BY PAMELA FAYERMAN
A new and significant COVID-19 outbreak on a surgical ward at Royal Inland Hospital in Kamloops is a wake-up call to not only wear masks and PPE but to conduct COVID-19 tests on all pre-surgery patients.
One patient has died out of 19 patients infected so far. Another 29 cases are among staff for a total of 48 cases.
There are 38 outbreaks in healthcare facilities across B.C. right now – 29 in long term care and nine in acute care hospitals. I have long questioned why COVID testing isn’t done on all pre-surgery patients. I’ve written about this often (see links below). Inexplicably, Provincial Health Officer Dr. Bonnie Henry has been opposed to widespread rapid and other testing among those without symptoms. She thinks pre-screening questions about symptoms or possible exposures are sufficient.
“We aren’t going to test for no purpose. That is wasteful,” she has said on various occasions. Today she acknowledged this: “It’s challenging to know when people are incubating the disease.”
We now know, however, that as many as a third of those who have COVID are asymptomatic. That, compounded with the fact that B.C. is a laggard when it comes to testing, is a recipe for outbreaks. B.C. has the lowest rate of testing among all provinces with a population of over one million, as shown by this CBC graph:
The good thing is that one health region has taken matters into its own hands. When COVID-19 cases started surging in the sprawling Fraser Health region last year, surgeons and other hospital leaders determined it was time to start testing patients requiring urgent and non-urgent operations.
They realized that pre-surgery testing, even in the absence of symptoms is absolutely necessary and not a waste of resources.
Some readers may have seen a recent Canadian Press story about pre-surgery testing in Fraser Health. It was confusing and conflated figures so I will attempt to clear this up although Fraser Health has been slow to respond to all my questions.
What we know is that two pilot studies have been initiated – one in emergency departments and one for elective surgery patients. All patients who go to Fraser Health hospitals for any reason are screened for signs and symptoms of COVID-19. They are also asked if they’ve had any exposure to COVID.
The rote screening process is far from perfect and misses those who may be asymptomatic.
In the pilots, all patients admitted to hospitals through emergency departments and deemed to need surgery were tested for COVID. Over a four-week period, 65 individuals needing urgent surgery, or 1.7% of all those who didn’t meet screening criteria, tested positive. That means that 65 seriously ill people could have caused outbreaks, risking the health and lives of health professionals and other patients. Fraser Health has not released the proportion of patients who still tested positive even after raising no flags on the pre-screening questionnaire.
During a three week period of the pilot study for elective surgery patients, 11 – or 0.4% – were positive for COVID. Fraser Health has not divulged what proportion of patients who passed the pre-screens tested positive however “identifying these individuals as being infected with COVID-19 ensured they were managed appropriately, with infection control measures to protect other patients and staff in place.” One presumes such patients were sent home to recover before getting their surgery but Fraser Health has not responded to that question.
“Given the high prevalence of COVID-19 in our communities and outbreaks occurring in both acute and long term care, these enhanced testing programs will remain in place at the present time,” added the statement from Fraser Health.
To reinforce the importance of what Fraser Health is doing, in its small pilot study, there were dozens of patients identified through testing who might otherwise have infected healthcare professionals and other patients. And since research has shown that COVID raises the mortality risk of patients undergoing surgery, patients are better off having their operations delayed until they’ve recovered.
All other health authorities should follow the Fraser Health lead without delay.