A nurse who died after contracting coronavirus had attended to a patient a few days before they had symptoms of the virus, an inquest has heard. Alexis Anne Adshead, of Gilfach Goch, died on April 23, 2020. Working as a nurse at Ty Eirin Care Home in Gilfach Goch at the time, Mrs Adshead, 58, first noticed symptoms of Covid on Thursday, April 2, 2020.
Other patients and staff at the home had presented with symptoms of coronavirus in the days leading up to when Mrs Adshead first noticed symptoms, including two residents - one of which Mrs Adshead had provided care to - and a colleague, the inquest heard.
Mrs Adshead's husband, Simon Adshead, said she developed a cough on the Thursday, which subsided a little the next day. She did not attend work the following Friday and Saturday due to her symptoms. However, on Tuesday, April 7 her condition worsened and she was taken to A&E by ambulance and given oxygen.
READ MORE: Care worker who died after catching Covid 'didn't want to let residents down'
Mrs Adshead was discharged on April 8, but returned to hospital the following day, where she developed multi-organ failure and sepsis, and was put on a ventilator. She died in the intensive care unit of Royal Glamorgan Hospital after a decision was made to put her into end-of-life care. Asthma was recorded as a contributing factor.
Dr Eleri Davies, now deputy medical director for Public Health Wales, was assistant medical director for PHW in March 2020. Dr Davies told the inquest that in March 2020 it was believed that symptom onset of coronavirus could be between 48 hours and 28 days from the time of exposure that led to infection.
The inquest heard that Mrs Adshead developed symptoms on April 2, 2020 and that one resident had become symptomatic on March 31, 2020. That resident later died from coronavirus on April 9 that year. Mrs Adshead had provided care to the patient on March 27 and would have been in "close proximity" to them, the inquest heard. When asked by the coroner if it was likely that the resident was infectious, Dr Davies said she was unable to say whether it was “more likely than not".
“It is possible, because [the resident] developed symptoms on March 31, then she could have developed the infection and infectiousness on March 27,” she said. Another resident became symptomatic on April 1 and later died of coronavirus on April 12, 2020, however, Dr Davies said she was unable to say whether the patient would have been infectious as she did not know when they acquired the infection.
A colleague became symptomatic on March 21, 2020 and the last day Mrs Adshead would have worked with them was March 18, the inquest heard. There were 16 days between possible exposure to coronavirus and the onset of Mrs Adshead’s symptoms. Dr Davies said she “could not be definitive” about whether the colleague would have been infectious.
“It’s important to note that in order for these cases to be presenting within the care home it was circulating in the community, therefore we cannot exclude community contacts and other contact outside the care home as possible sources for infection,” Dr Davies continued.
When asked about the relevance that Mr Adshead had developed coronavirus symptoms the day after his wife, Dr Davies said: “Mr Adshead may have acquired infection from Mrs Adshead.” She added: “People may acquire infection from a common source [...] they may have acquired it separately and infected each other but the direction of the timing of symptoms is difficult as that is self-reported.”
Dr Davies said some people may experience very mild symptoms. She added: “It is incredibly difficult to pinpoint exact timings and points of exposure". When asked about the extent of a common source of exposure for Mr and Mrs Adshead, given they developed symptoms 24 hours apart, Dr Davies said: “It is very difficult to say because of the self-reported nature of the symptoms, which people may not have been aware of, and people respond differently to infection. It does not mean that [with] symptoms reported in 24 hours of each other that the source would be the same. It is very difficult to pinpoint.”
The inquest heard evidence from Dr M Claire Royston, who was group medical director at Four Seasons healthcare, and the ‘responsible individual’ for Ty Eirin, overseeing its transition to Harbour Healthcare. Dr Royston said her last visit to the care home prior to the pandemic was “early March”, and that weekly meetings held as part of the administrative process included discussions about the pandemic.
When asked whether she had any concerns about the home’s preparedness to deal with the coronavirus pandemic, Dr Royston said: “No, I do not. I would also add, Ty Eirin was a large home and I had visited the home many times before all of this. My very clear recollection of Ty Eirin and of Sue [Bennett, manager of the home] and her team was that they were managers and team leaders that I had a great deal of respect for.”
She added: “It was not a home that I would have had in earlier years worried about. They managed issues of large infection well.” She added that she did not recall Ty Eirin having a problem with preparedness for coronavirus, or difficulties with supply of PPE.
The inquest heard that staff were required to wear PPE when “barrier nursing” a symptomatic resident, but not required to do so when moving around the home. When the first resident showed signs of symptoms around March 27, Ruth Roman, regional manager
for Harbour Healthcare, told that both goggles and visors were available in the home, having been supplied by the local authority. At the time, the symptomatic patient was being barrier nursed in her room.
In an inquest held into Mrs Adshead's death on Tuesday, Mr Adshead said his wife "put her residents first" and that "she wouldn’t dream of letting them down or not turning up for work". The inquest continues.
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