During the first wave of the pandemic, patients who went into hospital to be treated for conditions unrelated to Covid were infected while on a non-Covid ward and then died.
Hospital-acquired infections accounted for at least one in ten Covid deaths during the first wave, according to data released to this newspaper under the Freedom of Information Act.
But rates vary widely. At the Countess of Chester Hospital in Chester, 88 out of 231 Covid-19 deaths were hospital acquired – nearly 40 per cent of all the Trust’s Covid-19 deaths. And in Bristol and Weston, of 151 Covid-19 deaths, 51 of were linked to hospital-acquired infections, a third of all Covid-19 deaths at the Trust.
Other hospitals performed far better. The Royal Free Hospital in London, one of the largest hospital trusts in the country, recorded 504 Covid-19 deaths between March and August, making it one of the worst-hit in the country. However, fewer than ten of these were hospital-acquired, they said.
During the first wave of the pandemic, patients went into hospital to be treated for conditions unrelated to Covid, were infected while on a non-Covid ward and then died (file photo)
More than 100 NHS Trusts responded to our request for data, giving the clearest picture yet of outbreaks in UK hospitals.
Although the figures relate to all deaths from Covid from March 1 to August 31, experts are calling for urgent action to protect the public as the problem is said to be ‘ongoing’.
Some say part of the blame lies with poor hospital infection control protocols and staff spreading the virus to one another, and then to patients.
Dr David Nicholl, a Birmingham-based consultant neurologist who has been studying the problem of hospital acquired Covid, called the situation ‘shameful’ and accused NHS chiefs of ‘acting like North Korea’ by obfuscating figures ‘when they should be acting like South Korea’ in reporting clearly.
‘Transparency is terribly important, the data should be in the public domain,’ he added. ‘It’s ridiculous a newspaper had to do an FOI to get this information.’ NHS England yesterday confirmed our findings.
Professor Tom Jefferson, an epidemiologist from the University of Oxford’s Centre for Evidence Based Medicine, claimed hospitals had failed to implement many basic infection control rules.
A public health insider at one hospital in the North East confirmed that patients with Covid were segregated but doctors, nurses and cleaners would move between these wards, and congregate socially.
‘Hospital transmission is not just between patients, but between staff and patients, staff and staff,’ they said.
Thelma Lukehurst, 88, believes her husband, Dick, 91, died in July after catching Covid-19 while in hospital after breaking his leg. Dick tested negative for the virus on arrival but four days later began to develop Covid symptoms and tested positive
‘On the wards, staff would be in full PPE but they’d gather around nurses’ stations, take off masks while looking through notes, or sharing computer terminals, then cram into offices after shifts, sharing snacks.
‘After a shift, the only place to change would be a staff loo or cramped unisex changing room. Or they’d wear their uniform, and even scrubs to and from work. All of these things break every rule of infection control.’
As a result, the virus has rampaged through some hospitals. A total of 139 Trusts, out of 223 in England, responded to our request, and of these 93 provided the information we asked for.
Officially, Covid diagnosed between seven and 13 days after admission is a ‘possible’ hospital infection, and after 14 days a ‘definite’ infection.
In total, the 93 Trusts reported 10,184 Covid-19 deaths in hospitals, and 1,051 possibly, or definitely caught the virus while on non-Covid wards – roughly one in ten.
That means, of the approximate 30,000 deaths recorded in NHS Trusts during the first wave, at least 3,000 could have caught coronavirus in hospital. The Trusts also reported a total of 20,000 members of staff testing positive for Covid in the six-month period, with 111,000 off work either because they had the virus or suspected of having it.
Thelma Lukehurst, 88, believes her husband, Dick, 91, died in July after catching Covid-19 while in hospital after breaking his leg. Dick tested negative for the virus on arrival but four days later began to develop Covid symptoms and tested positive.
The couple, who were married for 43 years, had been shielding for three months before Dick was admitted to William Harvey Hospital in Ashford, Kent. ‘I miss him so much,’ said Thelma. ‘Everyone was clapping for the NHS, but all I could think about is what happened to my husband.’
Covid Q&A: Can I now visit a relative in care, and what is happening in Liverpool?
What are the rules for care homes now?
