6 Sep 2021

Middlemore infection: Testing for Covid-19 before hospital entry 'not possible'

6:43 pm on 6 September 2021

A case of Covid-19 in a Middlemore patient who shared a room with three others has raised questions around the screening and testing procedures of those admitted to hospital.

A security guard worked at Middlemore Hospital's emergency department on Thursday last week while symptomatic with Covid-19.

Medical specialists say testing patients for Covid-19 before admitting them to hospital is not an option. Photo: LDR / Stephen Forbes

Midwifery Employee Representation and Advisory Services (MERAS) co-leader Jill Ovens said there was capacity for all those going to hospital to be swabbed for Covid-19.

"We heard all weekend that we have been letting the side down in Auckland by not going out and getting tested for the least little sniffle and yet you have got patients presenting in emergency departments who are not automatically tested.

"It seems to me that if we want to get our testing numbers up the place to start is in our EDs."

There were 20 new cases of Covid 19 reported in the community today and far fewer tests done yesterday, with the number falling to 4750, which was half the number done on Saturday.

But Australasian College for Emergency Medicine's Dr John Bonning said testing patients for Covid-19 before admitting them to hospital was not an option, given the length of time it took for test results to be returned.

He said the Delta variant remained "really, really challenging".

Dr Bonning said while patients were screened and tested where possible before hospital admission, the symptoms had changed significantly.

"We look for people with fevers, aches, pains and flu-like illness, but the trouble is if you add in headache, abdominal pain, diahoerra, vomiting, muscle aches and respiratory symptoms it is just about everyone that comes to the emergency department."

Dr Bonning said gastro-intestinal symptoms, headaches and aching muscles were in some cases even more common that respiratory symptoms.

He said the most reliable test - the polymerase chain reaction (PCR) - took at least 12 hours to get results and the immediate rapid antigen testing was not very accurate.

"You can't have a system where you can't go to a ward until you've had a negative test because then you are stuck in the emergency department and that comes to our perennial problem of having people stuck forever in emergency departments."

He said ED staff across the country were wearing PPE and upon arrival, patients were screened into high risk and low risk, or hot and cold zones.

"It is really, really difficult to screen these people out but we are trying."

Head of the New Zealand Nursing Organisation Kerri Nuku said news of the positive case at Middlemore was unsettling for everyone involved and reflected a health system under pressure.

She said every patient should be treated as if they had Covid-19 until proven otherwise, but hospitals did not have the resources to treat them as such.

She was also aware there were staffing issues on the wards where the patient had been.

"This sort of pressure on the health system does often come up with some failures."

Nuku said the union wanted to see adequate support for nursing staff, with around 18 of their colleagues required to self-isolate after the incident.

"It's unsettling for the patients and the staff and we just hope there is going to be support provided to the nursing and healthcare staff and the patients and their families."

The chronic understaffing and burnout among nurses needed to be addressed properly to ensure mistakes and system failures weren't affecting patients and the community, she said.

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