SAMED’s member forum on 16 July 2020 examined factors and conditions which would facilitate return to procedure and restoring patient care as the South African COVID-19 outbreak enters the eye of the storm. Speaking from different vantage points, panellists from the industry, healthcare professionals and patient advocates reflected on local experiences, international best-practices, short-term strategies to remain viable businesses and opportunities to come out of the crisis as a more transformed and patient-centred healthcare system.

Donald May and Terry Chang from Advamed, the United States medical technology association, kicked off the programme with an observation that South Africa is grappling with the same issues due to COVID-19 as is happening in the USA. However, healthcare infrastructure and economic issues make for different outcomes. As social distancing became the norm, Advamed worked with associations representing healthcare providers to develop a common framework to address medical distancing. This entailed identifying and agreeing with other stakeholders on principles of bringing medical representatives back into health facilities. Factors such as who provides representatives with personal protective equipment (PPE) and alignment on testing procedures to avoid the need for unnecessary repeat of tests were key. Data on the negative impact brought on by patients not seeking and not receiving healthcare for conditions unrelated to COVID-19 supported consultations with professional organisations and enabled the adoption of a joint return to procedure approach.

“Another key activity focused on rebuilding patient confidence. Advamed worked with those whom patients trust the most – their physicians, healthcare providers and patient advocacy groups – to deliver a public campaign on processes and measures put in place to ensure patient safety,” said May. “Patients need information to make right decisions about when to seek healthcare.”

SAMED members representing varying sectors and company sizes then outlined how COVID-19 impacted their businesses and recommended ways for ensuring that the medtech industry continues to provide value to patient care.

Norman Dlamini, from the SMME distributing company Henopes Medical, acknowledged that COVID-19 caused serious challenges for its business operations and finances. He gave an example of the reduction of spinal surgery compared to a month prior to the pandemic, and the complete absence of these surgeries under level 5 restrictions. Business activity has picked up since level 3. Dlamini noted though that the rapid rise in infections over the last few weeks means that hospitals are prioritising beds for COVID-19 patients, with no elective surgery taking place. Dlamini foresees that this trend will get worse as the pandemic peaks over the coming months: “Only after that will we see restoration of patient care and return to procedure, so meanwhile we are looking at other opportunities to keep our business afloat – such as trauma and PPE products.”

Throwing away the rule book, not expecting the return of the normal as we knew it before, aligning leadership style with the new economy and sticking to sound business practices were some of the practical recommendations from local manufacturer, Joseph Ludorf of Malachite Medical, a subsidiary of Priontex. “We took time to acknowledge employee anxiety and address their health and safety. Also, to craft plans based on different scenarios on how the pandemic can affect our business and cashflow.” Ludorf believes that reliance on elective surgery for so long has made the industry lazy: “We must now remain resilient as disruption grows and peaks over the next six to eight weeks but at the same time diversify our approaches and business practices.” He outlined some of the factors he believes can help achieve this:
• Look for opportunities while remaining flexible to deal with the stop-start of elective surgery
• Consider the need for bank loans and try to preserve cash
• Work with trusted suppliers to maintain supply chain integrity
• Formulate and update internal policies so you can manage staff and manufacturing
• Invest in growth areas that don’t require money – such as staff training
• Monitor your company’s performance against plans and the business environment.

Representing the multinational medical device segment, Peter Mehlape from Medtronic explained which novel practices were proving to be beneficial so are likely to continue after the pandemic.

Since the company brings products from overseas, the priority was to collaborate with delivery networks like Fedex and DHL to ensure uninterrupted supply during the lockdown period. The company examined its operations and made necessary adaptations. “A collaboration with a pathology service mapped out an optimal approach to testing our employees as and when needed,” explains Mehlape.

He spoke about the digitalisation of HCP support during clinical procedures and how this investment enhances medical education and creates a value add that will reap benefits in the future.

Mehlape said that the health of employees was an equally critical requirement, and so specific educational and protective measures were implemented. “It gave me a chance to directly connect with some of our people for the first time. This is quite fun and a good practice to take forward.”

