Hospital exposure - Unanswered questions surround virus-positive TCI patient that sent UWI hospital staffers into quarantine
Published:Sunday | April 19, 2020 | 12:00 AM
The University Hospital of the West Indies (UHWI) is being overly cautious about the circumstances that sent a senior doctor, and likely other healthcare workers on the front line of the COVID-19 fight, into quarantine, after a critically ill patient from the Turks and Caicos Islands (TCI) was re-admitted to the facility on April 16, and later tested positive for the deadly contagious disease.
The UHWI is the region’s leading referral medical institution.
The male patient arrived at the Norman Manley International Airport in Kingston Thursday night, on-board an air ambulance, Minister of National Security Dr Horace Chang has confirmed.
He was later transported to UHWI in St Andrew, where he tested positive for the coronavirus disease 2019 (COVID-19), the hospital admitted.
The hospital issued a statement yesterday afternoon, after questions began swirling from early morning about the situation, which is reported to have exposed several top-ranking staff, including Professor Joseph Plummer, who is the head of surgery, and a member of the institution’s 56-member COVID-19 response team.
But it was the questions not answered by the hospital that have led to even more questions, and efforts by The Sunday Gleaner to get clarification were not successful. The hospital’s head of public relations, Nordia Francis Williams, said the institution is refraining from answering questions and will speak further next week.
The statement did not address the number of persons involved in the pre-positive care of the patient, and even though it started off saying it wanted to “correct information circulating”, it did not address reports that Professor Plummer was in quarantine.
It did not say where the TCI patient was housed while test results were pending, and neither did it say if any new protocols will be implemented as a result of the developments. Whether it explicitly sought the COVID-19 status of the patient ahead of arrival was also not clear.
According to the hospital, the patient was screened (based on the hospital’s screening form) and “at no time” was considered to be COVID-19 positive, although it is not clear whether there are special protocols for overseas cases coming from countries where the coronavirus disease 2019 (COVID-19) is confirmed. Turks and Caicos had 11 confirmed cases of the respiratory illness up to Friday, according to information on the territory’s government website. The UHWI said the COVID-19 test was done here “out of an abundance of caution”.
SAFEST TO TEST FIRST
The Medical Association of Jamaica declined to comment on the issue, but the Nurses Association of Jamaica said, while it is not “overly concerned” now, the hospital must have knowledge of patients’ COVID-19 status ahead of their arrival.
“The safest thing to do when we are taking [patients] from across borders is to ensure that we have a COVID test for those individuals,” said Carmen Johnson, the association’s president.
She said the organisation has not been able to determine the number of nurses who may have been exposed and, therefore, those who may have to be quarantined, because, according to her, the hospital was still doing a risk assessment.
Regarding the patient from the TCI, the hospital explained that the individual was treated there for gastric cancer on March 16 and returned home on March 26. It said, following an emergency operation in the TCI, a request was made to the UHWI for additional treatment and was discussed with the Ministry of Health’s Emergency Operation Centre, the Ministry of National Security and the Jamaica Civil Aviation Authority.
Although Jamaica’s borders are closed to incoming passenger traffic, the Cabinet can approve exemptions recommended by the National Security Minister, Dr Horace Chang, who confirmed that he did.
Sources say, weeks ago, the hospital rolled out a 67-page document which served as the driver of the institution’s response to the virus. The document, with a March 23 revised date, is titled ‘COVID-19 Specific’ and zoomed in on, among other things, patients who are ‘suspect’ or about whom there were suspicions.
Among the protocols in place at the hospital for ‘suspect’ patients are: “Individuals transferred to UHWI from another facility are escorted from ambulance to isolation unit. The transferring team must escort patient into isolation unit wearing PPE (personal protective equipment) for contact and droplet precautions, and contact should be made with the emergency medicine physician on duty.”
However, the original plan was largely centred around individuals who visited China or were in contact with Chinese subjects. The plan was subject to amendment as the situation changed.
According to its protocol, confirmed positive patients transferred to UHWI should go directly to Ward 7 or intensive care units. The hospital’s checklist for positive patients’ referral and admission is outlined and said “severe acute respiratory illness with actual or impending respiratory failure and confirmed COVID-19 infection who will benefit from ICU care”.
Yesterday, Health and Wellness Minister, Dr Christopher Tufton, on social media, said the situation at UHWI “was a medical emergency and, sometimes we have to help out, and sometimes there will be situations where we will need to make exemptions.”
FULL TEXT OF UHWI STATEMENT:
“The University Hospital of the West Indies (UHWI) would like to correct information circulating regarding a patient who recently returned to the hospital for treatment. The patient, a cancer patient of the hospital, had a bleeding gastric cancer treated on March 16, 2020, and was released and returned home to the Turks and Caicos Islands (TCI) on March 26, 2020. The patient had an emergency reoperation in the TCI and a request was made for advanced critical care, a service usually provided for all our contributing territories by the UHWI. The critical nature of the patient’s condition was discussed with the Emergency Operation Centre of the Ministry of Health and Wellness, Ministry of National Security and the Jamaica Civil Aviation Authority.
On returning to Jamaica on April 16, 2020, the team from the UHWI, who received the patient at the airport, was in full personal protective equipment (PPE). The patient was already intubated and had a viral filtration system.
Based on the UHWI’s screening form, at no time was the patient considered to be a COVID-19 patient, but, out of an abundance of caution, the UHWI decided to test the patient. The result is positive and the patient remains stable in the COVID-19 ICU.
All staff evaluation, assignment and quarantine have been done according to the hospital’s protocol. The UHWI urges the public to respect the privacy and confidentiality of the patient. We remain committed to providing critical and advanced care for the people of the region.”