COVID-19 Bulletin: Friday 9 July

July 9, 2021

As you can see from this week’s numbers, the number of patients with COVID-19 in our hospitals and in ICU continues to increase. We have expanded our “red” bed capacity and continue to enact our surge plan. There has been a significant rise of COVID-19 cases in the community.

We must ensure that we continue to follow the infection prevention and control guidelines – wear the correct PPE, follow the guidance for streaming patients to the right areas, wash hands and social distance.

Get tested regularly (every week) using the saliva LAMP test – details below.

Vaccination is really important and this week we have shared stories in the media of people who have not had their vaccine and became seriously unwell with COVID-19. You can walk in to the City vaccination hub if you and loved ones are not yet vaccinated.

Number not statistics: This week (last week)

1. New: Make no mistake, COVID-19 is on the rise

Whilst we are all enjoying some normality with rules and regulations around social distancing in the community soon to be relaxed, please do not be mistaken thinking that COVID-19 is no longer with us.

We are currently seeing increasing numbers of COVID-19 positive patients being admitted to our hospitals, and whilst we all wish for a prompt return to normality, we must not lower our guard and think that COVID-19 has been beaten.

In the coming weeks the COVID-19 restrictions regarding social distancing and mask wearing will be relaxed by the government. However, our current arrangements at the Trust will continue in light of the community case rate and COVID-19 in our hospitals. We must ensure we are able to continue to protect our patients, public and each other. These arrangements will remain in place in line with national guidelines for the NHS.

We all need to continue to be careful so please make sure you do the following:

• You should continue to follow the COVID infection protection rules, even with colleagues you work alongside regularly in your wards and departments. There is no such thing as a ‘work bubble’. The virus can still spread between colleagues, so it is important to wear a mask and maintain social distancing when on breaks and outside of work
• You can still spread the virus to others, even if you have been vaccinated
• Make sure you regularly complete your weekly COVID-19 saliva test (LAMP)
• If you see something, say something – it is ok to gently remind colleagues, patients, and visitors to make space, fix or change their PPE, or observe other measures appropriate to your setting.

We’re all in this together – it has been a challenging year and taking care of each other is important. If you need help, ask for it.

Watch this video for more information

2. New: Guidance on antibiotic use in COVID-19 infection

Antibiotics will be ineffective for treating COVID-19 infection, unless there is bacterial co-infection. Indiscriminate antibiotic use causes its own problems, including risk of Clostridioides difficile infection, antimicrobial resistance and limitations on availability of agents due to increased use.

Published evidence suggests that bacterial co-infection occurs in less than about 5% of patients admitted with COVID-19; the incidence of bacterial infection increases during prolonged hospitalisation, but even patients admitted to critical care are estimated to have relatively low rates of bacterial co-infection up to 17%.

High C-reactive protein (CRP) levels have been seen with COVID-19, this is not helpful in distinguishing between bacterial and viral infection. Chest X-ray findings in early infection may not assist in distinguishing between a viral and bacterial cause.

While not validated for COVID infection, the CURB-65 score should be used to objectively score the severity of potential infection and assign an appropriate antibiotic treatment regimen.

All antibiotics should be reviewed at 24-48 hours once COVID-19 swab results available.

Patients with confirmed COVID infection should have their antibiotics discontinued, unless there is strong evidence of bacterial infection (raised white cell count with raised CRP, signs and symptoms of a concurrent bacterial infection).

Procalcitonin levels can be used to determine if a bacterial infection is likely. Samples are sent to Dudley Group of Hospitals NHS Trust for processing, so the turnaround time is 48-72 hours after the sample has been sent.

If the procalcitonin level is less than 0.5 ng/L, then the antibiotics should be reviewed and discontinued unless there is alternative evidence of bacterial infection (e.g. positive sputum culture).

3. Update: Stick to the unplanned admissions pathway

As we begin to see increasing levels of COVID-19 positive patients within our hospitals it is absolutely essential that colleagues ensure they are sticking to the pathway for testing and streaming patients to red or amber areas.

1. Any COVID-19 symptomatic patient who has a negative PCR must move to red. We must treat based on symptoms.
2. Any patient being admitted whilst waiting on a Point of Care Test (POCT) result must go to a side room until the result is known.
3. Asymptomatic positive patients must be admitted to a red ward.

Full details can be found in the attached Unplanned Admissions Pathway.

4. Update: Regular testing for peace of mind in little time

The COVID-19 weekly saliva testing programme commonly known as LAMP is now well established across our organisation. Thank you to everyone who has taken the time to register and continue with the testing programme.

Even if you are vaccinated it is vital that you register and carry out the weekly tests. This will identify asymptomatic cases and is of particular benefit in helping to pick up positive cases that would then be sequenced to identify any variants.

