8 Sep 2021

Middlemore Hospital says Covid-19 screening rigorous amid calls for rapid testing after case in wards

10:01 am on 8 September 2021

A leading microbiologist says there may be a need to introduce rapid Covid-19 testing in hospitals.

Middlemore Hospital

Almost 30 Middlemore Hospital staff are in isolation and four wards are closed after a patient tested positive for Covid-19. Photo: RNZ / Claire Eastham-Farrelly

It comes as 29 staff at Middlemore Hospital enter 14 days of isolation after a patient complaining of abdominal pain tested positive for Covid-19. Four wards are closed and patients are being isolated at the hospital.

Siouxsie Wiles told First Up that in an outbreak, rapid tests may be one way to quickly identify Covid-19 patients in hospital.

"There are tests that are not as reliable as the PCR test but if somebody is actually actively infected they usually will test positive on these more rapid tests and that may be something to look into, whether we can get these into New Zealand...

"More rapid tests that could be done when someone first arrives in hospital could be really advantageous in this sort of instance."

She did not think rapid testing was needed when there were no outbreaks, but in the case of one, it would be helpful.

It was impractical to be giving patients nasal swabs and then putting them into isolation when presenting at hospital if they did not appear to have a Covid-19 related illness, Wiles said.

National Party leader Judith Collins this morning also said rapid antigen testing would have been useful in the case of the Middlemore patient.

Collins told Morning Report an antigen test result in 15 minutes was significantly better than "waiting for days" to find out if someone had Covid-19.

"It would have been really helpful for that patient in Middlemore who turned out to have Covid, if they had tested him before he was put into a ward."

Middlemore Hospital chief medical officer Dr Pete Watson told Morning Report if there was a reliable, rapid test it would be used widely.

"I think that is the issue at the moment as I understand it, is that rapid antigen test isn't as reliable in terms of you know there are a lot of false negative tests with that, so I guess that's the question. What we need to do at this point of time, I think, is continued to ensure that we screen everybody thoroughly and we test people absolutely as soon as we have any suspicion."

Screening process 'rigorous'

Watson said Middlemore Hospital had looked at the man's screening and it could reassure people it was rigorous.

"When this man presented he didn't have any symptoms of Covid and nor was there any history of being in any contact with Covid at a place of interest or had been a close context.

"So there was nothing in the presentation through the screening questions to indicate that he had Covid. He presented with abdominal pain, which isn't one of the common symptoms of Covid, so at that time he went into our non-Covid stream.

"We have a really rigorous approach to ensuring that people who might be at risk of Covid go into our Covid stream where they are all tested and cared for to ensure that no cross infectivity before we ascertain that they are not."

After the person was found to be positive for the coronavirus, it was discovered he came from a family of 11 where eight people had tested positive for Covid-19.

"A family was investigated through the regional Public Health service in terms of their contact - they have all been swabbed."

They had no reason to think they had been exposed but since testing turned out to be positive and a link had been found.

"So what happened was the gentleman came in, was in the emergency department for some time then was sent up to the surgical group, because you know that abdominal pain - and had a CT scan and has gone to the surgical ward for review in the morning by the consultant.

"When the consultant came round - this was Sunday morning they saw them - the symptoms had developed."

A test was advised at that point.

"At time there were no single rooms and isolation rooms in that ward so the decision in consultation with our team was to keep him in that space."

The test was returned positive mid-afternoon on Sunday and the patient was moved to the Covid-19 ward.

Middlemore had now added abdominal pain as one of the symptoms of the novel coronavirus.

Staff testing

As for the staff who came into contact with the case at Middlemore, Minister of Health Andrew Little told Morning Report they did not have test results back.

The man did not display symptoms when he arrived at the hospital.

"They had screened him at the time that he entered hospital and before he was admitted, and there was no indication either symptomatically or from anything, that he had said that indicated that he was suffering from the virus," Little said.

"I've seen the report from the Middlemore Hospital and until he developed a fever and the morning after he had been admitted to hospital that he was being swabbed for Covid, having been interviewed about where he had come from, he gave no indication that he had been in a location of interest or otherwise exposed.

"The front line health staff, they're making real world judgements in real time. They're dealing with people as they present they're asking the questions during the screening. They're taking precautions even for patients who are not Covid positive or been exposed to Covid.

