…authorities confirm several diagnosed with Histoplasmosis

WORKERS cleaning the tunnels at Guyana Manganese Inc.’s Matthews Ridge Mines in Region One (Barima-Waini) had no protective gears on with the exception of one, who wore a mask, thereby exposing them to a fungus found in the droppings of birds and bats, authorities confirmed on Monday.

To date, two persons have died, 10 flown to China for further medical attention, and two remain hospitalised in the Pakera District Hospital – the majority diagnosed with Histoplasmosis.

The authorities confirmed the facts surrounding the case on Monday during a joint press conference with the Ministry of Public Health, the Ministry of Social Protection and the Environmental Protection Agency (EPA) at the Mental Health Unit on Quamina Street, Georgetown. The Chief Medical Officer, Dr. Shamdeo Persaud led the press conference with support from Georgetown Public Hospital’s Internal Medicine Consultant, Dr. Genellys Camps; Dr. David Samaroo; Social Protection Ministry’s Occupation Safety and Health Consultant, Gweneth King; and EPA’s Senior Environmental Officer, Camille Adams.
King, responding to a series of questions, said that, based on information received, the workers were not wearing personal protective equipment when they were cleaning the tunnels. That means they were not wearing respirators which would have been necessary to prevent them from breathing in the fungus.

“If you have to do a job like that, you need personal protective equipment, otherwise to that you can expose yourself,” the OSH Consultant posited. The tunnels had not been in use for decades but the company – Guyana Manganese Inc. nonetheless allowed its workers to clean them without any protective gear. The company, which is a subsidiary of Bosai Minerals Group Guyana Incorporated (BMGGI), reportedly told the authorities that the protective gear was on the wharf.

“They said that they had the stuff in country but it was still on the wharf awaiting clearance from customs,” King told reporters. Despite the seriousness of the Occupational Safety and Health infringement which resulted in the death of two persons and hospitalization of more than 12 persons, the OSH Consultant, at the time, could not determine whether Guyana Manganese Inc. would be sanctioned.

“We will have to work within the confides of the Occupation Safety and Health Act and we are now going through our findings and preparing the report, so I wouldn’t want to comment on that any further,” King said in response to a question posed by Guyana Chronicle.

The Chief Medical Officer said with the help of the Pan American Health Organisation (PAHO), a time chart was created which showed that in some cases, the workers were in tunnels exposed to the fungus for as many as 10 days. “It varied from one person and this included even the Guyanese who were there. It varied between 4 minutes to 84 hours. Interestingly, two of the persons who actually died, were in the tunnel for the 84-hour period, and one of the more serious ones was also in the tunnel for 84 hours,” Dr. Persaud explained noting that 84 hours was over a 10-day period.

“Less than one hour, there were seven persons; up to 2 hours, two persons; three hours, three persons; and four hours, five persons. And the five persons in the 4 hours and above, some of those, were also (hospitalised). So it definitely indicated that longer hours of exposure in the tunnels were the ones most likely to come down with more severe disease as the case may be,” the CMO further explained.

According to him, it was a dose dependent exposure. “So it wasn’t just exposure to Histoplasmosis, it was the period of time and the dose that they were exposed to,” he noted. Dr. Persaud said from the review conducted by the Health Ministry in conjunction with its partners, only one person indicated that he has a mask on at the time of cleaning the tunnel. That person was among 23 workers interviewed by the authorities.

Weighing in on the issue, EPA Senior Environmental Officer, Camille Adams said all large scale mines in Guyana must be authorised by the EPA in accordance with the Environmental Protection Act of 1996. Adams noted that the Guyana Manganese Inc.’s Matthew’s Ridge mine is “undergoing authorisation.’ According to her, an Environmental Officer was due to fly into Matthews Ridge on March 26 to assess the mine in response to an application for authorisation to operate the mine. However, the issue arose. That assessment is yet to be completed.

