Almost as soon as the pandemic struck early last year, NHS England recognised that patients catching Covid-19 while they were in hospital for non-Covid care was a real risk and could lead to even more deaths than were already occurring. Unfortunately their fears have been borne out by events since – every acute hospital in England has been hit by this problem to some extent.
Over the last 15 months various NHS and medical bodies have looked into hospital-acquired Covid and published reports and detailed guidance to help hospitals stem its spread. They include the Healthcare Safety Investigation Branch (HSIB) and Public Health England (PHE). Last May, for example, PHE estimated that 20% of coronavirus infections in hospitalised patients and almost 90% of infections among healthcare staff may have been nosocomial, meaning they were caught in a hospital setting.
Researchers have produced estimates of how prevalent it has been. The government’s Scientific Advisory Group for Emergencies (SAGE) has said that “out of all Covid-19 infections in hospital patients, we estimate approximately 20%-25% may have been nosocomial across the first wave (beginning February to end of July)”. Media outlets have highlighted both outbreaks at particular hospitals and the serious threat to life generally posed by such a deadly virus spreading among patients who are already in hospital for another reason, such as for surgery, many of whom are vulnerable, often because they have one or more serious underlying illnesses.
NHS England aided understanding of the problem by starting to publish figures for how many nosocomial infections have occurred at each trust since last August. They show that trusts logged 41,216 cases of hospital-acquired Covid between 1 August 2020 and 9 May this year.
But what has not been clear – until now – is a more detailed picture of how many people are believed to have died either in total or at each trust after catching Covid from a fellow patient or member of staff. Freedom of information requests that were submitted still do not tell the whole story, not least because 45 of the 126 acute trusts the Guardian sought data from either did not reply or declined to say how many people who caught Covid in their hospitals had later died.
Replies from the 81 other trusts disclosed that a total of 32,307 inpatients either probably or definitely became infected during their stay, and up to 8,747 of them died, either while they were still in hospital or after they were discharged. In lieu of the NHS publishing exact figures for England as a whole, that is the closest approximation yet of the true death toll.
Given the fatalities the FoI responses contained, it is easy to see why Jeremy Hunt, the former health secretary, calls hospital-acquired Covid “one of the silent scandals of the pandemic”. In a pandemic of many tragically large numbers, 8,747 is another sobering reminder of just how lethal Covid is. The great majority, but not all, had Covid on their death certificate. With the few that did not, it is likely that Covid played a part by worsening an existing chronic illness.
Hospital-acquired Covid deaths, however many there actually have been, matter beyond numbers because, as Hunt points out, they involve a loss of life that was potentially avoidable.
As NHS leaders themselves acknowledge and expert reports have shown, they have happened because often-ageing and cramped NHS hospitals starved of cash to modernise during a decade of austerity have had too few single rooms to isolate the infected, and because trusts had little or no scope to test their staff and too little personal protective equipment, such as FFP3 masks, especially early in the pandemic.
Before the pandemic the NHS was over-stretched and resources were limited. The crisis distorted it further out of shape and despite NHS staff making huge efforts to contain the virus in extremely challenging circumstances, too often they were overwhelmed.
There are many other reasons, including inadequate ventilation, the sharing of equipment, and nurses and doctors having to gather at nurses’ stations and in doctors’ messes. Some bereaved relatives also cite hospitals deciding – inexplicably – to put their Covid-free loved ones in a bay or ward with one or more people who had the disease, sometimes resulting in tragedy.
While some of these inherent weaknesses have been addressed, others remain, leaving further infections and even more deaths in this way a distinct possibility if the NHS is hit by another Covid surge.
