How did 20 healthcare workers and six family members at Egypt’s main cancer hospital, the National Cancer Institute (NCI), contract the novel coronavirus? It’s a simple enough question, but the dean of the institute and the director have given conflicting statements on the source of the outbreak.
The dean said it was likely that a nurse who also works at a private hospital had contracted the virus and then infected his colleagues. Yet the director told a different story — namely that a woman in her eighties who had the virus visited the emergency room at the institute and infected the nurse, who then spread the disease to his fellow workers.
Cairo University — the parent organization of NCI — announced on Saturday that it has launched an administrative inquiry into the outbreak to assess any institutional failures, discipline those responsible, and determine the full scope of the crisis. The university’s statement claims the institute acted quickly from the outset, informing the Health Ministry that they should test potential cases, and moving to quarantine confirmed cases and those who had been in contact with them. The university announced a 24-hour shutdown of the institute to disinfect the facility, which ended on Saturday evening.
On Sunday, President Abdel Fattah al-Sisi directed authorities to “speedily conduct medical examinations” of doctors and nursing staff who worked at the institute over the past two weeks, and to quarantine any confirmed cases and anyone who was in contact with them, according to the presidential spokesperson. Around 800 staff members and patients at the institute have already been tested, the spokesperson for Cairo University said in a televised interview on Sunday.
To trace the COVID-19 outbreak at the National Cancer Institute, Mada Masr interviewed four nurses who contracted the virus, including a head nurse and the nurse whom the Cairo University dean accused of spreading the disease to his fellow workers. All four spoke to Mada Masr by phone from quarantine hospitals in Cairo, Alexandria and Qalyubiya. They describe how they were exposed to the virus and how they took it upon themselves to get tested to prevent a further outbreak while the institute refused to take any action.
Mohamed Nabil works as a nurse in an NCI ward at Hermel Hospital in Old Cairo. He is currently quarantined, along with his wife and their two children, at the quarantine hospital in Qeha, Qalyubiya.
According to Nabil, it all started on March 21, when a four-year-old leukemia patient was referred to his NCI ward by the head of pediatrics. The little girl was exhibiting symptoms of COVID-19 when she arrived at Hermel, but the doctor who filled out her admission paperwork neglected to write that down. She was tended to by three different nurses over three shifts. The following day, a pediatrician examined her and concluded that she was highly likely to have contracted the coronavirus. He ordered that swab samples be taken for a PCR test — yet the NCI administration refused to conduct the test. The administration regularly refuses to do such tests, citing the similarities between coronavirus symptoms and the side effects of chemotherapy.
“The nursing staff raised objections,” Nabil says. “Three of us had cared for this girl and we often don’t wear anything more than a regular surgical facemask, which doesn’t protect against infection.”
Nabil had been assigned a total of seven patients on that floor, including the four-year-old girl. When he learned the child was suspected to have contracted COVID-19, he asked the head nurse to take him off the other cases and reassign him to care only for the girl.
“Our patients are severely immunocompromised. I didn’t want the infection to spread,” he says. The head nurse initially refused, but when another nurse, Sayyed Mahmoud, offered to take on Nabil’s other patients, he finally agreed.
Nabil went home after work on Sunday, March 22. The following morning, he came to the hospital only to find that Mahmoud was suffering from a fever, tightness of breath, and body aches. Nabil immediately asked the NCI administration to provide an ambulance to transport Mahmoud to a fever hospital. The administration declined to do so and instead told him that Mahmoud should find his own way to hospital.
Mahmoud took fever reducers and painkillers, but he was not responding to the medication. The Hermel Hospital administration eventually intervened to get preliminary testing for Mahmoud at Mounira Hospital.
“A few of us nurses who were on call at the time took Sayyed to Mounira, wearing protective equipment and hospital gowns,” Nabil says. “They ran blood tests and conducted a chest X-ray and told us that he was 80 percent likely to have COVID-19. They recommended that we take him to Abbasiya Fever Hospital.”
