Just seeking a view from other hospital medics/infection control teams etc about how we might now approach suspected Covid cases in 2nd wave compared to first time round...

back in Spring we had very limited access to Covid-19 testing even for admitted patients who were pretty certain would test +ve and it was taking days for tests to turn round and back then we all got to recognise pattern of respiratory covid-19 in sick/very sick people

now, having learned more about how Covid presents and behaves, we know that there are plenty of patients who never get full on respiratory symptoms and might instead have delirium, generalised weakness/immobility, poor oral intake/nutrition, GI upset, electrolyte disturbance

but we are also able to test everyone at front door and repeat during admission (albeit we know a high first negative/false negative rate) and we also have a better idea how long people remain infectious for and how many may be asymptomatic so test +ve as chance finding

so if we have 1, 2, 3 people on say a 25-30 bed ward with possible Covid-19 but first negative test or maybe one of them is "weakly positive" perhaps only on point of care test and we have to decide on ward closure base on our own clinical estimation of how likely Covid-19 is...

then we can't just rely on what we thought of back in March/AprilMay as "typical" or obvious covid with hypoxia, lymphopaenia, cough, fever, X-ray changes, oxygen requirement, etc to say whether we think it is likely/very likely while we wait for 2nd confirmatory test

and of course when it comes to older people with frailty/multimorbidity/underlying cognitive impairment etc so so many will present with say delirium, immobility, not thriving, poor oral intake, GI upset for a whole host of non-covid reasons

if wards go back to full on "Hot" and "Cold" clinical areas that is one thing but at current levels we don't want to be closing down wards to admissions, discharges to care settings/home care, or visitors because 2 or 3 people *might* have it and cause system logjam

other hand we don't want to take chances with possible cross infection from people who have not yet tested positive.

Big dilemmas given we have the lowest bed base per 1000 people in whole OECD and close to the highest bed occupancy in pre-pandemic times
Plus elective backlog