Contracting Covid-19 in hospital
Sir, – Like many hospital doctors, I rarely take sick leave – not a single day in over 10 years, indeed. While that may sound like a boast, it’s not unusual, and indeed perhaps it should be read more as an admission. It came to mind reading of a correspondent’s recent experience, when his relative contracted Covid-19 during a hospital stay (Letters, December 19th). It’s not that I’ve never felt less than optimal. I’m often tired and have vague symptoms of one sort or another. But there is an enormous, largely rational, peer pressure to present for work. Replacements cannot realistically be found, and many forms of hospital work, from the emergency departments and intensive-care units, to placing epidurals and performing Caesarean sections, literally cannot be deferred. While some work can be, deferring operating lists or acute care causes widespread ramifications – patients will often have arranged cross-cover at work, set up childcare or planned for relatives to come and stay, such as while they recover from surgery. Postponing the case for a week inconveniences an unknown multitude of such people.
Covid-19 presents particular problems in this regard. Up to 80 per cent of cases may be asymptomatic, particularly in the young and healthy, adjectives applicable to most care workers. I know of many colleagues who have been amazed when they tested positive, and had to leave work immediately. And while the use of protective equipment is at unprecedented levels this year, this is a respiratory pathogen, with direct contact not necessary for spread. Patient-to-patient transmission occurs. Detection of antibodies in frontline healthcare workers in one Irish hospital suggested that about 20 per cent had had the disease, as The Irish Times has reported (“Almost 20 per cent of staff at Dublin hospital have antibody evidence of Covid-19 infection”, News, October 26th). Many had experienced no symptoms. Considering, in tandem then, a highly contagious pathogen, with a tendency to cause infection without symptoms, and a culture of working if mildly unwell, the “nosocomial” or hospital transmission of this illness is not a surprise. And while numbers in Ireland are smaller, making subgroup analysis more difficult, as long ago as September nursing representative groups in the US were reporting that over 1,700 healthcare workers there had died from Covid 19, with thousands more afflicted.
Infrastructural deficits in our healthcare institutions are well known, and perhaps this year will bring them to serious attention. But almost globally Covid-19 transmission in the healthcare setting has been reported, and is very much a focus of the relevant professionals. Clearly, whenever necessary, one should attend hospital. And in all eras, the risk of acquiring serious infection there exists. Like all health professionals, I hope the lady referred to in the letter recovers well, from Covid and the original reason for her admission. But the risk of infection in the healthcare setting is not new, and will remain long after we stop talking about Covid, unfortunately. – Yours, etc,