Nabil was told by fellow nurses at Abbasiya Fever Hospital that it was overcrowded and that they would not be able to get Mahmoud tested for several more days, so he took him back to Hermel. They eventually scheduled a visit for Mahmoud with their nurse colleagues at Helwan Fever Hospital. Mahmoud was tested there a few hours later, accompanied by Nabil and other nurses. His results came back positive on Wednesday, March 25.
“I called the NCI administration and asked them to take swabs from the doctors and nurses at Hermel,” Nabil says. “They said no and instead told us to take a week off and if any of us started to exhibit symptoms, then they would test us.”
By Saturday, March 28, both Nabil and his wife were running a high temperature and felt short of breath. They went back to Helwan Fever Hospital, where both of them as well as their two children were tested. They all came back positive. On Sunday, the family of four was taken to quarantine at Qeha Hospital in Qalyubiya.
“Later, I learned that the doctor who was on my shift and was exposed to the same child also tested positive,” says Nabil, adding that if it wasn’t for Sayyed exhibiting symptoms, the staff could have caused the deaths of others around them.
Sayyed Mahmoud works in the NCI’s pediatric ward at Hermel Hospital. He is currently quarantined in the 15th of May Hospital.
“I was the first NCI worker to start having coronavirus symptoms,” Mahmoud says. “When my tests results came back, everyone wanted to get tested.”
Even though Mahmoud works at the pediatric ward at Hermel Hospital and has not been to the main NCI headquarters in Fom al-Khalig in over seven months, the dean, Hatem Abo al-Qassem, considers him to be solely at fault for the 20 doctors and healthcare workers who contracted the virus there.
In a phone interview with the television show Al-Hekaya on Friday evening, Qassem told host Amr Adib that the virus spread to the institute through a nurse who moonlights at another hospital where cases have been recorded though he did not specify which hospital.
Mahmoud denies that he brought the virus to NCI. “I work at a large private hospital where we wear all the necessary protective equipment,” he says. “When a case was recorded there in early March — in a wing of the facility that is far from where I work — they shut down the hospital, disinfected the building, and tested all those who were in contact with the patient. Everyone’s tests came back negative.”
Mahmoud says the reason he contracted the virus was because NCI does not offer staff the necessary protective gear, an issue made worse by the fact that cancer patients are among the most susceptible to viral diseases because of the effect that chemotherapy and radiation therapy have on their immune systems.
Mahmoud points to the fact that despite his having tested positive for COVID-19, followed by a doctor and a fellow nurse, both the dean and the director of the institute both refused to shut down the ward where they worked at Hermel and instructed that work continue. Similarly, they both refused to shut down the main NCI headquarters when cases were confirmed there as well.
Mohamed Abd al-Khaleq is an emergency room nurse at NCI’s main headquarters in Fom al-Khalig. He is currently quarantined at Agami Hospital.
Khaleq says the woman in her eighties that the NCI director mentioned as having brought the virus to the institute had been denied care at Mounira Hospital. “A car just left her outside the institute’s main gate and she was eventually admitted. Later, it was discovered that she had the coronavirus,” Khaleq says. “Her case is just one of dozens that the institute receives on a daily basis.”
Abd al-Khaleq was one of the nurses who accompanied Mahmoud to Mounira Hospital and then to Helwan Hospital. “Neither of us are from Cairo and we share an apartment near the NCI with other nurses. When I learned that Mahmoud was sick, I had to go with him.”
When Mahmoud’s initial test results showed indications of coronavirus, Helwan Fever Hospital conducted blood tests and chest X-rays for Khaleq and the other nurses who were accompanying him and asked them all to self-quarantine for 14 days. If anyone of them were to experience fever, shortness of breath, vomiting, or diarrhea, they were instructed to come back to give a swab for a PCR test.
Khaleq went home and quarantined himself with his pregnant wife in Melig, his home village in Shibin al-Kom, Monufiya. He did not exhibit any symptoms.
