Hospital staff are not required to be tested for Covid-19, but that policy could change, according to the top doctor at Bermuda Hospitals Board.Michael Richmond, Chief of Staff at the BHB, said yesterday that employees were encouraged to get tested at the screening facility at Southside, but added that it was voluntary and that there was no record available of how many have been tested.The BHB has close to 800 medical staff. Testing is mandatory only for those who have symptoms of Covid-19 or have been potentially exposed to the virus.Dr Richmond was responding to questions from The Royal Gazette. His comments came after Kim Wilson, the Minister of Health, told a press conference on Wednesday that she did not know if the BHB required its staff to be tested or how many had been tested because it was beyond her “remit”.The board revealed on April 29 that four hospital staff had been found to be positive for the novel coronavirus. It is understood that no more positive cases in staff have been identified since.All patients have been tested on admission to the hospital since April 1.Dr Richmond said: “How best to protect staff and identify a staff member who might have Covid-19 who is asymptomatic or pre-symptomatic early is a topic hospitals around the world are grappling with.“We all worry that someone who does not know they are sick may be working. There is still a lot we are learning and we will continue to revise our processes as new evidence comes to light.”He said that, at present, staff who have been potentially exposed to Covid-19 or who start to experience symptoms must contact the BHB’s Employee Health Services for assessment. “The EHS team carry out the initial assessment and recommendation on quarantine or testing,” Dr Richmond explained.“This process is based on epidemiological science to focus testing and contact tracing on people with higher risks of infection, so action can be taken quickly and effectively. “BHB uses this testing as a tool to help in the identification and control of a potential Covid-19 infection, but it is not the only tool, as testing is not a perfect diagnostic tool. BHB would count a Covid-19 case with a clinical diagnosis by a doctor due to symptoms.”He added: “We encourage all of our staff, if they choose voluntarily, to get tested at the Southside facility. We do not know the numbers of BHB staff who have got tested at Southside to date, as they book individually and results initially go to their GP.”Dr Richmond said a test provided only a “snapshot in time from the test and is not perfectly sensitive”. He said: “We have to always be concerned that a true negative test result one day could become positive within a week due to a subsequent exposure or within hours or days because a patient is too early in the infection to shed enough virus for a positive test. Timing is everything when it comes to testing.“Within care environments, whatever the testing schedule, the focus must remain on wearing appropriate personal protective equipment and adhering to infection-control guidelines rigorously.”Dr Richmond said infection-control standards for all patients, not just Covid-19 patients, were the “best safeguard against in-hospital infections on a day-to-day basis and this will help minimise transmission in the event a staff member becomes infected or infectious after they are tested”.He said the BHB looked to the Centres for Disease Control and Prevention, the World Health Organisation, the Pan American Health Organisation and Public Health England on PPE and infection-control standards. He added: “For staff testing programmes, we use not only these international bodies and research, but speak to our clinical associates and partners. We recognise a lot is changing, so we remain open to updating testing practices.”Ms Wilson was asked last Wednesday about the BHB’s testing policy for staff.She said: “The BHB has their own monitoring and protocols, with respect to Covid-19 testing and which staff members test, etc, and they are also, as part of those protocols, allowing their staff to get the test at the Southside, so there are a number. I wouldn’t know how many because it is part of their protocol and, whether or not they require every person to be tested, that information is beyond my remit as well. “But they do have established protocols at BHB with respect to testing.”The Bermuda Hospitals Board Act 1970 gives the Minister of Health power to give “general directions” as to the policy to be followed by the BHB if it appears necessary to the minister to be in the public interest.The Ministry of Health has required staff and residents at the island’s 21 care homes to be tested for Covid-19. Screening was due to be completed at the weekend. As of Friday, there were 44 positive cases in five separate homes, including Matilda Smith Williams Seniors Residence in Devonshire and Westmeath Residential and Nursing Home in Pembroke. The three most recent cases, announced by Ms Wilson on Wednesday, were still under investigation.One resident at Matilda Smith Williams and two at Westmeath have died of Covid-19.The BHB, which has several continuing care units with vulnerable residents, including seniors, has yet to respond to questions posed last week on whether all staff and residents in those units have been tested.The Gazette asked the health minister last night if, pursuant to Section 24 of the BHB Act — which allows the minister to give direction to the BHB — she considered giving a directive to the BHB to have all its staff tested, plus all staff and residents at the continuing care units. And if not, is this because it is not deemed necessary by her public health advisers, including the Chief Medical Officer?She responded: “The Government will provide a full response during Monday’s press conference.”