I know of a West Vancouver resident who this week tested positive for COVID19, six days after she was released from Lion’s Gate Hospital where she had surgery.
The elderly woman is isolating in her apartment and receiving home care services from Vancouver Coastal Health. I am told she had COVID-19 testing in the hospital while she was an inpatient; Lion’s Gate has had COVID-19 outbreaks on patient wards. It would seem she could have acquired COVID in the hospital. Are the risks of contracting COVID-19 higher in hospitals than in communities? We don’t know. The government hasn’t given us that information.
In my last article, I drew attention to the fact that B.C. guidelines do not call for mandatory pre-operative testing for scheduled operations. And I have since heard from surgeons and anesthesiologists who are concerned about this. I asked Dr. Kathleen Ross, president of Doctors of BC, about the organization’s stance on this. She acknowledged some of the concerns and hinted at some flexibility as well as possible changes in the future if patients bring COVID-19 infections into hospitals or if hospital-acquired COVID cases spike:
“The guideline is not ‘no testing.’ It suggests testing based on screening for wide-ranging clinical symptoms, travel, and possible exposure. From a public health point of view, with the very low incidence of disease now, a positive test is not as accurate as we would like, though a negative test is reassuring. And a negative test 24 to 72 hours pre-surgery would not guarantee that the patient is asymptomatic on the day of surgery. We think the guidelines are flexible enough to allow testing if needed…”
“We have heard of some concerns regarding universal laboratory screening of elective surgery patients as we prepare to increase the number of outpatient surgeries we are conducting. We do understand the concern of those on the front line of clinical care and also realize the PHO/BCCDC recommendations are based on the most up to date science relating to SARS-CoV2 disease incidence in the population, droplet precautions, aerosol-generating procedures, the effectiveness of PPE, and appropriate donning and doffing procedures. With the disease incidence being low in the community, the positive predictive value of a test is not as useful as the predictive value of a negative test.
“The critical piece is the entire surgical team will decide together which risk category the patient is assigned to prior to the patient entering the surgical suite and which PPE protocols will apply to the individual patient for any given surgery. This will optimally protect patients and providers.
“I personally trust in our protocols and recommend PPE when I am assessing, treating, and operating on patients in my own practice settings. We are currently rigorously applying procedures relating to the handling of all patients, including PPE equipment, to protect patients, healthcare providers, and support workers. Doctors of BC will continue to work closely with all our partners to monitor SARS-CoV2 incidence and COVID-19 cases as these screening and PPE processes expand to include elective surgeries and investigations over the next several weeks.”
As you can see from the comments by Dr. Ross (a general practitioner), experts have a lot of faith in personal protective equipment, perhaps more trust in PPE than in testing which may explain B.C.’s relatively low rate of testing. Indeed, B.C. is such a laggard in testing that just over 1,000 tests were done yesterday while the province has the capacity for seven times that number.
If hospital-acquired COVID infections – in patients and health care workers – spike, then I would assume the guidelines will change and testing before operations will become the norm.
I also heard from a patient whose surgeon has asked her to get a COVID-19 test 48 hours before her surgery. Her age, (co-morbidities (diabetes and heart disease), and a previous “indeterminate” COVID test, may all be contributing factors. But she’s reassured that her specialist has exercised his discretion and ordered a test.
In some other jurisdictions, pre-op COVID testing is routine because of studies showing that more patients die or suffer through long recoveries after surgery if they have COVID-19.
A surgical oncologist posted this on Twitter after she read my previous article: