During the COVID-19 second-wave, which faced Melbourne in July 2020, multiple aged care wards at the Royal Melbourne Hospital (RMH) faced an outbreak that affected both staff and patients.
A study examining the symptom type and timing of onset, as well as outcomes has been published in the Internal Medicine Journal.
This study looked at a group of patients with COVID-19 who were cared for at the Royal Park Campus (RPC), which is usually a subacute campus where patients have rehabilitation following an acute illness.
On 15 July 2020, the first five cases were diagnosed among inpatients at RPC. Over the following weeks, the outbreak spread to three other wards. Overall sixty-four patients were diagnosed with COVID-19 during their admission at RPC.
Another eleven were diagnosed shortly after discharge from this campus. Thirty-one patients from residential care were also cared for at this campus during this time.
Lead author of the article and Royal Melbourne Hospital Geriatrician, Dr Kate Gregorevic said One of the challenges of diagnosing COVID-19 is there is huge variation in the initial symptoms.
“While many patients did have cough as an early symptom, others had diarrhoea, fever, lethargy or delirium. The early symptoms can also be really subtle, it can be hard to pick the exact moment someone becomes unwell,” Dr Gregorevic said
One of the key strategies was twice weekly screening of asymptomatic patients, as well as additional swabs for those who developed symptoms, even after a negative swab.
“Even with all this experience and knowledge I cannot clinically exclude a COVID-19 diagnosis without doing a swab, so the lesson is if in doubt, swab. In addition, if there is a high prevalence of COVID-19, for people with symptoms who swab negative, it is a good idea to swab again.” Dr Gregorevic said.
Another challenge in caring for this patient cohort were the high rates of comorbidities and complexity of patient care.
“Most of these patients had a pre-existing diagnosis of cardiovascular disease, lung disease or dementia, which meant it could be difficult to identify new symptoms.” Dr Gregorevic said.
The setting of the wards at RPC was also identified as a factor in some of the patient and staff transmission at the time. RPC is one of the oldest of the hospital’s campuses and many patients shared rooms and bathrooms.
“Hospital wards are busy places, with many staff coming and going. Patients on aged care wards usually need assistance with activities of daily living, like getting out of bed and showering, this means that staff cannot social distance. We now know that these factors also need to be considered when we think about which wards are high-risk” Dr Gregorevic said.
Eventually, given the high rates of transmission, four wards were closed at Royal park on 2 August and patients from the affected wards were transferred to other hospitals or to the two wards at RPC with better facilities for infection control.
One of the heartbreaking parts of the RPC outbreak was the impact on families who were not able to be by their loved ones side during this time.
“A key part of end of life care is connecting the family with services and support – and giving them the opportunity to be with their loved ones, but because of the risk of infection we could only allow short visits for one or two family members and that was really difficult for patients, families and staff.”
Over the course of this outbreak, 32 patients lost their lives due to their COVID-19 diagnosis.
“Most of the patients I looked after who had COVID-19 were too unwell to tell me about their lives, but what I did know was how much their families loved them,
“When I spoke to adult children, wives and husbands, nieces and nephews, I could tell how deeply they connected to the person lying sick in hospital. I knew one of the most important things about them, which was how much love they had helped create in their lifetime,” Dr Gregorevic said.”
While the hospital and Victoria navigated through an incredibly difficult time, research such as this provides an opportunity to reflect on what happened at the time, and how we can improve patient care and prevent future outbreaks.
“It was incredibly distressing working through this, but seeing the level of care, empathy and support from my colleagues during this really difficult period was amazing, I have a lot of hope for the future with the roll-out of the vaccine and knowing what we do now that we could navigate another outbreak in a different way,” Dr Gregorevic said.
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