The veteran journalist Paddy Clancy should have been taking it easy in the six-person ward in Sligo University Hospital while being treated for a chronic kidney condition in January. Instead, he sent furious emails to hospital management concerned that a contact of a patient with Covid-19 had been moved into his then Covid-19 free ward.
he patient, who tested positive, was moved to another ward, but within a number of days the remaining patients tested positive for Covid-19, including Paddy Clancy. To say he was furious was an understatement. He told RTÉ’S Prime Time programme a few weeks later: “It kills people like me. It can kill people like me. And I’m not ready to go.”
The Covid-19 pandemic brought several unanticipated twists: the decimation of nursing home residents, the devastation of healthcare staff, and a small but significant cohort of patients who went into hospital to be treated for an illness only to contract a potentially deadly virus while there. During the third surge of the pandemic, the cases of patients acquiring Covid-19 in some hospitals reached even greater levels than during the first wave.
Mr Clancy is now recovered and back home in Rossnowlagh, Co Donegal, but is still furious that he contracted the virus in a hospital at a time when he was seriously ill and vulnerable. “That is what really annoyed me, the fact that I went into hospital with one condition, and they treated me well for that. I felt safer than in any other hospital,” he said. When he caught the virus, he told his family: “I’m not a money grabber, but if they kill me, you go after them.”
Paddy Clancy thankfully has lived to tell his tale. Others have not. The legal firm, Damien Tansey Solicitors, is understood to be acting for more than 10 families who are considering suing the State over the deaths of loved ones who contracted Covid-19 in hospital and died. They allege that the cases were preventable and may involve negligence. The Department of Health recently confirmed that one family has already issued legal proceedings against the State.
The Health Service Executive has confirmed that 1,972 patients contracted the virus in hospitals since December 28. But the HSE has not divulged which hospitals, or how many.
The Sunday Independent publishes for the first time today the full breakdown of those figures: the numbers of patients who caught Covid-19 and in which of the country’s 45 hospitals — from the large acute centres in the cities to maternity hospitals and smaller regional hospitals.
The figures show that the hospitals with the highest rates of patient infection were the larger acute hospitals, with larger volumes of staff and with the greatest turnover of patients.
St Vincent’s University Hospital in Dublin had the highest number of hospital-acquired Covid-19 cases, with 151 patients contracting the virus during the third surge of the virus, between January and February this year. The hospital is one of the busiest in the country, serving southside Dublin, and caters for an older population that is more susceptible to Covid-19.
Only one other Dublin hospital is in the top in terms of numbers of patients who acquired Covid-19, and that is St James’s, with 131 patients infected in the six weeks from December 28 to February 14.
The other hospitals in the top five are regional centres, including Cork University Hospital, where 131 patients were infected with Covid-19 while being treated at the facility; University Hospital Galway, with 115 patients; and University Hospital Limerick, with 99 patients.
The HSE says 1,972 patients contracted the virus in hospital since December 28 but it has not released details of patient infection rates in individual hospitals.
The figures for the named hospitals were released by six of the country’s seven hospital groups: Saolta, which covers hospitals in the west and north-west; the RSCI Hospital Group; and the Dublin Midlands Hospital Group.
The figures also show how small numbers of patients contracted Covid-19 in two maternity hospitals: the Coombe Women & Infants Hospital, Dublin and Cork University Maternity Hospital. It is not stated whether the patients who contracted the virus were mothers or their babies. But in both cases, the numbers infected were fewer than five, according to figures supplied for both hospitals. The HSE does not provide exact Covid-19 figures when numbers are so small, to protect patient confidentiality.
Questions arise as to how much hospital-acquired infection could have been prevented or contained.
There is only one way the virus gets into hospitals and that is via people. With hospitals closed to visitors during the pandemic, the only routes in were through patients and staff. When cases of the virus rise in the community, they will also rise in hospitals. The Health Service Executive has been fighting to keep the virus out of hospitals since the start of the pandemic — that was the purpose in shutting down all non-essential services during the first wave. Funding was made available to improve infection controls in hospitals. Training communiques were circulated to staff.