“The company had come into the EPA I think it was on March 12, to discuss what they could do before the assessment was completed. Of course, all development companies want to get going as soon as they can. They discussed that…and they were permitted to do some rudimentary works to the area, not mining,” Adams explained. The Senior Environmental Officer clarified that the company was not mining at the time of the incident but was clearing the tunnels to make provision for a workshop.

Meanwhile, the Chief Medical Officer gave a detailed timeline of events that took place from the time the workers fell ill to their hospitalisation and subsequent release or transfer to China, in the case of 10 Chinese nationals.

Dr. Persaud detailed that the first four cases were reported on March 28, 2019, noting that a Chinese national died while receiving medical attention at Pakera District Hospital in Region One. The next day, four more workers were taken to Pakera District Hospital complaining of similar symptoms – fever, headaches, joint pains, and mild shortness of breath.

On day three, March 30, seven Chinese workers were transferred to the Georgetown Public Hospital Corporation (GPHC), and an additional six, including one Guyanese were attended to at Port Kaituma Hospital but were later transferred to the GPHC. One of the six persons visited the hospital on his own. He was evaluated but not admitted.

“Once the cases were reported, several teams visited the site from the regional level. The team included the Regional Health Officer and the Regional Environmental Health Officer along with some supporting medical staff. In the initial stage, we were sure what we were dealing with but since it was a febrile illness with respiratory symptoms we took all the necessary precaution to restrict access to both the site and the hospital where the patients were being kept,” the CMO told reporters.

Additional staffs sent to the region set up a temporary facility at the community centre in Matthews’s Ridge and attended to regular patients. However, following the transfer of the patients on April 3 to GPHC, they cleaned the Pakera District Hospital and closed down the temporary sites. Work resumed as normal at the hospital for Maternal Child Health and other services, the CMO further reported.

By that time, however, two persons had died, one at Pakera District Hospital and one at GPHC. Notably two persons were discharged from GPHC after recovering and another from the Pakera District Hospital. Dr. Persaud further confirmed that on Monday April 9, 10 workers were transferred to China for additional medical attention.

“Blood, sputum and urine samples were collected from those that were under care while tissue samples were collected during the post mortem from the two deceased. Testing of these samples was done locally at the National Public Health Reference Laboratory (NPHRL) and confirmation was done at Caribbean Public Health Agency (CARPHA) in Trinidad,” the CMO noted.

He said all tests were negative for influenza A & B, dengue, chikungunya and zika. However, it was noted that while the National Public Health Reference Lab had indicated that two of the critical patients (one of whom is now dead) had Leptospirosis, CARPHA later indicated that it was not Leptospirosis but rather Histoplamosis.

“On April 10th, we received word from CARPHA that five samples were tested for Histoplasmosis, four were positive. The Chinese CDC tested an additional six persons and five were positive for Histoplasmosis,” the CMO told reporters.

Histoplasmosis is an infection caused by a fungus found in the droppings of birds and bats in humid areas. It is not serious if confined to the lungs but can be fatal if spread throughout the body.

Meanwhile, he said from April 8-10, he along with two consultants from Pan American Health Organisation/World Health Organisation (PAHO/WHO) and a team from the Public Health Ministry visited the area. A team of nine officers from the Centre for Disease Control (CDC), China was also part of the visiting team. During the visit, the team met with the hospital staff, reviewed their procedures for infectious disease control and prevention. They also met with company officials. Interviews were conducted with the persons who were working in the mine.

Currently, the Health Ministry is monitoring persons at Matthew’s Ridge. During the last two days, two persons developed fever and were admitted to Pakera District Hospital and are under close observation and treatment for hanta virus which is a fungal infection. Samples were taken from the patients and are presently being processed for shipment to CARPHA.
Going forward, the authorities will be giving guidance to the company for work on the plant or any additional work within the areas identified as high risk. The capacity of the Pakera District Hospital will also be boosted with additional staff, equipment and supplies to respond to emergency in a timely manner.