A leading microbiologist says rapid tests for Covid-19 may need to be introduced in hospitals.
It comes as 29 Middlemore Hospital staff members enter 14 days of isolation after a patient complaining of abdominal pain tested positive for Covid-19. Four wards are closed and patients are isolated in the hospital.
Siouxsie Wiles said For the first time that in an outbreak, rapid tests can be a way to quickly identify Covid-19 patients in the hospital.
“There are tests that are not as reliable as the PCR test, but if someone is really actively infected they will generally test positive on these faster tests and that may be something to consider, if we can get them to New Zealand …
“The faster tests that could be done when someone comes to the hospital for the first time could be really advantageous in these types of cases.”
He didn’t think rapid tests were needed when there were no outbreaks, but in the case of one, it would be helpful.
It was not practical to give patients nasal swabs and then isolate them when they presented to the hospital if they did not appear to have a Covid-19-related illness, Wiles said.
National Party leader Judith Collins also said this morning that rapid antigen tests would have been helpful in the case of Middlemore’s patient.
Collins said Morning report the result of an antigen test in 15 minutes was significantly better than “waiting days” to find out if someone had Covid-19.
“It would have been really helpful for that patient in Middlemore who happened to have Covid, if they had examined him before he was admitted to a ward.”
Middlemore Hospital Medical Director Dr. Pete Watson said Morning report if there were a quick and reliable test, it would be widely used.
“I think that’s the problem at the moment, as I understand it, is that the rapid antigen test is not that reliable in terms of you know that there are a lot of false negative tests with that, so I guess that’s the question. “We need to do right now, I think, to make sure we screen everyone thoroughly and we screen people absolutely as soon as we have any suspicions.”
‘Rigorous’ selection process
Watson said Middlemore Hospital had analyzed the man’s evaluation and was able to assure people that it was rigorous.
“When this man came forward, he did not have any symptoms of Covid and there was also no history of having been in contact with Covid in a place of interest or in a close context.
“So there was nothing in the presentation through the screening questions to indicate that he had Covid. He had abdominal pain, which is not one of the common symptoms of Covid, so at that time non-Covid entered our stream.” .
“We have a really rigorous approach to making sure that people who could be at risk for Covid enter our Covid stream, where they are all tested and cared for to ensure there is no cross-infectivity before making sure they are not.”
After the person was found to be positive for the coronavirus, it was found that they came from a family of 11 where eight people had tested positive for Covid-19.
“One family was investigated through the regional public health service in terms of their contact; they have all been cleaned.”
They had no reason to think they had been exposed, but tests have since turned out positive and a link was found.
“So what happened was that the gentleman came in, he was in the emergency department for a while and then he was sent to the surgical group, because you know he has abdominal pain, and they did a CT scan and he went to the surgery room. for review at the hospital tomorrow by the consultant.
“When the consultant arrived, it was Sunday morning, they saw them, the symptoms had developed.”
A test was recommended at that time.
“At that time there were no individual rooms or isolation rooms in that room, so the decision in consultation with our team was to keep it in that space.”
The test came back positive mid-afternoon on Sunday and the patient was transferred to the Covid-19 ward.
Middlemore had now added abdominal pain as one of the symptoms of the new coronavirus.
As for the staff who contacted the case in Middlemore, Health Minister Andrew Little said Morning report they didn’t have the test results.
The man showed no symptoms when he arrived at the hospital.
“They had examined him at the time he entered the hospital and before he was admitted, and there was no indication, symptomatic or otherwise, that he had said to indicate that he had the virus,” Little said.
“I have seen the report from Middlemore Hospital and until he developed a fever and the morning after he was admitted to the hospital that they were cleaning him for Covid, after being interviewed about his place of origin, he gave no indication that he had been in a place of interest or otherwise exhibited.
“Frontline health personnel are making real-world judgments in real time. They are dealing with people as they introduce themselves, asking the questions during the assessment. They are taking precautions even for patients who are not Covid positive or have been exposed to Covid.
