Doctors and nurses call on British Columbia to test for COVID-19 on emergency surgical patients

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VANCOUVER – Screening patients for COVID-19 before their scheduled surgery and transferring them to emergency departments could reduce outbreaks in B.C. hospitals as cases increase, suggest results from a pilot project in the largest health authority in the province.

Fraser Health said that of 5,681 patients who had been booked for surgery, 65 tested positive for the virus but had no symptoms and would not have warranted testing based on a screening questionnaire. Of 2,969 patients booked for elective surgery, 11 were infected with the virus but were asymptomatic.

“Unidentified cases of COVID-19 can lead to transmission and contribute to epidemics,” the health authority said of its improved testing in a note to staff.

Testing began in mid-November for three weeks for surgical patients and four weeks for patients who had been in the emergency room.

“The triggers that led to the assessment were at least two COVID-19 outbreaks in acute care and a test positivity rate above 5%. These two conditions still exist within Fraser Health, ”the memo reads, adding that health officials have continued to test for the virus.

The positivity rate, or the percentage of all COVID-19 tests done that show infection, was 9.6% when testing started at Fraser Health and is now 8%, according to data from the BC Center for Disease Control.

The Northern Health Authority’s positivity rate climbed to 16% from 0.5% in October, according to data from the center, which also shows the region’s indoor health rate rose to 8.3%, after a low of 1.7% in November.

In the coastal region of Vancouver, the positivity rate is 5.2%, up from 0.4% in June. Vancouver Island Health Region’s positivity rate is the lowest in the province at just under three percent.

In November, more than 500 doctors and nurses from across British Columbia sent a letter to provincial health worker, Dr. Bonnie Henry and Minister of Health, Adrian Dix, saying routine tests should be done. in all acute care centers, as symptom screening was no longer sufficient in the second wave of the pandemic.

“Based on the increase in prevalence, we call for an urgent re-evaluation 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. », Indicates the letter about the screening protocol put in place in May.

It says screening questionnaires do not adequately identify the risks of COVID-19 infection because they rely on patients to honestly disclose all symptoms and some people arrive at the hospital with symptoms, delaying the process. surgery and putting others, including staff, at risk.

Henry said on Monday that 10 facilities are currently 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 Intensive Care Unit, all of which are closed to new admissions and transfers.

Henry admitted on Monday that Fraser Health was testing patients because of its high positivity rate and that Northern Health “had had a very difficult few months.”

However, she suggested that there was no need for more widespread testing on patients before scheduled surgeries or admission to hospital from emergency departments.

Dr Shannon Lockhart, a Vancouver anesthesiologist who was among the doctors who signed the letter to Henry and Dix, said physical distancing was not always possible in hospitals and there were several reasons why patients may not be able to wear a mask, especially when a breathing tube is removed after general anesthesia and they may cough, increasing the risk of transmission.

Healthcare workers who constantly put on and take off personal protective equipment during long shifts are prone to making mistakes, which creates additional risks, Lockhart said.

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“These stresses increase the risk of infections becoming super-spreading events, as we have seen in some of the epidemics in hospitals,” she said, adding that recent studies from around the world show that patients surgeries with COVID-19 are at greater risk of death.

Some areas of Ontario and Nova Scotia require patients to be tested for COVID-19 several days before their scheduled surgery.

This report by The Canadian Press was first published on January 13, 2021.

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