Thousands of patients in intensive care will be tested for signs of the coronavirus amid fears that it is circulating among units treating people who are seriously ill in hospital.
NHS bosses have ramped up their efforts to detect the virus by ordering all 135 acute hospital trusts in England to routinely test anyone in intensive care units (ICUs) who has a breathing problem.
They are worried that people who are already very sick in hospital with different illnesses could be infected with the virus by a fellow patient.
The plan is a direct response to the detection of Covid-19 in patients in intensive care units in Europe whose illness cannot be traced to any of the areas where the virus is circulating, such as northern Italy. Staff working in these units have also contracted the virus.
The move came to light in a letter sent to all NHS organisations on Tuesday by Prof Keith Willett, the senior doctor co-ordinating NHS England’s efforts against the virus. In it he told trusts: “In recent days, new Covid-19 infections have been diagnosed in intensive care units in a number of European countries, without any epidemiologial links to high risk areas.
“Nosocomial [hospital-acquired] transmission has occurred in these units affecting other patients and staff. It is essential that we detect cases admitted to intensive care at the earliest opportunity. We are requesting that all intensive care units and severe respiratory (Ecmo) centres commence case detection.”
Adult and paediatric ICUs should test any patient whose “presenting condition is an acute community acquired respiratory infection of any kind, regardless of known or suspected causative pathogen and clinical features”, the nine-page letter said.
Willett’s letter also reveals that NHS England has declared the coronavirus outbreak to be a level four incident, which is the the highest level of threat to the functioning of the health service. It previously designated Brexit and the damaging Wanna Cry attack on NHS IT systems in 2017 as level four incidents.
The move emerged as the government announced that 12 more people in the UK have tested positive for coronavirus, taking the total number of infected people to 51. Eight of the new patients announced on Tuesday had recently travelled from Italy. The latest cases also included the first person to have travelled from Germany, while the others had been to Singapore, Japan and Iran, which suggests that the virus was not contracted in the UK.
Health officials in the Canary Islands reported the first case of a British national testing positive at a quarantined hotel in Tenerife.
The 12 new UK cases constituted the second highest single-day increase in cases. They include the first known cases in Hampshire, Humberside and Northamptonshire. Others are from London, Wirral, Greater Manchester and Kent.
Dr Will Welfare, of Public Health England North West, said there were three new Covid-19 cases in Greater Manchester, including two from Bury. “As a result of contact tracing we know the new Bury cases announced today are known contacts of the previously confirmed case from Bury,” he said. “The third case is a resident of Bolton which is not linked to the two cases in Bury announced today. The Bolton resident became infected while in Italy.”
Meanwhile, millions of patients could have their NHS care postponed if an epidemic forces hospitals to cancel planned operations and outpatient clinics to free beds and doctors to focus on people with coronavirus.
“If the virus escalates in scale, the impact on an NHS that is already under intense strain, with record numbers of patients on waiting lists, people routinely being treated in hospital corridors and others waiting weeks for a GP appointment, will be grave,” said Dr Helena McKeown, a chief officer at the British Medical Association.
She added that the government’s proposal to bring back retired doctors to bolster the NHS “needs serious scrutiny”, as those who do so could be putting their own health at risk. Dr Paul Donaldson, of the Hospital Consultants and Specialists Association, said it was a “desperate measure we should never need to resort to.”
Experts said that the planned early discharge of inpatients to accommodate people seriously ill with Covid-19 would help hospitals but put extra pressure on already overstretched social care services.
There are concerns that hospitals may have too few beds in intensive care and high-dependency units to cope with the number of people needing help to breathe due to the virus. Dr Daniele Bryden, vice-dean of the Faculty of Intensive Care Medicine, warned that while demand on units had been rising at 4% a year since 2009, the number of beds and staff has not kept pace and shortages of specialist doctors and nurses are common.
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