New Haven Register (New Haven, CT)
HOSPITAL NOT FREE FROM VIRUS SPREAD
After two people who later tested positive passed virus to patients they had visited, Yale New Haven brought back visitation restrictions
NEW HAVEN — With COVID-19 increasing throughout Connecticut, Yale New Haven Hospital reverted to its restrictive visitor policy, but not before two visitors without symptoms passed the disease on to the patients they were visiting, officials said.
However, according to hospital officials, the chance of a patient or staff member contracting the disease is extremely low.
The incident, which occurred in the oncology unit at the end of October, was one of “a few different clusters of infections and some outbreaks in different areas” of the hospital, according to Dr. Richard Martinello, medical director for infection prevention for Yale New Haven Health.
“It’s obviously something that we take seriously, but in a pandemic this is what we would expect to happen,” he said.
All admitted patients, as well as outpatients undergoing procedures such as an endoscopy or one involving anesthesia, are tested, according to Martinello and Dr. Thomas Balcezak, chief clinical officer for the health system.
When the pandemic hit, the only visitors allowed were for women giving birth, children and people with special needs.
“It’s obviously something that we take seriously, but in a pandemic this is what we would expect to happen.” Dr. Richard Martinello, medical director for infection prevention for Yale New Haven Health
During the summer and fall, when the visitation policy was relaxed, visitors were screened.
“We wouldn’t allow a visitor if they had signs or symptoms of COVID,” Martinello said, “even if it’s an end- of-life issue.”
The problem is that some visitors who have symptoms do not reveal them or, more commonly, someone without symptoms will actually be positive for the coronavirus, Martinello said.
That was the case in oncology. “They had reached out to the hospital [after the visit] and told us that they were positive,” Martinello said. “Each of the two patients had contracted it. … Those two patients did become positive. The spread did not appear to go any further than that” based on contract tracing.
He did not know whether the visitors later showed symptoms of COVID.
“Just a few days after this we did change our policy on visitation,” Martinello said. That change limiting visitors with rare exceptions was made Nov. 10.
Dr. Elizabeth Prsic, director of adult inpatient palliative care and firm chief for operations and quality in medical oncology, said of the COVID spread incident, “I think the takeaway is there have been cases of positive visitors that were subsequently found to be positive. That put our particularly high-risk, vulnerable and highly immune-compromised patients at risk.”
Prsic signed a petition addressed to Gov. Ned Lamont asking that he suspend indoor dining and close gyms in order to keep the number of cases of COVID-19 down and not overwhelm the health care system.
“Last surge, it was more coming from isolated locations that were traceable, and now it’s out in the community,” said Prsic, who was glad when the visitation restrictions were brought back.
Balcezak said another cluster occurred in a general medicine unit. Through contact tracing, 300 to 400 people were tested and “a handful of staff” were found to be positive, he said. “The majority of the spread is community spread,” he said, not infections transmitted from patients who were admitted with COVID.
Martinello said that, in May, 5 percent of admitted patients were testing positive, so the hospital tested 13,000 of its 28,000 employees.
“Among those 13,000 we found about 30 people were positive,” a rate of 0.22 percent, he said.
Some had had mild symptoms, such as a headache, mild cough or sore throat, and didn’t realize they had COVID.
“What we wanted to check and determine was whether we had a high proportion of our staff who were positive,” Martinello said.
What they found was the rate was close to the rate of false positives. The testing stopped because “with such a low rate of positives, it’s possible that upwards of 50 percent of our staff who were found to be positive were actually false positive,” he said.
“We have concluded that the risk of acquiring COVID in the hospital is less than the risk of acquiring COVID in virtually any public setting,” Balcezak said. While limiting visitors was difficult because “there’s a lot of pressure on us from patients and families to allow visitors … it’s really based on the incidence of the disease [among] the public,” he said.
Among the inpatients who are tested, “We have seen a small percentage of these patients who are first found to be negative and then a few days into their hospitalization they’re found to be positive,” Martinello said.
That number is about
0.5 percent. Patients are asked to wear masks when medical staff are in the vicinity.
“The important thing here is we still require everybody to do their part to help prevent the spread of COVID,” he said. “It’s not just the possibility of transmitting COVID to our staff … but to their loved ones, themselves.”
Balcezak said about 3,500 tests are conducted each day at the hospital, including staff who travel to high- risk areas, such as states on Connecticut’s advisory list and those who have symptoms.
Employees are not tested unless they are symptomatic, Martinello said, even if they have been in the vicinity of a positive patient.
“When we do contact tracing, we try to identify instances where there may be a risky exposure,” he said.
When a patient is found to be positive, “we look to see what was going on with that patient and we reach out to the individual or their manager … to see what was the PPE that they were wearing,” he said. If the staff member was correctly wearing personal protective equipment — a respirator mask, eye protection, gloves and gown — then a test is not given.
“We know from our experience, the literature, the guidance from the CDC, that when our staff is wearing PPE the risk is extraordinarily low,” Martinello said.