“The level of precaution that is taken with the PPE and the protocols that are observed … I have great confidence that it will not happen again.”
Little was not sure when the doctors and nurses were considered to be close contacts, but said that “certainly at the last minute yesterday several staff members had been asked to isolate themselves and undergo tests.
“I don’t know, you know in terms of when they were at work, when they completed their shifts, when they were exposed.”
When asked if all patients admitted to the hospital should be screened for Covid-19, Little said: “I’m not sure it’s necessary.”
“I think a proper assessment is required, but I’m not sure the circumstances require all visitors to be tested for Covid.
“I think Middlemore Hospital management will take a closer look at what happened and this event and if other precautions need to be taken … Middlemore … their infection prevention has been exemplary.
“This has been a setback, a reasonably serious one. They will be looking at what is needed, but there are protocols in place. There are established ways to approach this. They will want to maintain the highest possible standards because we need them too, and they have to and they understand it. “.
Little was confident that a full investigation would be carried out into the incident.
But New Zealand Nurses Organization Professional Nurse Advisor Kate Weston said Morning report More rigorous screening of patients presenting in hospitals was needed.
“I think actually some more rigorous procedures on how they are actually evaluated [are needed] … to urgently explore the possibilities of that rapid test, including the saliva test for each presenting patient …
“What we are concerned about is that patients appear to be being treated as negative for Covid until proven positive rather than positive until proven not.
“So anyone with a hint of a respiratory symptom, like this poor guy in the middle, treat him like he’s contagious. If he has a cough, the cough is considered contagious until proven not.”
Weston wasn’t sure why there would have been a delay between the positive test and the removal of staff.
“As soon as there was a positive test, we would have expected that everyone who was a close contact would have been immediately … isolated.
“One of the things that perhaps contributes to this is that they are very understaffed, so having to fire someone in this environment is actually going to exacerbate a very short staffing situation already in place, so ‘Would I really be expecting see in the review how many employees you had? Were there enough people to do the job safely? Were they the right people?
“We are really concerned about how this has been handled because the staff come to work and then leave because they have been exposed, that is something very serious and it is something that cannot be allowed to be repeated.
“People are human. People are fallible. But it’s really more about the systems and really questioning whether the systems in place were enough to mitigate this risk.”
The situation was worrying, Weston said.
“The people who have been affected – the nurses, the doctors or health care assistants and others who have been removed – it’s really an incredibly stressful time.
“They have gone to work to do their job, and in the line of duty they have been exposed to highly contagious and dangerous diseases.
“So yeah, they will obviously be very distressed about that, and the colleagues who stayed behind to continue working will obviously be on high alert now as well.”
“They are working in a very difficult and dangerous environment right now because there is Covid in the community so hopefully Covid will walk through their door.”
Weston said that “this, unfortunately, was an unavoidable event.”
System under pressure
Watson said that in terms of staffing levels at Middlemore, the surgical teams had been working in groups, so the entire team, including those exposed, had withdrawn, which did not affect other groups.
“As for the nurses, we have had to redistribute the nurses from other places, but as a consequence of level 4 we have been doing less elective surgeries and these are operating rooms, so we have been able to redistribute the nursing staff from our surgical center in Manukau to the hospital to help with support.
“We are also very grateful for the support of other DHBs across the country, and this was happening anyway.”
However, he acknowledged that there were a number of problems related to the workforce.
Little said that Auckland’s health care system “was not only dealing with the business of running a hospital and, in the Middlemore situation, and Auckland and Waitematā, dealing with Covid patients, but also with the continued implementation of the vaccination and the pressure that that puts on staff resources, so yes, it is under pressure ”.
Staff from other parts of the country were providing support in Auckland, until now, mainly providing relief at vaccination centers rather than hospitals, he said.
“I know that work is being done to make sure there are additional staff and that staff who have been working 24 hours a day and working overtime for many weeks have a break.
“There is a lot of coordination.”
It was possible to request more staff from other parts of the country for support.