Nurse died of Covid 48 hours after negative swab test
A vulnerable nurse died of Covid 19 just 48 hours after a swab test falsely indicated she did not have the disease, an inquest has heard.
Sixty-two-year-old auxiliary nurse Karen Wilkes, passed away on April 21, 2020, and a post mortem examination conducted the following day revealed she did in fact have the coronavirus.
Area coroner for Manchester West Prof Alan Walsh had ordered a full investigation into concerns raised by the family that Karen, of Endfield Street, Pemberton, may have caught virus from a patient she had been caring for on the clinical decisions ward, adjoining the A&E department at the Royal Albert Edward Infirmary in Wigan.
But concluding that the Billinge-born mother-of-two died of natural causes Prof Walsh said at the Bolton inquest there was no way of knowing whether the patient she had cared for actually had the disease or not.
The patient had tested positive for Covid on April 28, and had been in and out of hospital since April 3 when Karen spent a lengthy amount of time with her on the ward, including taking her to the toilet.
Prof Walsh heard that Karen suffered shortness of breath and breathing difficulties after overcoming lung cancer after which she had part of her right lung removed 10 years ago.
This, said her sister Sandra Martland , made her prone to getting chest infections.
Karen had been sent home from the ward after developing a 'new cough' on April 8 and had been referred to Leigh Infirmary for a swab test.
However, she was too unwell to attend an initial swab test and Prof Walsh criticised hospital bosses for recording her inability to turn up for the appointment as simply 'did not attend' instead of making it clear that it was because she was too ill.
Eventually, another appointment was made for a swab test. Then, Sandra followed her sister's car to the infirmary and watched her 'swerve a couple of times'.
Sandra told the hearing: "Karen told me later 'I have no idea how I got home'."
Tragically, the results of the test did arrive until after Karen had been found dead at home by one of her daughters.
Pathologist Dr Naveen Sharma said that the cause of death was Covid 19 pneumonia and that swabs taken from her during the post mortem examination showed she had Covid 19.
Karen's line manager was Julie Batterbury, who at the time was solely responsible for risk assessing 25 staff on the ward.
But because the two women never worked on the same shift until April 8 - the day she sent the auxiliary nurse home - her vulnerable condition was not recorded or taken into account.
Now, risk assessments are carried out by Ms Batterbury and two other nursing sisters, Prof Walsh was told.
Paramedics were called to Karen's home on April 13, and although her temperature was up, other signs were normal.
But Prof Walsh pointed out that the North West Ambulance Service did not inform the attending paramedics that Karen had lost her sense of taste and smell, "classic symptoms of Covid 19," he said. After checking her vital signs the ambulance crew left her home without taking her to hospital.
Prof Walsh said that 'some training in communication may be needed' at NWAS.
He also pointed to anomalies in the patient report form filled out by paramedics which did not give accurate times and which attending trainee paramedic James Curran agreed was ' below the required standard'.
The coroner was told that since Karen's death a new high-tech synchronised technology allowed details to be automatically logged on the system.
Medical examiner Dr Kirsten Baron who conducted an investigation for the Wrightington, Wigan and Leigh NHS Trust said that at the time of Kaen's death, when the pandemic was beginning to take hold, she would not have been classed as vulnerable 'according to government guidelines at the time', but admitted ward managers would 'discretion' in certain cases.
She also said that even if the paramedics had taken Karen to the accident and emergency ward with the symptoms she had on April 13 it was highly likely she would have been discharged immediately.
Dr Baron said swab tests were known to give false negatives in about 10 per cent of cases.
"They have never been 100 per cent effective," she said.
Concluding that Karen had died of natural causes, Prof Walsh said that although he had seen areas where risk assessment processes could have been improved and communication between NWAS call operatives could be improved he did not deem it necessary to report the issues further.
And he praised the dignity with which Sandra and Karen's daughter, Leanne Martland-Wilkes had conducting themselves during the inquest.
He said: "I have highlighted one or two matters which I think should be taken on board, for example, the observations of the ambulance service on recording and passing of information to ambulance personnel, but I don't see any issues that should be reported.
"I think the ambulance service and the hospital trust have some matters that can be learned from the evidence.
"It's quite rare for us to have an inquest into a Covid related death, but I wanted there to be a full and frank investigation. into Karen's death.
"I don't think we will ever know where she contracted Covid."
And he told Sandra and Leanne: "I want to thank you for the dignity you have shown in a very calm way. You've shown your concerns and it's right that we investigated them.
"Karen was a committed career auxiliary nurse who had her own health problems but always wanted to serve the community. Like many others, she was at the front end of hospital treatment during the early stages of the outbreak of Covid 19 and the lockdown."