Coronavirus UK: Care home deaths NOT inevitable, report says

Vanessa Chalmers

Coronavirus deaths in care homes are not inevitable, a report has warned amid fears the killer virus has claimed the lives of thousands of Britain’s most vulnerable. 

Researchers at the London School of Economics have highlighted exactly where the UK has fallen short of protecting some 400,000 care home residents and staff. 

More than 5,000 care home residents have died from COVID-19. Official data shows care home deaths account for more than a third of all fatalities. 

The LSE report claimed Number 10 has followed a ‘reactive’ response to the COVID-19 crisis, rather than preventing the outbreak from the outset. 

In contrast, Hong Kong – which took action to prevent a crisis early on – has recorded no official deaths in care homes.

In some cases, swab tests have been limited to six residents with symptoms per care home, forcing staff to make assumptions on who may have the killer infection.

Carers are allowed to continue working even if they have had contact with a positive case, while in Germany a 14-day self isolation period is compulsory. 

In South Korea, where total and care home deaths have been relatively low, regular temperature checks are taken of residents. A fever is one of the tell-tale symptoms. 

Similarly in Hong Kong, residents are self-isolating even if there is no outbreak and must wear a face mask if they leave their room.  

But Adelina Comas-Herrera, an author of the report, said she expects half of the UK’s deaths to have taken place in care homes up until now.

This would suggest the UK’s true death toll is in the region of 50,000, with most of the deaths included in the official toll of 28,000 being in hospitals. 

The pattern has been reported in Spain and Italy, where governments were slow to act and were underprepared for the pandemic with low levels of PPE.

More than 4,000 care home residents in England and Wales have died during the pandemic up until April 17, official data shows, 19 per cent of the total on that date. This compares to Germany’s 2,401. A third of its total deaths have been in care homes, but that includes prisons and other community settings. Adelina Comas-Herrera, an author of the report, said she expects half of the UK’s deaths to have taken place in care homes, suggesting the true death toll could be in the region of 50,0000

Carers are allowed to continue working even if they have had contact with a positive case Pictured: Careworker Fabiana Connors visits client Jack Hornsby at his home during the coronavirus pandemic on May 3, 2020 in Elstree, England

There have been large numbers of deaths in care homes in Italy, Spain, the UK and the US but official data for these countries is either incomplete or difficult to interpret, LSE say. Pictured: A care home in France

Ms Comas-Herrera, a PhD student in the Department of Health Policy at the London School of Economics and Political Science, has been gathering resources worldwide to create LTCcovid.

LTCcovid (Long-Term Care responses to COVID-19) will document the impact of COVID-19 in care settings over the course of the pandemic.

Its most recent report said: ‘While it is early to come to firm conclusions and there are many difficulties with data, these differences suggest that having large numbers of deaths as result of COVID-19 is not inevitable and that appropriate measures to prevent and control infections in care homes can save lives.’ 

LTCcovid collection of information finds that countries that appear to have had relative success in preventing COVID-19 entering care homes have very strict processes to isolate and test all care home residents and staff.

They don’t just focus on those who have symptoms, but anyone who may have had contact with people who have tested positive for COVID-19. 

At least in the UK, timely and systematic testing of care home residents and staff has been lacking. 

It has come to light that testing was initially done on the first five symptomatic residents, meaning potentially several more would have gone untested. 

Testing capacity has been and is still very limited since the start, so priorities lie with people in hospitals and NHS workers. 

HOW HAVE DIFFERENT COUNTRIES CONTROLLED COVID-19 IN CARE HOMES? 

 UK

Admission to care homes, including from hospital, are as normal. But residents are tested prior to admission.If patients show suspected COVID-19 symptoms, they should be isolated in their room. If there are two or more suspected cases, public health officials should be notified. It has come to light that testing was initially done on the first five symptomatic residents. This has been accelerated to include all symptomatic residents.Residents and staff isolation guidance continues to be based on symptoms, not on potential contact with people with COVID-19.Care home should implement daily monitoring for COVID19 symptoms among residents. Care home staff who come into contact with a COVID-19 resident while not wearing PPE can remain at work, but individual risk assessments should be conducted.

Germany

If there is a confirmed COVID-19 case, all residents and staff must be tested, sometimes repeatedly such as in Hamburg.Strict self-isolation rules for staff who have had face-to-face contact with confirmed cases. When a patient is discharged from hospital after having two negative COVID-19 tests, they must isolate for two weeks, have no symptoms for at least 48 hours.In Lower Saxony, patients discharged must go to rehabilitation hospitals to receive short-term care. Some states have frozen new admissions to care homes entirely. Some states ban visitors while others still allow adults who are close relatives. All staff who have direct contact with vulnerable people must cover their noses and mouths to protect patients, even if the person does not have symptoms.The Robert Koch Institute, the public health institute in Germany (RKI), recommends daily documentation of health of residents and staff. The Government raised care workers’ wages on April 23. 

