It was a small scare with no one dead - so far. But it raised one of those intriguing questions about the balance of good and harm in health that remain endlessly fascinating.

It was a small scare with no one dead - so far. But it raised one of those intriguing questions about the balance of good and harm in health that remain endlessly fascinating. A gynaecologist infected with hepatitis C was thought to have passed the virus to a patient, triggering an alert that led to 2,000 women being offered tests last week. He had worked at 25 hospitals throughout England and Scotland for 23 years.

It caused hardly a ripple in the national media. But there was one puzzle about the case. A test for hepatitis C has existed since 1991. It is used to screen all blood donations for the virus. So why wasn't it used on the gynaecologist, and for all other doctors involved in surgery where just a simple scratch or pin-prick could lead to transmission?

Well, routine testing of health workers has never been introduced because there is no vaccination against the infection.

Under new guidance, students intending to take up surgery will be screened. But the decision not to test existing health workers has divided the medical establishment. Public health specialists have argued that testing is necessary to protect patients. But surgeons have protested that routine testing would lead to a serious loss to the surgical workforce. One in 200 surgeons is thought to be infected and, once identified as a carrier of hepatitis C, their career is over.

The official view, though not explicitly stated, is that the harm to patient care caused by the loss of surgeons from the workforce outweighs the harm caused by rare cases of viral transmission.

Five to 10 patients a year are estimated to contract hepatitis C from healthcare workers, and there is a tacit acceptance that this is the price we must pay to keep the NHS running. I think it is a reasonable balance, but I suspect many won't. In case it is any comfort to those who don't, the risk of dying as a result of hepatitis C is about equivalent to the risk of being killed by lightning.

Food for thought

Jamie Oliver did it for school meals - who is going to do it for hospital food? The goo that passes for sustenance in some NHS trusts is ripe for a makeover. The Hospital Caterers' Association claims it has had the problem cracked since the NHS called Lloyd Grossman in six years before Jamie Oliver made his debut in the school canteen. Perhaps Lloyd Grossman's early efforts were a bit too fancy, but now that that hiccup has been overcome, standards have risen, it claims.

Still, in the latest survey of patients 67 hospitals were rated "poor" and seven were "unacceptable". Still a way to go, then.

As the chair of the association said last week, hospital catering is about more than the quality of the food on the plate. "It is no good to anyone unless it actually gets into the mouths and stomachs of patients."

Which means not delivering it while they are in X-ray and removing it before they come back.

Deadly outbreak

From a small scare to a big one - but which has also garnered little coverage. The strain of Marburg virus currently cutting a swath through the population of Angola is possibly the most lethal organism ever to have appeared on the planet. More than 230 people have died since last October in the northern Uige province.

The death-rate is more than 90 per cent, and the disease kills within a fortnight. This is nearly 10 times the death rate from Severe Acute Respiratory Syndrome (Sars) - which killed 774 people worldwide in 2003, less than one in 10 of those infected. Even smallpox, widely regarded as fearsome disease, kills only 30 per cent of those infected.

Previous outbreaks of Marburg virus, while lethal, have had lower death rates - around 80 per cent in the Congo in 1998 and 25 per cent in the initial outbreak in 1967, according to the World Health Organisation. The Lancet reports speculation that this version of the virus is a more deadly, recombinant, strain - in which case deaths may yet rise further. It must be very frightening for the citizens of Uige province - all the more so because their plight has received so little attention.

j.laurance@independent.co.uk

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