Impala mine approach to Covid-19 17/07/2020 Screening and Tracing - - PowerPoint PPT Presentation

Impala mine approach to Covid-19

17/07/2020

Screening and Tracing Work Flowsheet

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Employee assessment flow sheet

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On-shaft Screening

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IMS Testing Process

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COVID -19 RT-PCR TEST

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VULNERABLE EMPLOYEES Assistance measures

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1. Fitness Medical Examinations : identify Vulnerable Employees. 2. Restrictions : fitness category and restricted duration. 3. Education : targeted Covid-19 education for all vulnerable employees. 4. Immune boosting : Vit C tablets and Influenza vaccination. (every vulnerable employee personally offered vaccination, 10 000 administered) 5. Monitoring : Chronic medication script tracking and blocking. 6. Controlled conditions : six monthly scripts issued to well controlled patients. 7. Tracking : Vulnerable and High risk employee data mining. 8. Personal Responsibility: Daily medical declaration and temperature screening.

CLINICAL MARKERS OF SEVERITY OF DISEASE

• AGE >60
• Death rate increases with age :
• <50 yrs =22.4%
• 16-49 yrs =24.3%
• 50-69 yrs = 40.3%
• > 70 yrs 73.2%
• Comorbidity (DM and hypertension)
• Hypoxaemia requiring Mechanical ventilation
• Organ dysfunction Myocardial ischaemia and Heart failure
• Men vs woman :70.5% vs 54.3.%
• BMI 30+=60.9%
• BMI 25 to <30 =41.7%

http://dx.doi.org/10.18772/26180197.2020.v2nSIa2:COVID-19 and the Rationale for Pharmacotherapy: A South African Perspective

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VULNERABLE EMPLOYEES – Additional measures

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1. 1st vulnerable employee review: All co morbidities checked by OMP’s. 2. 2nd vulnerable employee review: +60 years with co-morbidities re-checked by OMP’s. 3. New Covid-19 PCR Testing Protocols

• Symptomatic
• Over 50 years with any co-morbidity
• All ages with poor controlled co-morbidity

4. Vulnerable Employees : first access to in-house quarantine, isolation and hospitalization. 5. 3rd vulnerable employees review : over 60 years with multiple co-morbidities - controlled or not controlled. New control criteria.

• 6. Additional Immune boosting : Add Zinc and Vit D for vulnerable employees.

Flattening the Curve

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ASSA Model Applied to Impala Rustenburg

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Application to Impala Scenario 1 Scenario 2 Number of employees 40,000 40,000 % of Pop Infected at peak 0.9922% 3.8868% Peak Number of Infections (symptomatic) 397 1,555 % of Pop Require Hospital 0.1343% 0.2100% Hospital Bed Peak 54 84 % of Pop Require ICU 0.0206% 0.0324% ICU Bed Peak 8 13 % deaths of Population 0.0815% 0.1484% Cumulative Deaths 33 59

Impala Modeling (New Infections & Hospitalisation/week) and Cumulative Deaths

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COVID 19 Status Update: Total Positive cases as at 15 July 2020

13 42 46 53 64 86 105 121 140 166 177 206 217 221 233 262 284 291 306 310 314 352 366 415 379 374 401 408 427 397 451 469 403 438 451 459 462 481 459 450 7 7 7 9 12 12 12 12 12 23 30 37 46 54 64 72 92 122 147 153 171 202 218 259 297 322 332 348 380 409 451 531 559 604 644 670 700 752 798

• 1

2 2 2 2 2 3 4 4 4 6 6 6 6 7 7 7 7 7 7 7 7 7

• 200

400 600 800 1 000 1 200 1 400 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Jul-20

Covid-19 Positive Cases

Deceased Recovered Active

Total Cases: 1255

COVID 19 Tests Conducted as at 14 July 2020

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1000 2000 3000 4000 5000 6000 7000 8000 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 Jun-20 Jul-20

