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

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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 :

o <50 yrs =22.4%

o 16-49 yrs =24.3%

o 50-69 yrs = 40.3%

o > 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

10

5

12

1

14

0

16

6

17

7

20

6

21

7

22

1

23

3

26

2

28

4

29

1

30

6

31

0

31

4

35

2

36

6

41

5

37

9

37

4

40

1

40

8

42

7

39

7

45

1

46

9

40

3

43

8

45

1

45

9

46

2

48

1

45

9

45

0

7 7 7 9 12

12

12

12

12

23

30

37

46

54

64

72

92

12

2

14

7

15

3 17

1

20

2 2

18

25

9

29

7 32

2

33

2

34

8

38

0 4

09

45

1

53

1 55

9

60

4

64

4

67

0

70

0

75

2

79

8

- - - --

- - --

-- - -

--

-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

14

0

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

811

30

89

43

97

90

6562

106

0

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

0

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

16

COVID 19 Status Update: Total Positive cases per age group

17

9

50

162

217 216

143

172

141

29

0

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

0

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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25

Awareness & Education

Multiple training

modules have

been developed

to ensure that

employees

understand how

to adapt to new

working

environment

26

Medical Facilities Screening Procedures

Medical Care Readiness

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28

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

9

33

DMR Visit

34

35

Questions