that they can protect not only themselves but their families with these PPEs, they feel a little more comfortable,” she asserted.

With Government rolling out the COVID-19 vaccination exercise last month, frontline workers at the GPHC were the first to benefit. According to Dr Jeffery, more than half of the 2000 plus staff complement at the hospital have already been vaccinated, and with the GPH now a vaccination site, he is anticipating more to be inoculated soon.

GPHC return to normal

The GPH’s Director of Medical and Professional Services went on to state that the focus of the hospital now is to get it back to normal functioning. In order to do this, they have deployed its support-staff and “best persons” to run and manage the Ocean View facility to make that the COVID-19 centre.

“Once we can get the Ocean View facility fully functional, then the burden at the Georgetown Hospital would become less. We’re coming up with protocols so we can return to normal. Protocols for how we gonna manage patients if we have to do surgeries on them. We had protocols for the emergencies, now we’re trying to go back to the elective surgeries.

“So, the actual Georgetown Hospital transformation would not be a physical transformation, but a functional transformation. We want to transform back to where we were, where we could operate as we see fit, and freely without having to worry too much. We have come up with protocols, and we are already moving in that direction. I think we’re soon gonna be almost back to normal, once we can get all the activities, including surgical activities of COVID patients, to Ocean View,” Dr Jeffery posited.