Covid-19 Bulletin: Friday 13 March 2020
March 13, 2020
The Trust is now publishing a daily bulletin. This will take all guidance and information and tell you which changes we are implementing when and how. Please use this bulletin and daily cascade arrangements within clinical groups to guide local action. Remember KINDNESS is our watchword in implementing these changes.
- Tonight and tomorrow we are separating some wards and our A&E flows.
In order to safely treat all our patients, we have temporarily cancelled non-urgent routine surgical procedures that require inpatient beds. From Tuesday most outpatient clinics will be telephone only. Plans are in place to scale up our acute medical units and critical care. We are also separating patients with suspected COVID-19 in our AMUs and EDs.
At City, AMU 1 will be used for patients with suspected COVID-19 and AMU 2 for all other patients with expansion into D25. AMAA moves to the Medical Infusion Suite which will be relocated to Rowley Regis Hospital. ITU has expansion capacity at D16.
At Sandwell, AMU A bays F and G will be kept for patients with no COVID-19 symptoms with expansion into Lyndon 2 for patients who don’t need monitors. ITU can expand into the now vacated OPAU.
Surgical patients on L3 are today moving to L2, and L3 will next week become the general surgical ward allowing SDU to endeavour to continue its current function.
2. Changes to COVID-19 testing
In line with national guidelines there will be no further testing in the community. Testing is now only for inpatients regardless of travel history if they present with
- Either clinical or radiological evidence of pneumonia
- Acute respiratory distress syndrome
- Influenza like illness (fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing)
Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised.
3. Isolation protocol and PPE requirements
A clear protocol is in place for isolation of patients and the PPE requirements for attending to our patients. The attached document gives the full detail. You must read this to ensure you know what to do. It may differ from prior guidance you have seen. It covers:
- Isolation in a HBNO4 side room or side room with en-suite facilities for COVID-19 confirmed cases
- Cohort isolation in a bay for suspected COVID-19 patients (who fit the case definition and have been swabbed)
- Cohort isolation or side room for patients in contact (adjacent beds) to COVID-19 positive patient
If capacity prevents such patients being managed as outlined, this must be highlighted to the site team.
4. Changes to services including visiting hours
Tomorrow at midday our visiting arrangements (on all sites) change to protect patients, relatives and staff. There is no visiting apart from immediate next of kin who can remain with children, end of life patients and people who can’t make decisions for themselves (only for people covered in their notes as needing support because of mental capacity act regulations).
We have put digital phones and tablets in place in our ward areas so that patients can telephone or video call their family and friends. We hope this will help them stay in touch and reduce social isolation. PLEASE NOTE THAT THE EQUIPMENT SHOULD BE THOROUGHLY WIPED WITH CLINELL WIPES BETWEEN EACH USE.
5. Updated guidelines for staff
As you are aware, the guidelines for self-isolation have changed and this applies to staff as well as the public. People are advised to stay at home (self-isolate) without any testing for COVID-19, regardless of travel history or contact with confirmed cases, if they have:
- A new continuous cough, OR
- High temperature (of 37.8 degrees centigrade or higher)
The geographic element of the case definition has now been removed. Travel and contact history are no longer important for diagnosis, which is on the basis of symptoms alone. If people who have travelled do not have symptoms they do not need to stay at home, regardless of their travel history.
Individuals should stay at home (self-isolate) for 7 days from the onset of symptoms following the current advice. If someone has serious symptoms they cannot manage at home they should use NHS 111 online (people should only call NHS111 if they cannot get online).
After 7 days of self-isolation, people who feel better and no longer have a high temperature can return to their normal routine. This includes back to work in a healthcare setting. If they have not had any signs of improvement after 7 days and have not already sought medical advice, they should use NHS111 online (people should only call NHS111 if they cannot get online) before they leave their home or let visitors in. The cough may persist for several weeks in some people, despite the coronavirus infection having cleared. A persistent cough alone does not mean someone must continue to stay at home for more than 7 days.
Staff who have been in contact with a confirmed COVID-19 case are able to carry on working if they are asymptomatic. They should self-isolate for 7 days if they have symptoms. The questions and answers for staff are attached.