By Vivienne Clarke
Emergency medicine consultant Dr Fergal Hickey has said that having coronavirus patients in an emergency department is similar to “bringing a drum of petrol to a house fire.”
It comes as public health authorities are “working rapidly” to identify contacts of patients who are being treated for coronavirus in University Hospital Limerick.
Dr Hickey told RTÉ radio’s Today with Séan O’Rourke show that it is worrying to consider the impact of the virus on emergency departments “where, at the best of times, there is not enough space.”
“It is completely inappropriate for a patient who is feeling unwell to turn up at emergency departments wanting to be tested.”
That is dangerous and unhelpful, “these people are getting in the way,” he added.
Commenting on the case at Cork University Hospital (CUH) where a case of community transmission of Covid-19 was confirmed, Dr Hickey said he understood that the patient had presented with pneumonia and had been in the emergency department for an extended period of time before they were diagnosed.
All the staff and other patients who were in the emergency department during that time were all “potentially at risk”.
“We’re going to have to worry about the impact on emergency departments, where, at the best of times there is not enough space.”
With regard to the reported 60 staff at CUH who have been instructed to self isolate because they came in contact with the patient, Dr Hickey pointed out that they were specialist staff and it would be difficult to find replacement staff.
“These are specialist clinicians, they have an expertise that you cannot just get from somewhere else. It would be like putting someone into an operating theatre and expecting them to know what to do.”
Dr Hickey said that information and advice so far from the HSE and National Public Health Emergency Team was “perfect” and the process of consideration and treatment algorithms were of the highest order.
However, Dr Hickey warned that any changes will pose a major challenge as hospitals “do not have the capacity to isolate from the front door” and with many patients it will not be obvious that they do not have the virus until tested.
He said he did not want to mix coronavirus patients with vulnerable patients.
At UHL, four patients have been put into isolation bays and are being monitored by staff who must wear gowns, gloves, and eye goggles, as part of protocols to help prevent further spread of the virus.
A joint statement released by the UL Hospitals Group, HSE MidWest Community Healthcare, and HSE Public Health MidWest, which did not identify the four patients with Covid-19, confirmed that the Emergency Department at UHL was closed off last Wednesday to allow for a deep clean, and patients were diverted to other hospitals.
The ED was closed to allow for a deep clean after the patients tested positive for the virus on Wednesday.
A joint statement released this morning read: “UL Hospitals Group and HSE MidWest Community Healthcare can confirm they are working closely with public health colleagues in tracing contacts of four confirmed cases of COVID-19 (novel coronavirus). These patients are currently isolated in hospital and receiving appropriate care.”
“The cases were confirmed on March 4th and public health are now working rapidly to identify any contacts this small cluster may have had in the days prior to this positive result.”
“This work will be completed as quickly as possible.”
“Public health colleagues are in the process of informing the relevant contacts and advising on any relevant follow-up actions that may be necessary to protect their own health, that of their families and the community at large.”
The contacts include patients who attended Zone A (minor injuries) of the Emergency Department in UHL between the hours of 10am and 2pm on Wednesday last, February 26.
These patients “are being contacted directly”.
“Patients in any other area of the Emergency Department or the wider hospital are not considered to be contacts.”
Useful information
- The HSE have developed an information pack on how to protect yourself and others from coronavirus. Read it here
- Anyone with symptoms of coronavirus who has been in close contact with a confirmed case in the last 14 days should isolate themselves from other people - this means going into a different, well-ventilated room alone, with a phone; phone their GP, or emergency department - if this is not possible, phone 112 or 999 and in a medical emergency (if you have severe symptoms) phone 112 or 999
“Patients who attended a small number of other health services are also being contacted by public health in line with procedure.”
“We can confirm that the Emergency Department was put off call for a three-hour period on Wednesday night to facilitate a precautionary deep clean of affected areas. Patients arriving by ambulance were diverted to Galway University Hospitals during this interval in line with established national protocols.”
“Staff who were in close contact with one of the confirmed cases have been advised not to report for duty and to follow the guidance of public health and occupational health colleagues.”
“Staff at UL Hospitals Group and in HSE Community Healthcare have been preparing for positive cases of COVID-19 for a number of weeks now and are closely following the plans established by the HSE and the Department of Health and in line with the WHO and ECDC guidance.”
The mid west health authorities added: “We remain in the containment phase in relation to COVID -19 and as long as this remains the case, it is important that members of the public follow the most up-to-date advice from the HSE.”
“General advice and information on COVID-19 for members of the public is available on www.hse.ie\coronavirus and the vast majority of people in the MidWest can access all the relevant information here.”
The Emergency Department at University Hospital Limerick is operating as normal today.
- Additional reporting by David Raleigh