New Government rules are in force to allow families in England to visit loved ones in care homes – as long it’s ‘in a Covid-secure way’. Suggestions in the guidance include floor to ceiling screens between visitors and residents, window visits and visits where the family remains in the car.
So yes, you can visit, but charities say the new advice is impractical. Julia Jones, co-founder of dementia charity John’s Campaign, said: ‘When people are in the later stages of dementia, when people love each other, when people are approaching the end of their lives, they need to hold hands.’
Will the new testing scheme in Liverpool tell us exactly who has Covid?
A pilot scheme in Liverpool is offering tests for all half a million residents. The new ‘lateral flow’ tests being used do not need to be sent to a lab and are said to provide a result in 20 minutes.
However, questions have been raised over their accuracy, as the kits can provide on-the-spot results only in people with the highest ‘viral loads’. This means it detects Covid in those with a large amount of the virus present in their nose and throat – which could exclude those who have just caught it.
According to Dr Emily Adams, a senior lecturer at Liverpool School of Tropical Medicine, the test detected the virus in about 75 per cent of cases.
That means that Liverpool residents testing negative both with a swab and a lateral flow test cannot say for certain they do not have Covid-19.
Scientists in charge of stemming hospital outbreaks say hospital-acquired cases of Covid-19 ‘were a major problem’ in the early days of the pandemic but say hospitals are ‘absolutely safe’ now.
However, reports this week show rates of hospital-acquired infections are rising again as the country hits a second wave.
NHS England did not publish data on hospital-acquired infections until September.
At present, 17 per cent of Covid-19 infections in England occurred in hospitals, and in the north west this rate is as high as 25 per cent.
Figures for individual hospitals are buried in spreadsheets on the NHS England website and not easy to find.
Dr Nicholl said he was currently receiving reports of hospital outbreaks ‘across the country’ and said radical action was needed immediately: ‘Everyone is doing their best, but that isn’t the same as doing the best.’
Prof Jefferson, part of a team tracking hospital outbreaks, said: ‘The Government has failed to learn from the mistakes of the first wave.’
The development raises the spectre of deadly superbugs MRSA and C Difficile, which spread like wildfire in hospitals in the 1990s and early 2000s, killing thousands. At first this spike was blamed on falling NHS cleaning standards but subsequent investigations found hospital staff hygiene was to blame, with many not washing their hands between treating patients.
Early on in the coronavirus crisis, NHS England directed hospitals to create ‘hot’ and ‘cold’ zones, separating Covid patients from non-Covid patients.
Staff were also separated depending on who they were treating and instructed to social distance at all times from other members of staff. But a damning report from the Healthcare Safety Investigation Branch watchdog warned staff this wasn’t happening, because they were forced to congregate in areas to use computers, access records and take breaks.
The report also said older hospitals were at a greater risk of outbreaks because of narrow corridors, small rooms and poor ventilation.
Other studies suggest moving patients between beds on wards to create space was another vector for infection.
Hospital outbreaks of coronavirus began as early as March, peaking in April in line with the infection rate across the country. It wasn’t until June that NHS England took action.
A letter, sent to all trusts on June 9 told management that minimising close contact between staff, particularly at central work stations, was ‘paramount in reducing healthcare-associated infections’. When hospital-acquired infections continued to persist, a second letter was sent on June 24, stressing staff must wear face masks at all times.
But Prof Jefferson says this was too little too late, and that lives might have been saved if more attention had been paid to infection control in hospitals.
The Care Quality Commission, the NHS regulatory board, has opened investigations into a number of trusts. One is East Kent, where Thelma Lukehurst’s husband Dick died.
Dick, a former BT engineer, fractured his femur after falling in his garden. He was taken to William Harvey hospital where he underwent an operation.
Thelma says he was in good spirits. ‘He called me after the operation. He was an engineer so he found it all really interesting.’
But doctors told Thelma her husband had to stay in hospital while his leg recovered. ‘He hated it in there. I wanted to take him out but they said he had to stay.
‘When we spoke on the phone he said: ‘At least I don’t have Covid.’ I said of course you don’t, where would you catch it from?’