Covid-19 - Number of Tests conducted

Community Dependents & Applicants Employees

15 59 34 8 11 30 89 43 97 90 65 62 106

50 100 150 200 1 Shaft 6 Shaft EF Shaft 9 Shaft 10 Shaft 11 Shaft 12 Shaft 14 Shaft 16 Shaft 20 Shaft MinPro Serv

Active Isolation & Quarantine @ 14-Jul-20

ICU / High Care Quarantine Isolation

Active Isolation & Quarantine per Shaft as at 14 July 2020

605 2 726 5 767 7 275 6 723 5 309 5 242 4 280 1 069 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older

Total Employees In Service

Total in Service per Age group

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COVID 19 Status Update: Total Positive cases per age group

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9 50 162 217 216 143 172 141 29 50 100 150 200 250 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older

Total Cases: 1 139 per Age Group

9 50 162 217 216 143 172 141 29 605 2 726 5 767 7 275 6 723 5 309 5 242 4 280 1 069 1000 2000 3000 4000 5000 6000 7000 8000 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older

Age Group Split

Nr of Cases In Service

Total In Service vs Total Number of Employees Infected

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COVID 19 Status Update: Recoveries per Age group

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Chest X-rays Covid-19 positive Patients

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CLINICAL PRESENTATIONS OF COVID-19

 INCUBATION PERIOD 5-7,4 DAYS

• FIRST PHASE- 80% cases
• Viral response –Mild constitutional symptoms –FLU

Laboratory Features ;Lymphopenia ,Increase Prothrombin time ,Increases D-dimer and Mildly Increased LDH

• SECOND PHASE – Moderate Symptoms 15%
• Pulmonary symptoms –dyspnoea ,mild hypoxaemia SATS ranging 90-95%

Laboratory Markers –Increasing CRP ,low Procalcitonin

• THIRD PHASE – Severe symptoms 5%
• Acute respiratory distress syndrome
• Hyperinflamatory phase –Cytokine storm
• Laboratory markers :Increase IL-2,IL-7 ,TNF(tumour necrosis factor),IL-6
• Increase in IL-6 results in organ dysfunction ,ARDS,renal dysfunction ,hypotension and Cardiac failure

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LABORATORY PARAMETERS ASSOCIATED ARDS PROGRESSION TO DEATH

• Neutrophilia
• Increase LDH
• Increase D-DIMER
• Hyperferritinaemia
• Increase IL-6-organ dysfunction hyperinflation markers of virally induces Haemophagocytic lympho-histocytosis
• Mortality
• Cardiac disease and thrombotic episodes contribute to death .Use LMWH for thrombosis
• Analysis of D-dimer ,Prothrombin Time and age were positively low platelet count negatively correlated with 28

day mortality

• Heparin benefit –extensive thrombosis evidenced by sepsis induced coagulopathy

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CONVENTIONAL ANITIVIRAL TREATMENT

• LMWH
• Reduced hypercoagulability
• Inhibited IL-6 release by counteracting IL-6 biological activilty blocking the cytokine storm
• Hypercoagulability predispose to PE
• Cardiac Disease
• Troponin levels –ProBNP (prior cardiac disease) -outcome
• Risk 35.5% with cardiovascular disease & HPT ,Cardiomyopathy with increase Troponin levels -52% mortality

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CARDIAC DISEASE EXPONENTIAL INCREASE IN MORTALITY

CARDIO-VASCULAR DISEASE TROPONIN -T % PERCENTAGE NO CVD Normal TNT levels 7.62% CVD Normal TNT 13.33% NO CVD Increase TNT 37.50% CVD Increase TNT 69.44% Patient with CVD –Myocardial injury –increase TNT ,high CRP ,Increase TNT,Increase mortality rates with /without use of ACE inhibitors 36.8% and 25.6%

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Awareness & Education

Multiple training modules have been developed to ensure that employees understand how to adapt to new working environment

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Medical Facilities Screening Procedures

Medical Care Readiness

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Impala Covid -19 Examination Rooms : Current

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Triage area Stage 4 C

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Male High Care Isolation

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Security Hospital Covid Triage Quarantine Isolation

Layout of Medical Facility

Security Isolation Hospital COVID Triage Quarantine

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DMR Visit

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Questions