Some BC hospital patients left vulnerable without COVID, flu tests

After spending two weeks at Victoria General Hospital for a chronic health condition, Sue Ferguson’s husband Andy came home on Nov. 13. A week later, he was back at the hospital.

According to Ferguson, Andy came down with respiratory illness symptoms about five days before he was discharged from the hospital—but hospital staff dismissed it as a cold.

“Everybody's got colds...and so they just treated it like a cold and didn't test him,” Ferguson said.

A few days after Andy got home, his wife started to feel sick as well. Rapid tests confirmed their hunch: the couple had COVID-19.

Ferguson believes her husband picked up the virus at the hospital, where he had stayed in a bed in the hallway for two weeks.

“If you're putting people in hallways because you have no room, and you're not testing patients to see if they have COVID and treating them appropriately, then how could it not get out of control?” she said.

Last week, public health officials told Capital Daily that all patients who go to the hospital with respiratory illness symptoms are tested, using a multiplex PCR test, to determine whether they have COVID-19, influenza, respiratory syncytial virus (RSV), or something else. But that claim was widely disputed by frontline healthcare workers.

Island Health shared a different response in a statement, days after the article disputing the province’s claims was published.

“Testing of patients to determine source of illness is based on clinical judgement and, in general, is done in situations where identifying a specific cause of illness is necessary to inform treatment and medical intervention,” the health authority said in an email.

“Island Health has increased laboratory surveillance for emerging respiratory illnesses and patients presenting to emergency departments with significant respiratory symptoms are more likely to be swabbed for COVID-19, influenza and RSV.”

Ferguson called her doctor the day she and her husband found out they had COVID-19 by testing themselves at home. Right away, the doctor started her on a course of Paxlovid—antiviral pills for COVID-19 that need to be administered within five days of a patient first developing symptoms—and she has almost fully recovered.

By the time the couple confirmed their diagnosis, though, it was too late for her husband to get the treatment, and he still has serious symptoms of the virus.

On Saturday, Ferguson had to call an ambulance for her husband, whose existing chronic conditions, she said, were exacerbated by COVID-19.

“He's a type one diabetic and he vomited so hard, it put him into ketoacidosis—it’s a very serious condition for diabetics,” Ferguson said. “COVID is not the primary, but the COVID pushed his other symptoms over the top…if you take out one block in a Jenga tower, everything collapses, and that is basically what happened with my husband.”

‍ No tests, even when advised

Given the conflicting answers from Island Health and the province, the guidance around who gets tested is patchy, at best.

According to Dr. Jeff Unger, an emergency physician in Victoria, only those who are at risk of serious illness are administered an all-encompassing PCR test. On the mainland, pediatric heart surgeon Dr. Sanjiv Gandhi said the criteria for testing also includes a patient having been admitted to hospital.

Ferguson’s husband fit both of those guidelines, but still was not tested for the illness he acquired at the hospital before he was discharged.

Dr. Susan Kuo, a family physician in Richmond, said she has referred several children to hospitals in the Lower Mainland in the past few weeks and advised that they get a PCR test done, but at hospitals, families were told a test was not necessary. A few of those families consented to Dr. Kuo talking publicly about their cases.

In one case, an immunocompromised 10-year-old who had a fever for four days was refused a PCR test at an urgent care facility. In another, a three-year-old with respiratory illness symptoms was denied a test at BC Children’s Hospital, and their mom was told to come back in a few more days.

“They said to her, ‘Your child's only had a fever for five days. That's not good enough to get a PCR test,’” Dr. Kuo said. She said the advice was to give the toddler Tylenol and go back to the hospital in four days if symptoms did not subside.

The next day, Dr. Kuo saw a two-year-old who’d had a high fever for five days. She suspected the child had RSV, based on her own experience listening to children’s breathing regularly over her 30-year career as a family physician. This time, she referred the family to Lions Gate hospital and advised they get a PCR test there—once again, the family was refused a test.

In all three cases, Dr. Kuo got back the same vague report from the hospitals: the child had a viral infection.

“PCR testing is very important because this is the test that tells us whether the child has COVID, influenza, or RSV,” Dr. Kuo said. “So if it's influenza, we actually have a medication called Tamiflu, and we can give Tamiflu even to small babies, and it can be a lifesaver because influenza can still kill.”

In Victoria, like on the mainland, this respiratory illness season is causing widespread sickness among children.

Absences in schools are on the rise. The pediatric ICU at Victoria General Hospital was so full one night last week that any new patients would have had to be sent to the BC Children’s Hospital in Vancouver. And a clinical pharmacist at Royal Jubilee Hospital, who requested to remain unnamed because they fear repercussions for speaking out, said parents are desperately seeking children’s Tylenol and Motrin due to a Canada-wide manufacturer shortage.

Among adults, the pharmacist said more patients are contracting respiratory illnesses during their hospital stays, even if they were admitted for other reasons. Dr. Jeff Unger has seen the same trend among patients who were tested during their stay.

Ferguson’s husband falls into this category of hospital-acquired illness, even though he was not tested for it.

For her part, Ferguson said she and her husband would have self-isolated if they had known he had COVID-19 when he returned from the hospital, even though provincial rules no longer require self-isolation as of last week.

“We're in a senior community [in Langford] and I do a coffee club on Tuesday mornings, and I had 15 women in there with me the day before I started getting symptoms,” Ferguson said. “I just get frustrated because this is a management issue…and to tell the public that they're testing is just an absolute fallacy.”

In response to Capital Daily’s questions this week, the BC health ministry completely revised their original position on the guidance for testing. Now, their response is more in line with what frontline healthcare workers have said.

“Not all patients who present at hospital will be tested for respiratory illness…that is a clinical decision,” the ministry said in an email.

The ministry also indicated that they do not know what percentage of hospital patients are tested, adding that this question is “best directed to clinicians who are caring for patients.”

Given these uncertainties, it remains unclear how the province knows which type of illness is more prevalent this season—information they claimed to have when the provincial health officer presented a breakdown last week.