Intended for healthcare professionals


Covid-19: Reinstate routine testing in hospitals to protect vulnerable patients, say charities

BMJ 2023; 383 doi: (Published 11 October 2023) Cite this as: BMJ 2023;383:p2363
  1. Elisabeth Mahase
  1. The BMJ

Charities representing vulnerable patients have called on the UK government to boost covid precautions in hospitals, such as routine covid testing in clinical settings and asking staff to wear masks if patients feel at risk.

Latest data show that the number of people testing positive for SARS-CoV-2 in England increased by 29% in the week to 4 October, from 11 513 to 14 856. There has also been a 25% rise in patients being admitted to hospital with covid, from 3060 to 3819 in the week to 29 September.1

At the same time the number of PCR tests for covid that have taken place in England dropped by 15% in the seven days to 3 October, from 38 352 to 32 806. PCR testing is no longer available to the public free of charge through the NHS, but patients may be tested before having surgery or if they have to stay in hospital for a number of days.

Staff told not to test

PCR testing in hospitals for asymptomatic staff and patients was scrapped last summer,2 and current government guidance states that most healthcare staff with symptoms of a respiratory infection do not need to test for covid-19.3

One trust has been telling staff not to test themselves for SARS-CoV-2, even with lateral flow tests, as it could mean them taking more time off work than they need to. In an email seen by The BMJ, staff at Shropshire Community Health NHS Trust were told, “The Infection Prevention Control (IPC) team have been receiving many reports of staff testing positive for Covid. In line with national guidance, staff should NOT be taking lateral flow device [tests].”

The email added that “testing for covid can result in having to remain at home for longer than their symptoms persist” and that staff should instead “respond to their own symptoms and stay at home if they feel unwell.”

The instruction not to self-test for SARS-CoV-2 has raised concerns among clinicians and researchers. Stephen Griffin, professor of cancer virology at the University of Leeds, said, “‘Short sighted’ doesn’t even begin to describe my outrage at this callous approach to staff and patient safety.”

Clair Hobbs, the Shropshire trust’s director of nursing, clinical delivery, and workforce, has apologised for the communication and told The BMJ that the trust “prioritises the wellbeing and safety” of its patients and staff.

She said that, while lateral flow tests “accurately highlight if a person is infected with covid-19, they do not identify cold or flu infections which pose a risk for patient groups under our care.” As such, staff should follow a “risk based approach to sickness absence” to protect patients and their colleagues. The trust has said that it will reissue the communication to make that message clearer.

Immunocompromised people

Charities have said that it is time for policies to change. Laura Challinor, senior policy and public affairs manager at Blood Cancer UK, told The BMJ, “As we go into the autumn with covid-19 cases rising and the uncertainty of a new variant, routine testing in healthcare settings should now be reinstated to monitor and mitigate the risk of covid-19 for people with weakened immune systems.”

Fiona Loud, policy director at Kidney Care UK, has said that regular mask wearing should also return. “We support a call for clear guidance on protecting people who are immunocompromised in healthcare settings. This should include regular testing and wearing masks, but we appreciate that every setting will have different circumstances,” she said.

Loud added that Kidney Care UK “supports a call for asymptomatic testing for those working with people who are vulnerable” and that policy makers should now be providing hospitals with updated, evidence based guidance to help them review their covid prevention and protection policies.

Dan Scorer, head of policy for Mencap, made similar calls. “Covid is once again on the rise,” he said. “We hope government and healthcare providers will respond positively and work to reduce risks to patients and staff with clear national guidance on wearing of masks within healthcare settings.”

Henny Braund, chief executive of the Anthony Nolan charity, has called on the government to go a step further by installing a “dedicated lead for people who are immunocompromised, to prioritise clear support for those most at risk from being left behind.”

The BMJ contacted the Department of Health and Social Care but had received no response at the time of publication.

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