Pandemic Preparedness and Response - COVID-19 Oil Sector Response in Equatorial Guinea

MCDI's and Noble Energy's COVID-19 pandemic response strategy has involved: (1) pre-deployment screening of Noble personnel traveling to Equatorial Guinea; (2) establishing and operating quarantine and isolation sites in Equatorial Guinea; (3) recruiting, training and supervising clinical and support staff; (4) establishing telemedicine support; (5) procuring testing supplies, essential medicines, medical devices, and personal protective equipment (PPE); (6) investigating and controlling worksite outbreaks; and (7) undertaking medical evacuation. Successful planning implementation has required close coordination and integration with Noble Energy's operations and special projects teams. See this video for more on MCDI's and Noble Energy's COVID-19 response.

1. Pre-Deployment Screening

Employees of Noble Energy deploying for work in Equatorial Guinea are screened in advance via an online risk assessment survey questionnaire sent out 7-10 days before travel, and with a follow-up survey sent 24 - 48 hours before travel to ensure there is no new onset of symptoms. Employees who arrive on Bioko Island without proof of a negative PCR result obtained within 2 days of their travel date from their country of origin, are administered a COVID-19 PCR test upon arrival.

2. Quarantine and Isolation

To ensure that Noble Energy platforms remain free of both SARS-CoV-2 infection and active COVID-19 cases, newly deployed workers spend 14 days under medical observation upon arrival in Equatorial Guinea at designated quarantine sites prior to being sent to offshore facilities.

Quarantine sites have been established in hotels outside of the main residential areas on Bioko Island, with a current capacity to accommodate approximately 200 arrivals at a time. These sites are equipped with the latest modern conveniences and are staffed 24/7 by support and medical staff. For safety, medical and support staff wear personal protective equipment (i.e., masks and gloves) when working in the quarantine sites, and high-touch areas are disinfected daily with hospital-grade cleaning products.

Support services provided to Noble employees arriving and being quarantined in Equatorial Guinea include: welcoming committee, transport from the airport to the quarantine site, hotel lodging, room service, toiletries, meals, Internet access, language support, disinfection services, provision of compliance monitors (internal security), management of logistics and supplies (replacement of PPE and medical supplies), epidemic control, infection prevention and control, and general public health consulting on a daily basis.

Employees in quarantine receive twice-daily visits from medical staff who monitor vital signs of employees in the doorway of their rooms, and follow-up on care for any non-COVID-19-related chronic health conditions. Samples are taken from quarantined employees on or after Day 10 in quarantine, so that SARS-CoV-2 PCR test results are available no later than Day 14 in order to be able to release workers to travel to their job sites. The criteria for release are (1) that the employee has respected the 14-day quarantine period without becoming ill with COVID-19 symptoms, and (2) that they have tested negative by PCR test on or after Day 10 in quarantine. PCR test specimens taken from quarantined individuals are processed at the Baney Research Laboratory to confirm their SARS-CoV-2 infection status.

Employees who test positive for COVID-19 or who manifest any symptoms of COVID-19 during their 14 day quarantine period are transferred immediately to an isolation site located in separate hotels exclusively dedicated to patients in isolation. A number of these rooms have had negative air pressure installed and have access to portable telemedicine kits and more advanced medical equipment and medicines.

Individuals in isolation are monitored around-the-clock by local medical staff capable of treating mild to moderate symptoms on site with, as necessary, support by remote specialists via telemedicine (see more below). Medical and support staff at the isolation sites wear full PPE including hoods, masks, gloves and shoe coverings. Patients can be administered other non-SARS-CoV-2 diagnostic tests, which are analyzed by a private laboratory (Castroverde) in Malabo. If the condition of an isolated patient worsens (e.g. requiring invasive oxygen support), the patient is referred as appropriate either to a local tertiary care hospital (INSESO), or can be medically evacuated if deemed necessary (see more below).

3. Recruitment, Training and Supervision of Clinical and Support Staff

To ensure work sites as well as quarantine and isolation facilities are hygienic, and staff are following the protocol for infection prevention and control, MCDI has trained Noble Energy employees and hotel support staff in disinfection, PPE use, food service, security service, and waste management protocols. Together with MCD's US Public Health Division, MCDI has developed an e-learning module covering general precautions for COVID-19 in the context of quarantine and isolation sites, which is used for on-boarding and staff refresher trainings.

Further, MCDI has facilitated in-person trainings to certify Equatoguinean medical staff in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), and provides on-site coaching and drills to keep health professionals' skills current. MCDI ensures the highest quality of preventive, emergency, and critical care available anywhere in Equatorial Guinea is provided to individuals under its responsibility, in keeping with national and international care and treatment guidelines. The quality of clinical care and support services is assured through external quality assurance protocols and random supervisory spot checks conducted by MCDI and Noble Energy teams.

4. Telemedicine Support

With technical guidance and support from MCD's US Public Health Division, which serves as the programmatic home of one of 12 regional Telehealth Resource Centers in the United States established to provide technical assistance, education and information to health providers in establishing telehealth and telemedicine services in the northeastern region of the US, and the American College of Emergency Physicians' International Medicine Section, MCDI contracted with a Costa Rican practice, Servicios Medicos Loyola SA, to provide remote telemedicine support for the Equato Guinean physicians recruited by MCDI to provide care at the quarantine and isolation sites on Bioko Island. These telemedicine services are provided through link-up via a combination of phone, WhatsApp, email and portable telemedicine kits and telemedicine software sourced from AMD Telemedicine.

5. Procurement

MCDI has succeeded in procuring a wide range of PPE, essential diagnostic testing supplies (including a rapid PCR Bosch Vivalytic analyzer), medicines (including for providing oxygen support and treating potential associated bacterial infections), medical devices (including ventilators and portable telemedicine kits) in a timely manner in spite of the intense global demand for these items. In accordance with international guidelines, MCDI is also procuring Remdesivir for the treatment of hospitalized COVID-19 patients.

For contingencies requiring reliable rapid testing for COVID-19, the project has also incorporated the use of CE-marked point-of-care PCR testing devices. For outbreak control, MCDI has also analyzed antibody test results side-by-side with PCR results to map out and interrupt the chain of transmission.

6. Outbreak Control

Thanks to the rigorous pre-screening, quarantining and isolation services, only 2 worksite outbreaks have occurred: one in June 2020 that involved 2 expatriate staff at Noble Energy's offices in Malabo, and one on a drilling platform in October 2020 involving 5 national staff. In the first case, MCDI and Noble Energy in consultation with the Ministry of Health of Equatorial Guinea immediately undertook contact tracing and rapid antibody testing, and removed and isolated the two staff who tested positive and/or presented with COVID-19 symptoms. In the second case, all 92 employees on the platform were administered a rapid antibody test, and the five who tested positive were flown off the platform by helicopter and admitted to an isolation site on Bioko Island. Of the five who tested positive by the rapid antibody test, only two ultimately tested positive for SARS-CoV2 by PCR analysis. Out of an abundance of caution, one of the two who tested positive for SARS-CoV2 by PCR was later medically evacuated (see more below).

7. Medical Evacuation

MCDI in conjunction with Noble Energy and Medilink have developed and instituted a protocol to medically evacuate expatriate workers whose blood oxygen saturation levels fall below 94%. In these cases, the first choice for medical evacuation is to their country of origin, however, Medilink has agreements in place with receiving hospitals in South African and the United Arab Emirates. As indicated, to date, only 1 employee has been evacuated to South Africa, and there have been no fatalities among Noble Energy's staff.

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