Healthcare worker with problems was refused shielding
A NHS healthcare worker who died with Covid had been refused shielding status despite a history of respiratory problems, an inquest has heard.
Allan Macalalad, 44, was employed in the operating department at the University Hospital of Wales (UHW) in Cardiff when he became unwell in May 2020.
An inquest at Pontypridd Coroners’ Court heard the theatre assistant was admitted to the Royal Glamorgan Hospital in Llantrisant on May 17 complaining of a “shortness of breath”.
A CT scan at the hospital showed the father-of-one had a blood clot in his lungs and, after suffering a cardiac arrest, he died on May 26 with tests showing that he had been infected with Covid-19.
The inquest heard Mr Macalalad, who lived in Llwynypia, near Tonypandy, with his wife Elsie, a nurse, and their son Justin, had approached his GP in March 2020 with concerns about the coronavirus pandemic and his personal health history.
Mr Macalalad, who was born in the Philippines, had been diagnosed with type two non-insulin-dependent diabetes in 2011.
In August 2019 he underwent surgery for empyema after complaining of rib pain and a dry cough. Shortly after he was treated for pneumonia and a collapsed lung.
Empyema is the medical term for pockets of pus that have collected inside a body cavity. They can form if a bacterial infection is left untreated or if it fails to fully respond to treatment. It can cause fever, chest pains, breathlessness, and coughing up mucus.
Mr Macalalad made a good recovery from this surgery, however the inquest heard that in March 2020 he was increasingly anxious about how his health conditions increased his vulnerability to coronavirus.
Mr Macalalad approached his GP and voiced his concern about his role in a hospital as well as his respiratory history.
He was told he did not fulfil the relevant criteria to qualify for a shielding letter.
He also voiced concern about a cough that he had developed over previous weeks and was referred for a chest X-ray.
At the same time Mr Macalalad’s employer, Cardiff and Vale University Health Board, was conducting coronavirus vulnerability risk assessments.
In April 2020, as a result of the assessment, Mr Macalalad was moved from his post as a theatre assistant to a non patient-facing role.
In his original role, Mr Macalalad was a band two short-stay healthcare assistant on the surgical short stay theatre unit at UHW.
The inquest heard that in his usual role Mr Macalalad would often be in contact with patients, and he expressed to interim theatre manager Paul Warman in March 2020 that he felt he was “at risk”.
As a result of several risk assessments, the latest taking place on March 30, Mr Macalalad was officially transferred to a non patient-facing role to commence as of April 3.
He was initially moved to the reception on the theatre department of the children’s ward before being moved to help at the stores department.
On May 5 last year Mr Macalalad received a call from his wife, Elsie, a nurse at Ysbyty Cwm Rhondda, to say she had been sent home from work with coronavirus symptoms.
While he was asymptomatic Mr Macalalad returned home from work and self-isolated.
Two days later, on May 7, his wife tested positive for Covid-19 and Mr Macalalad developed symptoms.
On May 10 he visited the A&E department of the Royal Glamorgan Hospital after experiencing difficulty in breathing.
After a chest X-ray and an assessment he was discharged with a course of antibiotics.
Five days after receiving a positive coronavirus result on May 12 he was admitted to the Royal Glamorgan Hospital again due to difficulty in breathing.
After being admitted on May 17 the inquest heard how for the majority of his time in the hospital, his observations showed him to be stable though his recovery was fluctuating.
Mr Macalalad received treatment of continuous positive airway pressure (CPAP) via a mask but continued observations on his heart rate, oxygen levels, and temperature were considered often normal.
The results of the chest X-ray showed that small blood clots had appeared on his chest and although his condition had deteriorated slightly, written evidence by Dr Ahmed Benjamin – a consultant respiratory physician at the Royal Glamorgan Hospital – said that Mr Macalalalad was considered stable.
In the early hours of May 26 the inquest heard that two police officers arrived at the front door of Mr Macalalad’s family home having received a call from ward six to say that he had suffered a cardiac arrest.
Mr Macalalad was discovered unresponsive having suffered a cardiac arrest while wearing a CPAP mask. Despite attempts to resuscitate him over the next 50 minutes through CPR and adrenaline treatment, he was declared dead.
As part of his evidence read to the court, Dr Benjamin said that there was “no inclination a cardiac arrest was imminent” and that Mr Macalalad “had been weaned off oxygen with the view of possibly being discharged within a week or so”.
The medical cause of death recorded by Dr Benjamin was that the primary cause of death was pulmonary thromboembolism and coronavirus pneumonitis with type two diabetes as the secondary cause.
As part of written evidence Chantelle Nichols, a health and safety executive at UHW, said the likelihood of occupational exposure to the virus in the case of Mr Macalalad was not sustained.
The inquest heard that as a result of his role change there was “nothing to demonstrate” that Mr Macalalad had been a direct close contact of a coronavirus case or a known case while at work. However it was acknowledged that there is always the possibility he came into contact with staff who were asymptomatic who would not have been tested in accordance with the public health policy at the time.
Closing the inquest, coroner Graeme Hughes said the conclusion drawn that Mr Macalalad died of a pulmonary thromboembolism and coronavirus pneumonitis with type two diabetes as the secondary cause was sustained.
Mr Hughes also said that it was likely that Mr Macalalad’s previous respiratory conditions had played a part in his ability to fight the virus.
He ruled that it was unlikely that the causation of Covid infection occurred during his employment and while there was the possibility that he could have come into contact with somebody asymptomatic at work there was not enough evidence to suggest the death was industrially linked.
Mr Hughes recorded a conclusion of natural causes and offered his condolences to the family of Mr Macalalad including those in the Philippines.