VANCOUVER – Testing patients for COVID-19 prior to their scheduled surgery and transfer to emergency department wards could reduce hospital outbreaks in British Columbia as cases increase, suggest the results of a pilot project at the province’s highest health authority.
Fraser Health said that of 5,681 patients who were scheduled for surgery, 65 tested positive for the virus, but had no symptoms and would not have justified a test based on a screening questionnaire. Of the 2,969 patients scheduled for elective surgery, 11 were infected with the virus, but were asymptomatic.
“Unidentified COVID-19 cases can lead to transmission and contribute to outbreaks,” said the health official about the improved test in a memo to the team.
Testing began in mid-November for three weeks for surgical patients and four weeks for patients who were in emergency rooms.
“The triggers that led to the evaluation were two or more outbreaks of COVID-19 in acute care and a positive test rate of more than five percent. Both conditions still exist at Fraser Health, ”says the memo, adding that the health authority continued testing for the virus.
The rate of positivity, or the percentage of all COVID-19 tests performed that show infection, was 9.6 percent when testing started at Fraser Health and now stands at 8 percent, show data from the BC Center for Disease Control .
The positivity rate of the Northern Health Authority soared to 16 percent from 0.5 percent in October, according to data from the center, which also show that the rate for the Interior Health region has increased to 8.3 percent , from a 1.7 percent drop in November.
In the coastal region of Vancouver, the rate of positivity is 5.2 percent, down from 0.4 percent in June. The positivity rate for the Vancouver Island health region is the lowest in the province, just under three percent.
In November, more than 500 doctors and nurses across British Columbia sent a letter to the provincial health officer, Dr. Bonnie Henry, and to the Minister of Health, Adrian Dix, saying that routine tests should be done at all acute care centers, because symptom tracking was no longer sufficient in the second wave of the pandemic.
“Based on the increase in prevalence, we request an urgent reassessment of the issue of preoperative testing for surgical patients to ensure that we prioritize the safety of our patients and maintain current levels of surgical productivity,” says the letter on the screening protocol implemented in May.
He says the screening questionnaires do not adequately identify the risks of COVID-19 infection because they depend on patients to reveal all symptoms and some people arrive at the hospital with symptoms, delaying surgery and putting others, including employees, at risk .
Henry said on Monday that 10 facilities are experiencing outbreaks, affecting 1,364 residents and 669 employees.
They include two units at St. Paul’s Hospital in Vancouver, as well as the Cardiac Care Intensive Care Unit, all closed to new admissions and transfers.
Henry acknowledged on Monday that Fraser Health is testing patients because of its high positivity rate and that Northern Health “has had some very challenging months”.
However, she suggested that there is no need for more comprehensive testing of patients before scheduled surgeries or hospital admission by emergency departments.
Dr. Shannon Lockhart, a Vancouver anesthesiologist who is among the doctors who signed the letter to Henry and Dix, said that physical distance is not always possible in hospitals and there are several reasons why patients may not be able to wear a mask, especially when a breathing tube is removed after general anesthesia and they can cough, increasing the risk of transmission.
Health workers who constantly put on and take off personal protective equipment over long shifts are prone to making mistakes, creating more risks, said Lockhart.
“These restrictions increase the risk of infections becoming over-spreading events, as we have seen in some hospital outbreaks,” she said, adding that recent studies from around the world show that surgical patients with COVID-19 are at greater risk of death.
Parts of Ontario and Nova Scotia require patients to be tested for COVID-19 several days before scheduled surgery.
This report by The Canadian Press was first published on January 13, 2021.