Thelma says Dick’s ward was small and constantly busy, with people being moved in and out. She visited the hospital to drop off some of Dick’s things and says she was taken aback at the lack of precautions.
She said: ‘I just walked straight in. No one asked if I’d been tested. No one asked me where I was going. Lots of the staff weren’t wearing masks.’
Soon after, Dick tested positive for Covid. His breathing became laboured and soon he was too weak to hold up a phone.
Doctors told Thelma there was little they could do help him as his condition worsened. When it became clear Dick would die, doctors allowed Thelma one last visit. Her husband was too weak to speak.
Thelma returned to the hospital the next day. ‘A doctor pulled me aside and said, ‘Sorry love, he’s passed.’ All I could think was how awful his last days must’ve been. In bed, alone and unable to even move. I felt empty afterwards, but now I feel anger – at how careless the whole thing was. He must have caught it in hospital. We isolated for three months not seeing anyone, and then he goes in, and immediately catches it. Hospitals should be the one place you can be kept safe, not where you catch a deadly disease.’
Thelma wrote to the hospital in August asking them to explain what happened to her husband. It has still not responded to her.
Hospital-acquired infections accounted for at least one in ten Covid deaths during the first wave, according to data released under the Freedom of Information Act (file photo)
When The Mail on Sunday requested East Kent’s hospital-acquired infection rates, it chose to withhold the information as it would be ‘potentially misleading’ and said it would publish its own report soon.
A spokesperson said: ‘It is unlikely Mr Lukehurst acquired Covid in hospital. His inquest concluded that Covid was not a cause of death.’
In fact, the inquest into Mr Lukehurst’s death revealed he had died of acute bronchopneumonia, with Covid-19 a contributory factor. And Care Quality Commission inspectors who visited William Harvey hospital confirmed Thelma’s fears, finding a catalogue of errors.
Nurses were seen wearing face masks not fully covering their mouths and noses, staff were seen not using hand gel when entering and exiting Covid wards, and Covid patients were not masked while being moved around the hospital.
Dr Jonathan Hewitt, co-author of a Cardiff University and King’s College London study into Covid-19 hospital-acquired infections said ‘greater awareness is needed’ in staff. He said: ‘Within hospitals it is impossible to fully isolate staff from each other. But there are steps staff can take to ensure transmission is minimal.’
Dr Hewitt says staff must ensure they routinely wash their hands before dealing with patients and wear the necessary PPE.
Last week NHS Wales boss Dr Andrew Goodall announced hospital transmission rates were again rising, making up one in 40 confirmed cases there. And figures suggest a similar rise is taking place across England.
At Epsom and St Helier University Trust in Surrey and University Hospital Dorset Trust, more than 44 per cent of Covid cases recorded last week were hospital acquired, according to NHS England data. In the same week, Liverpool University Hospitals Trust, currently one of the worst Covid-hit trusts in the country, recorded a hospital-acquired infection rate of 27 per cent.
Some hospitals have taken on the fight against hospital-acquired infections.
Croydon University Hospital in South London, has set up a ‘mini-hospital’ on trust grounds to segregate patients undergoing routine treatment. Patients are also expected to quarantine for seven to 14 days and are tested three days before their operation. We visited last week, and saw the system in action. The Elective Centre, as it’s known, has its own entrance, meaning patients can stay separate from any potential Covid cases visiting the hospital.
Staff working there are not allowed to enter the main hospital, which is now reserved for Covid patients and outpatient ‘day’ clinics, for 12 hours and are regularly tested.
Prof Jefferson says it is ‘an obvious step’. ‘We could have put Covid patients in the Nightingale hospitals for example and kept all the other patients safe.’
Countess of Chester Hospital NHS Trust said: ‘To keep patients and staff safe we have rigorous infection, prevention and control measures in place, including regular swab testing, appropriate isolation and cohorting of known and suspected cases of Covid-19.’
University Hospitals Bristol and Weston NHS Trust said of our report: ‘The figures relate to patients who have died and had tested positive for Covid-19.
‘This does not mean that they passed away from Covid-19 related disease.’
The other Trusts mentioned were approached for comment, and said deaths ‘with’ Covid-19 were not always the same as deaths ‘from’ Covid-19.