Ahead of the third wave of the virus, the National Public Health Emergency Team (Nphet) drew up 29 infection control measures to be implemented by the HSE. The health regulator, Hiqa, had also reviewed infection control measures in hospitals, and identified a small number of deficiencies that were subsequently addressed.
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But according to a briefing document prepared for Nphet, the HSE did not set up a working group to focus specifically on hospital-acquired infections until December 10. It did so on Nphet’s advice, and it met for the first time on December 21, just as the surge in Covid-19 cases began.
The HSE had planned to start serial testing healthcare workers on January 4, but on a trial basis and limited to three hospitals. But according to the briefing document for Nphet, the post-Christmas surge in cases meant that serial testing had to be postponed.
By the time the trials got properly under way, from January 20, the worst of the surge had passed.
The Nphet briefing document, dated January 21, cites several factors for the rise in cases of hospital-acquired — also known as nosocomial — Covid-19. These included the new and potentially more transmissible variants of Covid-19 and older hospital infrastructures that facilitated its spread. It also cited the almost incontrovertible evidence that when Covid-19 rises in the community, it rises everywhere, including hospitals.
Could more have been done sooner?
“Every infection control practitioner in the HSE is asking themselves the same question,” Professor Martin Cormican, the HSE’s clinical lead for infection control and a member of Nphet, said.
He “deeply regrets” the levels of hospital-acquired infection. “There is no doubt that there are people who got hospital-acquired Covid-19 who had shorter lives than they would otherwise have had,” he said. “Of course, that is a profound regret. I am sorry that our systems didn’t work better. We were trying. It is fair to say that no other country had a perfect answer to this either. I am deeply disappointed that we didn’t do better. We certainly tried to.”
This “invisibility” of the virus was what most struck infection control managers, he said. “The biggest challenge was not being able to detect presence of Covid-19,” he said. “If I get infected today, there is no test that is going to find the virus in me today. Or any test that will find it tomorrow. The virus has first to multiply to such a level that it can be detected.”
Serial testing all health workers in hospitals for the virus in January may have helped control hospital outbreaks. However, the focus was on vaccinating healthcare workers, he said.
“As soon as the vaccine became available, it was the best tool we had,” he said.
Vaccines, and reducing the levels of Covid in the community, had a “transformative” effect in clearing hospitals of the virus.
“One of the things we had a very strong impression of was that the hospitals with the worst infections were in the areas with the highest levels of community transmission.”
Professor Paddy Mallon, an infectious diseases consultant at St Vincent’s University Hospital, said keeping the virus out of hospitals was the focus of the entire health service from the start.
“We were all cognisant of the fact that we did not want Covid-19 getting within the hospitals,” he said. “We were working incredibly hard on the frontline to do that.
“Some of the challenges we can control. Some of the challenges are beyond our control,” he said. “There probably does need to be some serious reflection on what impact our current health infrastructure has on the ability of a pandemic virus to spread,” he said.
For now, vaccines have “turned off the tap” on hospital infections. A statement from St Vincent’s University Hospital said it experienced “the highest level” of hospital-acquired Covid-19 infection in January this year.
“These high levels of hospital-acquired infections were in the context of record levels of community transmission of Covid-19, the presence of the more transmissible UK variant of Covid-19 (B.1.1.7) detected, the highest levels of admission of Covid-19 cases to the hospital and minimal patient population vaccination.”
It added that its patient demographic is older than the average, with more complex illnesses, and more susceptible to Covid-19.
The figures for patients with hospital-acquired Covid-19 were released by six hospital groups under the Freedom of Information Act. They are Saolta, which covers hospitals in the west and north-west; the RSCI Hospital Group; and the Dublin Midlands Hospital Group; the South and South West Hospitals Group; the University of Limerick Hospitals Group and the Ireland East Hospital Group.