His closing remarks called on the participants to remember the heavy toll of the pandemic on many people, especially the healthcare workers and the industry’s role in assisting HCPs working in areas such as dental and ophthalmic surgery which were especially hard hit by the current crisis. “Our industry is an eco-system and we need to be able to survive and cross the line together.”

Ian Wakefield from Becton Dickinson and Company (BD) spoke as a multinational organisation operating in the IVD segment. His main message was that as the medtech industry, we should not be adapting to the crisis – we should already be getting ready for the post-COVID era.

However, while looking at the immediate situation, Wakefield described as “painful” the magnitude of service disruptions. For example, HPV testing had dropped by 90 percent.

Like other companies, the pandemic forced BD to look at how it conducts business and staff and customer engagement. Operational changes that affect staff, including social distancing and working remotely needed urgent attention. So did the education of employees who were previously not part of conversations about infection control and safety. “We implemented multiple trackers to facilitate and monitor how we work virtually – the only associates that are physically in the field are the technical personnel. But supporting them and everyone working from their homes so that we continue to head in the same direction and come through it together is very important for us.”

This is shaping BD’s “hybrid” workspace of the future which will according to Wakefield provide for better customer service due to a more balanced life-work relationship.

Getting the virtual customer service and digitalisation of different systems right so that some 35 000 instruments continue to be available for testing done in labs and hospitals was also an essential part of the company’s response. Wakefield says that in the future, online training sessions that can accommodate greater numbers of HCPs can provide for more efficient customer interactions.

“So, we have remained effective, the business continuity systems needed for taking orders and delivering supplies are in place and our associates have the tools and systems to continue to contribute to healthcare.”

Prof. Martin Brand, President-Elect of the Federation of Surgeons of SA, was the next speaker, who addressed the clinical perspective of resuming patient care. He started by acknowledging that the redirecting of health resources towards COVID-19 means that elective procedures were put on the backburner.

The Federation had published a guideline recommending how to approach phased return to elective procedures. Prof. Brand stressed that getting ready to restart elective procedures in a hospital should be preceded by decrease in incidence for two weeks prior and cautioned that returning to procedure too quickly risks a second wave with a detrimental knock-on effect and further delays.

The guideline assists HCPs in dealing with individual patient’s condition by categorising procedures in terms of the implication for patient’s health and quality of life. The categories are: (i) discretionary elective and essential; (ii) essential surgery; (iii) urgent, essential and (iv) emergency surgery.

Prof. Brand recommended that hospitals consider their capacity, resources and logistics and how these match patient needs within a given timeframe. In closing, he recognised the need to sustain clinicians and practices, and that support from suppliers and companies was vital.

Salomé Meyer from the Cancer Alliance made an impassioned case for keeping the patient at the centre of care. She noted that trust and transparency were the golden thread in the previous presentations – and foundations of good patient compliance. “We must be able to be honest with patients about the environment we are in today.” This includes empowering patients with information on safety and logistical feasibility of the procedure to enable them to be part of decision-making.

The end user – being the patient – should be informed and involved across different aspects of healthcare, from design of device or medicine to its implementation, which has in Meyer’s opinion visibly improved over the last decade. COVID-19 has contributed to the greater use of virtual consultations and telemedicine and these allow for better interactions between patients and HCPs. “Each patient is different. Respect for cultural and religious differences is an element of patient-centred healthcare.”

Meyer said that within the context of COVID-19, providing cancer treatment or other services also means understanding the patients’ support systems, transport and home situations. “All of this helps to deliver better healthcare and maybe it can reduce unnecessary patient visits.”

Reflecting on the event, SAMED Chairperson Avanthi Govender Bester said a recurring theme was that as individual suppliers, the industry, and as HCPs and patient advocates, all the participants felt they were experiencing same issues, that no one is immune to uncertainty and that it was reassuring to address these issues as a collective. “This pandemic has brought us closer and is demanding that we work together. As SAMED, we have created an agile COVID-19 working group, joined other forums and continue our engagement with stakeholders so we can address the impacts of the crisis and looking beyond COVID-19, realise the full value of medical technologies for healthcare professionals and patients.”