22nd December 2020
UK COVID Deaths – Daily 691 / 7-Day average 469
Total UK COVID Deaths within 28 days – 68,307
Total UK Deaths with COVID-19 on the death certificate – 79,349 (up to 11th Dec)
James Cook Hospital – Total COVID deaths – 381
All COVID cases within South Tees Hospitals Trust – 90
James Cook Critical Care
COVID cases – 11 (6 ventilated)
Non-COVID cases – 35 (10 ventilated)
Last week we had something of a scare. Nicky’s father, Gordon was readmitted to hospital after developing a fever and rigours. The obvious concern was that, following the first bought of chemotherapy for his lymphoma, he had picked up a bacterial infection whilst immunosuppressed. He was admitted to the haematology ward and investigations were performed. It was not apparent where the source of the infection was and so he was routinely started on intravenous broad-spectrum antibiotics. Of course, later that day we learnt that his symptoms were due to COVID-19 as he had tested positive.
There then followed a couple of days where we waited to see if his condition would worsen. Fortunately, this has not happened and he has remained firmly at the ‘feeling lousy’ end of the COVID disease spectrum. He has now been discharged from hospital and is back at home. It seems unlikely now that he will become significantly unwell which is a huge relief for us all.
It seems highly likely that Gordon contracted COVID-19 whilst in hospital. This is not surprising - the risk of becoming infected during a stay in hospital is the first and foremost concern of everyone who is admitted to hospital at the moment.
A ‘probable hospital-acquired COVID-19 infection’ is recorded if any patient tests positive eight to fourteen days after they were admitted to hospital. Patients are routinely tested on arrival, at day three and again at day five. Patients may also be tested if they develop symptoms of COVID-19 at any time or undergo repeat testing to exclude false negatives if the medical staff believe that COVID-19 is a possible diagnosis.
Trying to obtain an accurate estimation of the number of these hospital-acquired infections is very difficult. Between 1st August and 26th November, there may have been about 10,000 such coronavirus infections. This would mean that about 16% of all patients in hospital with COVID-19 had caught it whilst they were a hospital inpatient. However, being certain where someone caught the virus is difficult. In symptomatic COVID-19 infections, the average incubation period is about five-six days but as many as 10% of people don’t become unwell until after ten days and about 1-2% may take up to 14 days to develop symptoms. This means that someone who is admitted to hospital and tests negative when they arrive could develop symptoms and test positive eight to ten days later despite having been infected elsewhere. You can see the problem.
However, there is no doubt that these hospital-acquired or ‘nosocomial’ coronavirus infections are far from uncommon. Over time, there have been many reports of outbreaks in various hospitals throughout the country, some of which have been on a fairly large scale. A small scale outbreak at our hospital was reported in the local media at the end of September with a limited number of infections occurring across three to four wards. To be honest, this was pretty small scale stuff when compared to the hospitals that made national news headlines but it was concerning nonetheless.
I have to say that, here at James Cook, herculean efforts are being made to minimise the risk of cross-infection. Many staff are working tirelessly to make the hospital as safe as possible. The red/amber/green pathway is adhered to religiously. It may be frustrating for many of us who have to shuffle beds around and implement special measures to keep patients apart but it is vital to minimise the risk to the different groups of patients. Obviously the red or COVID positive patients are kept separated from the rest of the hospital. There are currently five designated COVID wards and two designated Critical Care Units given over to such patients. Some facilities such as CT scanners and operating theatres are allocated exclusively to the ‘red pathway’ and are not used by any COVID negative patient. Almost all of the rest of the hospital is given over to the amber patients. These do not have any features of COVID-19 and test negative on arrival to hospital. They will be tested again on days three and five and must remain within the amber pathway. There are a small number of green pathway patients who must be kept apart from their amber counterparts. These patients have isolated at home for 14 days prior to their routine surgery to ensure that they don’t contract COVID-19 during their postoperative period.
Unfortunately, despite measures such as these, the inadvertent spread of the virus in hospitals and care homes is unavoidable. When you are dealing with a highly infectious disease whose prevalence in the population is increasing, inevitably both staff and patients will become infected. I am not sure that the oft-touted media image of sloppy doctors and nurses not paying attention to infection control is necessarily helpful in this situation.
Whilst meticulous attention to hand-hygiene, mask-wearing and social-distancing is vital, it would be wrong to attribute every infection to failings on the part of ‘grubby’ medical and nursing staff. Stories of staff not abiding by infection control procedures, not washing their hands, using mobile phones, congregating or socialising in shared areas or clustering around shared keyboards or desks, highlight problems that we are all too aware of. However, there are underlying problems that are very important. The NHS has very little overall bed capacity and this, combined with a high occupancy rate and a high turnover of patients makes separating and distancing people very difficult. Our hospital, like countless others has an insufficient number of isolation rooms, insufficient control over airflow and ventilation on the wards and insufficient space for staff to change, eat, drink or hold socially-distanced handover meetings. Many hospitals have too few computers, work-stations and sinks and this leads to people congregating together.
Staffing shortages, poor morale and fatigue are also key human factors in the transmission of infection. These are playing a more important role as the pandemic marches on.
So, do Nicky and I blame Gordon’s hospital for what is highly likely to be a nosocomial COVID-19 infection? No. It would show a huge lack of understanding on my part to do so. New measures, such as the widespread use of facemasks and the recent introduction of twice weekly testing for all frontline NHS staff will undoubtedly help but ultimately, as the incidence of infection in the community rises, so will the risk of hospital-acquired infection.