Medical students live and breathe this mantra during their training: “first do no harm.” At their graduation, the Hippocratic Oath is often read aloud.
Coming across the following story, then, was not only jarring, but hit at the core of what physicians hold sacred.
“I attended my first funeral for someone who died from COVID-19 this week,” Tracy Sherlock wrote in the Richmond News last month. “This was a man in his 70s who had a previous organ transplant and who caught COVID-19 while in the hospital for something else.”
Sadly, although this is shocking, it’s not surprising. During the latest Omicron wave, we expect large numbers of patients in B.C. have been infected with COVID-19 during their hospital stays.
We’ve known for some time that SARS-CoV-2 spreads through the air. Not only have we learned that simply breathing and talking are “aerosol-generating procedures,” but also that most transmission occurs before any symptoms may be present, if they develop at all. This means screening based solely on symptoms is a limited tool at best.
When Omicron was found to be more infectious than Delta, and better able to evade two doses of vaccine, it became obvious that because of aerosol spread, the need for ventilation and filtration, as well as the highest grade of filtration masks with a tighter fit (or respirators) could not be ignored any longer.
We knew several months ago that we needed to bolster all our layers of protection, making them as impenetrable as possible if we were to avoid transmission, infection and the spread of this highly contagious COVID-19 variant — especially in indoor settings.
It should be obvious, but it has not been for everyone. For over two years, B.C.’s public health leaders have refused to act on a large body of evidence provided by engineers and aerosol scientists from around the world.
Unlike the World Health Organization, the US Centers for Disease Control, the Public Health Agency of Canada and now the White House, B.C. public health leaders have continued to prioritize handwashing, cleaning surfaces and Plexiglas barriers as measures to stop droplets and prevent contact spread, downplaying the reality of airborne transmission.
This stubborn focus continues despite the BC Centre for Disease Control having quietly updated its website on Aug. 24, 2021 to include aerosol transmission.
With the arrival of Omicron, B.C. public health officials failed to urgently roll out third vaccine doses for British Columbians while other Canadian provinces and countries were furiously doing so.
Health-care providers were (and still are) denied N95 respirators, despite the arrival of the more contagious variant, and thus they could both infect and be infected by patients with COVID-19. This could come from infected patients they were caring for, or others whose contaminated aerosols escaped their rooms.
Most alarmingly, hospitals in some B.C. health authorities stopped limiting COVID-positive patients to specific hospital wards or red zones and allowed COVID-negative patients to be in the same rooms as those who tested positive, while of course maintaining droplet precautions with a two-metre distance between beds and a curtain barrier.
But health officials reassured us that only “fully-vaccinated” COVID-negative patients would get to share a room with those who were COVID-positive. It did not seem to matter that B.C. still defined “fully vaccinated” as two doses, when the National Advisory Committee on Immunization was recommending at least three shots to protect against Omicron.
“Omicron is generally mild,” B.C. health officials told us.
“Mild for whom?” we ask. Not for the unvaccinated, not for our youngest children for whom a vaccine has yet to be approved, and certainly not for our elders or the clinically and extremely vulnerable among us.
It was also far from mild for those who developed lingering symptoms, or long COVID, nor for the 603 British Columbians who died between Dec. 11 and March 12.
The B.C. approach opened the door for COVID to spread in hospitals. As one small pre-Omicron study showed, the risk of being infected through sharing a hospital room with someone with COVID-19 was 39 per cent. This is likely an underestimation given the more contagious nature of Omicron.
Using household transmission as a proxy for sharing a hospital room, a Danish study showed that transmission, or secondary attack rate, was 10 per cent higher with Omicron compared to Delta.
Anecdotal accounts share some of the effects in this province.
It is unlikely we will ever know the true number of patients, visitors and health-care workers who acquired COVID-19 in B.C. hospitals during the first Omicron wave and the following one with Omicron sub-variant BA2.
Journalists’ attempts to get data on hospital transmission during prior waves were met with Freedom of Information obstacles and delays. When finally some data arrived, the pages were covered in black ink, hiding the information.
Reluctantly, the government finally shared a report with aggregated data on infections and deaths involving patients and staff in B.C.’s acute hospitals and a few care centres, up to Nov. 12, 2021. We were told 1,619 individuals were infected with COVID-19 while seeking acute medical treatment or while at work in acute care, and 274 patients died as a result.
Read that again. In a place where we should be doing the most we can to protect everyone, we are making people sick due to poor policy.
Without more recent B.C. data available on hospital-acquired COVID infections during the first Omicron wave and now BA2, we turn to the National Health Service in England for an indication of what could well be happening in the province now.
An April update by the independent COVID-19 Actuaries Response Group found that in the previous three weeks (March 26 to April 9) 22 per cent of COVID hospital admissions were patients who had acquired COVID during their hospital stay and were diagnosed more than seven days after admission for an unrelated medical issue. Pre-Omicron, this figure was around five per cent.
It is difficult to know if the situation is better or worse here in B.C. Some U.K. hospitals have switched to N95 equivalent respirators (FFP3 masks) for their staff, which would be expected to decrease hospital COVID-19 transmission. Meanwhile, B.C. health authorities have refused to do so.
For any comparison to be fair, we must take vaccination rates into account. In England 67.5 per cent of those 12 and older have received a third dose while in B.C. the closest available comparison is the 18 and older group, with 60 per cent having received third shots.
What is clear though is that allowing COVID-positive and COVID-negative patients to share hospital rooms magnifies the risk of acquiring COVID in hospital.
We argue that B.C.’s unused PCR testing capacity resulting from severely restricted community testing should be redeployed to hospitals and long-term care facilities to mitigate Omicron spread. Others have called for the same, and some hospitals have actually put this strategy to work and successfully limited harm to both patients and health-care workers.
In B.C., it has become clear we need to limit the spread of COVID in our hospitals and stop disregarding the fundamental principle of first do no harm.
Protect Our Province BC is a grassroots group of physicians, nurses, health scientists, health policy specialists and community advocates working to help people in B.C. stay safe by sharing accurate information about the COVID-19 pandemic and advocating for evidence-based policies.
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