“I told a fellow nurse who works at Shibin al-Kom Fever Hospital. He told me to go give a swab,” says Khaleq. He promptly headed to the hospital on Friday morning, and stayed there until the positive results came back on Saturday.
“I have been in quarantine at Agami Hospital for seven days, and I’m still asymptomatic. If I had waited for the symptoms [before getting tested], I would have infected droves of people by now.” Khaleq did in fact give the coronavirus to his pregnant wife and two of her siblings.
“Once they informed me that I’m a carrier and that I would be taken to quarantine, I called the NCI nurses and doctors whom I work with, and I called the administration. I told them so they would test everyone but the administration refused. They told me that I got it from being in contact with Sayyed. They told everyone, ‘just stay home for 14 days; we will only test those of you who show symptoms.’”
The Pandemic Investigation and Surveillance Department in Khaleq’s village issued similar instructions as the NCI — they told Khaleq’s family and his wife’s family to quarantine themselves at home for 14 days. A policeman was posted outside the two houses but no swabs were taken from any of them to run PCR tests.
Later, a nurse suggested to Khaleq that the two families should go to the local fever hospital and claim they were exhibiting symptoms. Swabs were taken from 20 people. Three came back positive: Khaleq’s pregnant wife, her nine-year-old brother, and her 16-year-old sister. They were taken to quarantine, along with Khaleq, at Qeha Hospital.
Based on these accounts, it is possible that Khaleq may have been the link between Hermel (where at least three COVID-19 cases were confirmed) and the main NCI headquarters (where at least 15 cases were later recorded), as Qassem suggested.
But Khaleq does not believe this to be true. He points out that the four-year-old, whose doctor said is highly likely to be COVID-19 positive, has yet to be tested. Another doctor who came in contact with the child tested positive. Therefore, it could be Nabil — who also tended to the child — who infected Mahmoud, not the other way around. Khaleq also points out that the NCI treats patients exhibiting COVID-19 symptoms every day and none of them are swabbed for testing. It is entirely possible, Khaleq says, that patients could infect the medical staff, or the other way around.
He also says that the NCI treated potential COVID-19 patients in early March, but the dean and the director failed to take any precautions to control possible infection. Thousands of patients and family members ride the elevators each day, Khaleq says. The emergency room is visited by dozens of people who check every box on the list of COVID-19 symptoms. For Khaleq, this suggests he may not have been the first case at the main headquarters.
Rania Nassef is a head nurse who oversees the third and fourth floors of the National Cancer Institute. She is currently in quarantine at Agouza Hospital.
“Every head nurse in our room suffered from a fever, muscle weakness and fatigue,” says Nassef. “This was four days before I started exhibiting symptoms. Every time we asked for swab testing, the administration would reprimand us. They told us, ‘Wherever could you possibly get the coronavirus from? You just have the flu, don’t pretend it’s anything else so you can get out of work.’”
Nassef paid for a PCR test at Ain Shams Specialized Hospital out of pocket, borrowing LE2,500 from a fellow nurse. Her test results came back positive the following day and she is now in quarantine at Agouza Hospital.
“It was me who called the Health Ministry,” says Nassef. “It was me who asked them to take swabs from the nursing staff and the doctors. Sure enough, nine head nurses and three doctors tested positive. Then their spouses and children also tested positive. Yet the dean continued to refuse to test the other nurses and doctors working on different floors.”
Nassef’s initiative probably saved the medical staff and prevented the NCI from becoming a COVID-19 epicenter. However, she says, “I’m emotionally devastated. I had to be taken to the ICU yesterday because of an elevated heart rate.”
Instead of owning up to the fact that he endangered the lives of the medical staff, the dean said at a meeting on Thursday with the nursing staff that, similar to Mahmoud, Nassef had spread the infection at NCI from a private hospital, according to Nassef, despite the fact that she has not worked outside of the institute for months.