"The level of precaution that is taken with PPE and the protocols that are observed... I have great confidence that it won't happen again."

Little was not certain of the timing regarding doctors and nurses being considered close contacts but said "certainly late yesterday a number of staff had been required to isolate and undergo testing themselves.

"I don't know, you know in terms of the timing of when they were at work, when they completed their shifts, when they had been exposed."

Screening procedures

Asked if every patient entering hospital should be tested for Covid-19, Little said "I'm not sure it's necessary".

"I think there is appropriate screening required, but I'm not sure the circumstances call for every visitor to be to be tested for Covid.

"I think the Middlemore Hospital management will be looking closely at what happened and this event and whether other precautions need to be taken... Middlemore ... their infection prevention has been exemplary.

"This has been a hiccup to that, a reasonably serious one. They'll be examining what is needed, but there are established protocols. There are established ways of approaching this. They'll be wants to maintain the highest possible standards because we need them too, and they have to and they understand that."

Little was confident there would be a thorough investigation inquiry into the incident.

No caption

Andrew Little. Photo: RNZ / Samuel Rillstone

But New Zealand Nurses Organisation professional nursing advisor Kate Weston told Morning Report more rigorous screening of patients presenting at hospitals was needed.

"I think really some more rigorous procedures around how they are actually screening [are needed] ... to really urgently explore the possibilities of that rapid testing, even saliva testing for every patient that's presenting...

"What concerns us is that patients seem to be being treated as being negative for Covid until they are proven to be positive rather than considering them positive until they're proven not to be.

"So anyone that's got a hint of a respiratory symptom such as this poor man at the centre of it - treat him as if he is contagious. If he's got a cough, the cough is considered contagious until it's proven not to be."

Weston was unsure why there would have been a lag time between the positive test and staff being stood down.

"As soon as there was a positive test back, we would have expected everyone who was a close contact to have been immediately … isolated.

"One of the things that's perhaps contributing to it is that they are so short-staffed, so to have to stand down anybody at all in this environment is actually going to exacerbate an already pre-existing, very tight staffing situation, so we'd be really expecting to see in the review just how many staff did you have any way? Were there enough people to do the job safely? Were they the right people?

"We're really concerned at how this has been handled because staff coming to work and then being stood down because they've been exposed - that is something that is very serious, and it's something that can't afford to be repeated.

"People are human. People are fallible. But it's actually more about the systems and really questioning whether the systems in place were sufficient to mitigate against this risk."

The situation was concerning, Weston said.

"The people who have been affected - the nurses, the doctors or healthcare assistants and others that have been stood down - it's really an incredibly stressful time.

"They've gone to work to do their job, and the line of their duty they've been exposed to highly contagious and dangerous disease.

"So yeah, they're obviously going to be very distressed about that, and the colleagues left behind to continue working will obviously be on high alert now, too.

"They're working in a very difficult and dangerous environment right now because there is Covid in the community, so you've got to expect that Covid is coming through your door."

Weston said "this, unfortunately, was an inevitable event".

System under pressure

Watson said as for staffing levels at Middlemore, surgical teams had been working in groups so the whole team including those exposed had been stood down, which did not affect other groups.

"In terms of the nurses, we've had to redeploy nurses from other places but as a consequence of level 4 we've been doing less elective surgery and these are surgical wards, so we've been able to redeploy nursing staff from our surgical centre in Manukau over to the hospital to help support.

"We've also been really grateful for the support from other DHB's around the country, and this was happening anyway."

However, he acknowledged that there were a number of workforce issues.

Little said Auckland's healthcare system was "not just dealing with the business of running a hospital and in Middlemore's situation - and Auckland and Waitematā - are dealing with Covid patients, but also the continued vaccination rollout and the pressure that that places on staff resource as well, so yes, it is under pressure".

Staff from elsewhere in the country were providing support in Auckland - so far, mainly providing relief at vaccination centres rather than hospitals, he said.

"I know that the work is underway to make sure that there are additional staff and that staff that have been working around the clock and doing extra hours over many weeks and get some respite.

"There's a lot of coordination going on."

Having to ask for more staff from elsewhere in the country for support was possible.

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