If you are currently undertaking lateral flow tests for asymptomatic testing, please consider moving to LAMP testing. The tests are far more reliable, they simply require a saliva sample rather than swabbing. Any remaining lateral flow tests that are unopened should be returned to the community contact centre, Hallam Building at Sandwell or the Phlebotomy department at the Birmingham Treatment Centre.

All line managers are asked to remind colleagues to:

• Call and book a kit collection slot by calling 0121 507 2664 and selecting option 6, on weekends (Saturday – Sunday, 8am – 4pm) 07816992873 or 07970428995
• To undertake weekly testing and drop off their samples regularly each week

Guidance update:

Staff that have tested positive for COVID-19 can recommence LAMP testing after 28 days from a positive result, this replaces previous advice which was a  90 days interval before recommencing LAMP testing.

Advice for lateral flow remains the same at 90 days.

Uptake of the weekly saliva test is monitored to ensure we are doing everything we can to protect our patients, the public and each other.

The latest data by group is below:

5. Reminder: Wellbeing and recovery – support available

Many team leaders have expressed a wish to arrange some time for teams to be away from the work environment and jointly reflect on experiences. This time-out can take a range of formats, but in order to help managers, the Trust is willing to consider centrally funding reasonable costs associated with these time-outs.

This could include:

• Hire of an external venue
• Facilitator/external speaker costs
• Transport to external venue
• Refreshment costs (no alcohol)
• External team building activities
• Backfill costs.

The procurement team will help with the purchasing of supplies/items for away days and each proposal will be assessed for value for money and appropriateness.

In order for your time-out proposal to be considered for funding, and to access procurement support, please complete the form (Word) and send it to swbh.recovery@nhs.net.

If you would like some advice on speakers or content then please contact your HR Business Partner.

6. Reminder: City gym is open for business

If the sight of athletes running around a pitch has got you eager to get fit, you’ll be pleased to know the staff gym at City Hospital is now open for business.

It’s been some time since we’ve been able to feel the burn and utilise our on-site gyms but following a refurbishment to make the premises making it COVID-19 safe and compliant with Infection Control Guidance City Gym is now up and running.

Guidance for using City gym under COVID-19 restrictions:

• The NHS Track and Trace QR code must be scanned upon arrival. While we ask you do NOT scan the other Track and Trace QR codes in the hospital, the gym is a different case.
• Social distancing of two metres remains in effect: We’ve created the space you need to work out while keeping a safe distance. The gym has also been rearranged and clearly marked out for you to use safely, so it is easy for everyone to follow.
• The maximum number of users is five at any one time; this will remain in place in line with the government recommendations. Please note: The maximum gym time usage is one hour per visit, in order to allow other staff the opportunity to use the facility.
• We’ve placed more hand sanitiser dispensers  and wipes around the gym so it’s easy to regularly clean your hands and equipment during your visit. We ask that you also sanitise your hands before entering the gym to keep yourself and others safe.

For existing members: Your pass will be activated ready for use on Monday 29 June 2021.

For new members: Please contact Jatinder Sekhon on 0121 507 5586/3854 to complete your registration.

The video below is the gym induction film that colleagues should watch before they use the facility.

7. Reminder: Are you compliant with your FIT Testing?

We have recently made changes to how you arrange to get FIT tested. Previously colleagues have been asked to call ext. 5050 to arrange an appointment. It has now changed and colleagues can now access FIT testing in the following ways:

• Log onto ESR and search for ‘fit testing’ under ‘my learning’ and book an appointment to be fit tested
• FIT testing is a mandatory role specific requirement
• FIT Testing is held in the Old Security Bungalow, City Hospital

Note: If you book an appointment for FIT Testing via ESR you will only become compliant on your mandatory training if you attend the appointment.

For any urgent requests or more information please contact the infection, prevention and control team on ext. 5195.

8. Reminder: Join the community swabbing reserves

Being able to test, track and tackle community outbreak of COVID-19 is critical in our fight to prevent the virus taking hold in our communities. Our community swabbing service has led the way in responding to local community outbreaks since the very first surge, playing a vital role in our ability to understand the spread of infections and to support the community to protect itself.

This vital work can only be done with support from our staff, calling on the colleagues who have been able to be redeployed or those who are willing to offer their time on the Trust bank. This role is not restricted to clinical staff as full training is provided.

To ensure this critical work can be carried on and to support our ability to respond to outbreaks at short notice we’re calling on colleagues to take the time to put their names forward to become Community Swabbing Reservists.

To join the reserves contact Jo Tonks on email: joanne.tonks@nhs.net.