Does admitting patients suspected of having COVID-19 to hospital increase the spread of the virus? That’s one explanation for why the number of deaths in the Italian region of Veneto is so much lower than in Lombardy. As of Saturday, April 4th, Lombardy had a case fatality rate (CFR) of 17.6%, while Veneto’s CFR was just 5.6%. The population of Lombardy is 10 million and Veneto 4.9 million, but Lombardy had recorded 8,656 Covid deaths by April 4th, while Veneto had recorded 607.
Part of the reason for this discrepancy is that the authorities have done much more testing and contact tracing in Veneto. But another reason may be that far fewer people suspected of having the virus have been admitted to hospital in Veneto. In Lombardy, 65% of patients diagnosed with COVID-19 were admitted to hospital at the start of the outbreak, while in Veneto only 20% of people were. The theory isn’t that people diagnosed with the virus are more likely to die if admitted to hospital, but that the higher percentage of admissions in Lombardy meant non-COVID-19 patients and hospital staff were more likely to be infected and then infect others.
A group of doctors from the Papa Giovanni XXIII hospital in Bergamo wrote a paper for the New England Journal of Medicine setting out this theory last month. “We are learning that hospitals might be the main COVID-19 carriers,” they wrote. “They are rapidly populated by infected patients, facilitating transmission to uninfected patients.”
If this theory is correct, it suggests that the policy of ramping up the NHS’s capacity to treat patients with COVID-19, and admitting more and more of them, may be spreading the infection. If the NHS’s admission criteria for Covid patients changes, and more patients are told to remain in their homes, as the Papa Giovanni XXIII hospital staff are recommending, that could mean relaxing the social distancing measures won’t result in the NHS becoming overwhelmed.
Further Reading
‘At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation‘, Mirco Nacoti, MD, et al, New England Journal of Medicine, March 21st 2020
‘Fewer deaths in Veneto offer clues for fight against virus‘ by Miles Johnson, Financial Times, April 5th 2020
‘Hospitalising coronavirus patients can cause more deaths, Italy data suggests‘ by Nick Squares, The Telegraph, April 6th 2020
‘Ground Zero: When the Cure is Worse than the Disease‘ by Jonathan Tepper, Medium, April 13th 2020
‘When Our Hospitals Are The Pandemic Superspreaders‘ by Jonathan Tepper, April 20th 2020
‘The Ongoing Problem of UK Hospital Acquired Infections‘ by Carl Heneghan, et al, CEBM, October 30th 2020
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To date (13 April 2020) 11329 people have died of CV-19 in the UK. The number of people employed by the NHS is about 1.5 million or 1/43 of the UK’s population. Therefore, if NHS staff are exposed at a similar level to CV-19 as the rest of the population then about 260 NHS staff ought to have died from CV-19.
But only 19 NHS staff are reported as having died. 19 too many of course. But part of the reason is that NHS jobs vary hugely in the extent to which staff are exposed. Nonetheless, the figure is still very small, even if one takes into account that people of working age with no underlying conditions are significantly less susceptible to dying from the virus, perhaps as little as 20 percent or below compared to someone over 70 and with an existing condition.
It might be usefully pointed out that the NHS ought to expect to lose about 57 staff to all other causes every week, simply based on the average 2 in 1000 death rate applied to the 1.5 million people of working age employed by it.
19 NHS staff lost to CV-19 so far represent just 0.64 percent of the staff the NHS will theoretically lose every year to all causes.
However, Transport for London employs only 27,000 staff, 1/55 of the NHS worksforce, but has suffered 21 staff deaths to date. This is equal to 38 percent of the staff TfL can expect to lose to all causes in a normal year, a dramatically higher figure than the NHS. Surely, even if exposure to infected people was the same we ought to have seen TfL lose only 1/55 of the number the NHS has lost? This has manifestly not happened. Why? There are several possible explanations which include:
a) NHS staff are in fact far less exposed to risk of death from CV-19 than either TfL staff or the general population. They work in a protected environment and despite claims of a shortage of PPE they do have access to it most of the time
b) TfL staff are exposed to infected members of the public and do not have PPE
Either way this is an interesting factor to take into account when considering whether or not the NHS is playing a role in spreading the infection.
Perhaps some thought needs to be given to the Health sector in general. Do the higher levels of the NHS and Department of Health have a (perverse) incentive to keep the COVID roadshow going for as long as possible?
The NHS has been in financial crisis for years, whatever the size of their budgets. But now all their debts have been written off, they are being provided with whatever they say they want and volunteer money is flowing like water Plus a growing public acceptance that the NHS and social care sector should get a larger slice of public finances in the future.
Why would they want it to end before they absolutely have to.
Even the staff must be slightly pleased to have fewer drunks in A&E on Saturday nights and (presumably) no road traffic accident emergencies to deal with.
Yes; the BBC has now cofirmed it (https://www.bbc.co.uk/news/uk-wales-53640448).