Covid-19 update: Scotland’s hospitals are safe with tiny hospital acquired infection levels

Figure: Epidemic curve of COVID-19 cases with first positive specimen taken during an inpatient stay, by onset status: week-ending 1 March to week-ending 27 September 2020   Figure is an epidemic curve of COVID-19 cases with first positive specimen taken during an inpatient stay. The length of the bars are the counts of COVID-19 cases during each week, from week ending 1 March to week ending 27 September 2020, with the bars broken down by hospital onset status: non-hospital onset (day 1 or 2 of in-patient stay), indeterminate hospital onset, probable hospital onset and definite hospital onset. The chart shows a steep increase in overall cases and definite hospital onset cases until a peak on week ending 5 April. This is followed by a decline in overall cases and definite hospital onset cases with few cases observed during July and August. However overall cases and definite hospital onset cases have started to increase since week ending 30 Aug.
https://beta.isdscotland.org/find-publications-and-data/population-health/covid-19/hospital-onset-covid-19-cases-in-scotland/

As ‘our’ media swarm all over any sign of death in a hospital, scaring the vulnerable and endangering lives in the process, a bit of context is important.

From the NHS Scotland information services division, published 4 days ago, that only 8 or 0.2% of patients in the week-ending 27 September were victims of probable (3) or definite (5) hospital onset Covid-19 infection.

These are the most recent data published.

99.4% of cases were acquired in the community before admission to hospital.

This represents a slight fall from the previous week and a continuation of very low levels of infection.

NHS England figures unsurprisingly do not seem to be available for context but BBC Wales has reported sharp increases since the beginning of September:

Covid-19 infection in hospitals. Numbers of probable and definite hospital onset infections by week.  Up to 18 October.

Looking at the comparable period, end September, you can see the Scottish figure of 8 dwarfed by the level, in just 4 hospitals, reporting more than 100 cases, in a country with only half the population.

One Lancet study in August does suggest reasons why NHS England is keeping quiet on this:

The two English hospitals had 262 cases [131 each] of hospital-onset infection, the four Welsh hospitals had 146 cases [36 each] but the four Scottish hospitals had only 72 cases [18 each].

Why so few English and so many Scots and Welsh hospitals in the thus skewed sample? Did the English hospitals fear exposure? Did Matt Hancock tell them not to take part?

Data were collected across ten centres in the UK (Ysbyty Ystrad Fawr [Caerphilly], Royal Gwent Hospital [Newport], Nevill Hall Hospital [Abergavenny], Southmead Hospital Bristol [Bristol], Aberdeen Royal Infirmary [Aberdeen], Royal Alexandra Hospital [Paisley], Royal Inverclyde Hospital [Inverclyde], Salford Royal Infirmary [Salford], Glasgow Royal Infirmary [Glasgow], and the University Hospital of Wales [Cardiff]) and one Italian hospital (University Hospital of Modena Policlinico [Modena]). 

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30146-8/fulltext

Regulars here will remember the above Glasgow anaesthetist (right) prophesying infection doom after noticing wrongly placed hand-sanitisers in the QEUH. Her comments then went viral and she was interviewed or quoted on every BBC Scotland outlet.

Figure: Epidemic curve of COVID-19 cases with first positive specimen taken during an inpatient stay, by onset status: week-ending 1 March to week-ending 27 September 2020   Figure is an epidemic curve of COVID-19 cases with first positive specimen taken during an inpatient stay. The length of the bars are the counts of COVID-19 cases during each week, from week ending 1 March to week ending 27 September 2020, with the bars broken down by hospital onset status: non-hospital onset (day 1 or 2 of in-patient stay), indeterminate hospital onset, probable hospital onset and definite hospital onset. The chart shows a steep increase in overall cases and definite hospital onset cases until a peak on week ending 5 April. This is followed by a decline in overall cases and definite hospital onset cases with few cases observed during July and August. However overall cases and definite hospital onset cases have started to increase since week ending 30 Aug.

One thought on “Covid-19 update: Scotland’s hospitals are safe with tiny hospital acquired infection levels”

  1. https://www.bmj.com/content/369/bmj.m2013

    The situation may have improved since this was published – only to get worse as cases mount in England now.

    “Doctors have told The BMJ they are deeply concerned at the number of patients becoming infected with covid-19 in NHS hospitals in England and have called for more stringent infection control measures to combat its spread.

    They cite limited capacity for testing and retesting as a barrier to keeping covid and non-covid patients separated in so called “green” and “red” zones. There also have concerns about the availability of side rooms and cubicles to keep patients separate and believe that poor ventilation in areas other than intensive care units may be contributing to nosocomial infections.

    Jan Coebergh, a consultant neurologist in Surrey who has worked on covid wards at several sites since the outbreak began, told The BMJ that he had seen distressing cases of patients becoming infected with the virus from other patients while in hospital and who were likely to die as a result.. ..

    …Currently there are no official figures on numbers of patients contracting covid-19 in hospitals. However, the Guardian newspaper reported that the proportion of covid-19 infections acquired in hospital was between 10% and 20%, although NHS sources told the paper that the figures were skewed by poor infection control procedures at one single trust and that the true rate was lower, at around 5% to 7%.2”

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