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 2

Employee assessment flow sheet 3

On-shaft Screening 4

IMS Testing Process 5

COVID -19 RT-PCR TEST 6

VULNERABLE EMPLOYEES Assistance measures 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. 7

CLINICAL MARKERS OF SEVERITY OF DISEASE  AGE >60  Death rate increases with age : o <50 yrs =22.4% 16-49 yrs =24.3% o o 50-69 yrs = 40.3% > 70 yrs 73.2% o  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 8

VULNERABLE EMPLOYEES – Additional measures 1 st vulnerable employee review : All co morbidities checked by OMP’s. 1. 2 nd vulnerable employee review : +60 years with co-morbidities re- checked by OMP’s. 2 . 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. 9

Flattening the Curve 10

ASSA Model Applied to Impala Rustenburg 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 397 1,555 (symptomatic) % 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 11

Impala Modeling (New Infections & Hospitalisation/week) and Cumulative Deaths 12

COVID 19 Status Update: Total Positive cases as at 15 July 2020 Covid-19 Positive Cases 1 400 Total Cases: 1255 7 7 Deceased 7 1 200 7 7 Recovered 7 7 Active 1 000 7 7 6 798 752 700 670 6 6 644 800 6 604 4 559 451 4 531 409 4 3 348 380 2 600 332 322 2 218 297 259 2 2 202 2 171 1 153 147 400 - 122 - 92 72 - 64 - - - 54 481 46 469 459 462 459 37 451 451 450 438 - 30 427 415 408 401 397 403 - 379 374 366 23 352 200 - 12 314 306 310 - 291 284 12 - 262 12 233 - 221 217 206 12 - 177 12 166 - 140 - - 121 9 105 7 7 86 7 64 53 42 46 - 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 13

COVID 19 Tests Conducted as at 14 July 2020 8000 Covid-19 - Number of Tests conducted 7000 Community Dependents & Applicants 6000 Employees 5000 4000 3000 2000 1000 0 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 14

Active Isolation & Quarantine per Shaft as at 14 July 2020 Active Isolation & Quarantine @ 14-Jul-20 200 ICU / High Care Quarantine Isolation 150 106 97 100 90 89 65 62 59 50 43 34 30 11 8 0 1 Shaft 6 Shaft EF Shaft 9 Shaft 10 Shaft 11 Shaft 12 Shaft 14 Shaft 16 Shaft 20 Shaft MinPro Serv 15

Total in Service per Age group Total Employees In Service 8 000 7 275 7 000 6 723 6 000 5 767 5 309 5 242 5 000 4 280 4 000 3 000 2 726 2 000 1 069 1 000 605 0 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older 16

COVID 19 Status Update: Total Positive cases per age group Total Cases: 1 139 per Age Group 250 217 216 200 172 162 143 150 141 100 50 50 29 9 0 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older 17

Total In Service vs Total Number of Employees Infected Age Group Split 8000 7 275 7000 6 723 6000 5 767 5 309 5 242 5000 4 280 4000 3000 2 726 2000 1 069 1000 605 217 216 162 172 143 141 50 29 9 0 18 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 and Older Nr of Cases In Service 18

COVID 19 Status Update: Recoveries per Age group 19

Chest X-rays Covid-19 positive Patients 20

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 21

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 22

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 23

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% 24

Awareness & Education Multiple training modules have been developed to ensure that employees understand how to adapt to new working environment 25

Medical Facilities Screening Procedures 26

Medical Care Readiness 27

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Impala Covid -19 Examination Rooms : Current 29

Triage area Stage 4 C 30

Male High Care Isolation 31

Layout of Medical Facility Security Security Quarantine Quarantine Isolation Isolation Hospital Hospital Covid Triage COVID Triage 9

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DMR Visit 34

Questions 35