Hong Kong

All residents must stay in their room whether or not there is an outbreak. They must wear a surgical face mask if they have to leave, it was reported on March 27.Families have only been allowed to visit on compassionate grounds since March 27.Staff who have been overseas are subject to compulsory quarantine for 14 days.

South Korea

Started restricting visitors on March 7.Regular temperature checks.Anyone who needs to isolate must go to quarantine facilities such as the Human Resources Development Institute.Exclusion of workers who had recently been to China or other risky countries.All staff were provided with PPE on March 27.

Italy

Many Regions banned new admissions to nursing homes. When this was not the case, nursing homes managers themselves opted for the freezing of new admission if isolation was not possible.Suspended visits on March 9 until May 4. Three weeks at the start of the outbreak had no restrictions.Shortage of PPE supplies in care homes. Workers have not been sufficiently protected and nursing home providers are buying their own PPE.Nursing homes are following their own initiatives of checking residents’ symptoms regularly because formal guidelines have been implemented.Testing needs to be allowed by Local Health Authorities in a case by case basis. Some Nursing Homes are starting buying testing services on their own.

Spain

‘Mass purchasing’ of PPE to try and protect workers.Use of adapted hotels and other facilities as quarantine and rehabilitation facilities following hospital discharge.New guidance issued on 24th March extends isolation measures for residents and staff who are asymptomatic but may have been in contact with positive cases. But many care homes report that if they adhered to this they would need to send all staff home.Recruitment of staff by relaxing accreditation requirements 

US

Guidance for testing long term residents was issued on April 27 by the CDC.Restricted visitors from March 13.Isolation of residents varies by state. Some states, including Connecticut, Massachusetts, Oregon, and Indiana are also creating new COVID-only skilled nursing facilities in underused homes. But the proposal to move residents testing positive to new locations has largely been abandoned because of an outcry from the public.Rapid response teams ready to reach out and assess nursing homes as the fight outbreaks – but this is reportedly an ad-hoc basis.Nursing homes are eligible to receive accelerated Medicare Payments. Some private firms are giving bonuses.On the April 30, the federal government announced it will begin sending a seven-day supply of personal protective equipment (PPE) to over 15,400 nursing homes. Until this point it has been priority access 

Source: LTCcovid

Care homes have to decide who to isolate based on assumptions of who has the illness, leaving others to mingle with each other while following social distancing rules. 

But ‘there is also growing evidence of asymptomatic transmission in care homes, which highlights the importance of regular testing in care homes instead of relying on symptoms to identify people with potential COVID-19 infections’, Ms Comas-Herreras writes.

‘Geriatricians are also raising concerns that, among care home residents, the symptoms of COVID-19 may not be the typical cough and fever that is covered in the guidance documents for care homes in many countries, but that a range of other symptoms (such as delirium, diarrhoea, lethargy, falls and reduced appetite) are more frequent among care home residents with COVID-19.’

Current guidelines in the UK only require the isolation of residents and staff who are symptomatic. Similar guidelines were in place in Spain until the 24th of March.

But the World Health Organization’s guidelines insist on isolation of residents and staff who are suspected to have COVID-19. 

The Government has been slated for its lack of support to nursing homes, with no routine testing available, no up-to-date records of the number of people infected or dead, and ‘paltry’ attempts to deliver adequate protective clothing for staff. 

The South Korean approach has been robust, albeit potentially distressing for care home residents.

Any resident that displays symptoms of COVID-19 enter quarantine facilities such as the Human Resources Development Institute and the English Learning Campus, both in Seoul. 

Care workers clean their room and the resident can only return once they have tested negative after a two-week isolation period. 

Authorities acted fast to prevent outbreaks if there were a spike in cases in the community.

In Gyungsang-do, the region with the second highest recorded rate of COVID-19 cases in South Korea, 564 care homes were quarantined to prevent the virus entering the home, local media report.

Staff were stopped from leaving the facility for two weeks with financial incentives to keep them going.   

Ms Comas-Herrera said Germany was ‘an outlier’ in Europe owing to its proactive stance on testing and stricter guidelines on discharging elderly patients from hospital, The Times reports.   

States across Germany have reacted differently to control infection in care homes, with measures ranging from quarantining COVID-19 patients at separate facilities to compulsory wearing of face masks by staff when entering residents’ rooms. 

Meanwhile the Italian government acted late on the COVID-19 outbreak management in nursing homes, restricting visitations after the lockdown when thousands were already infected in the population.  

It’s difficult to compare death rates of COVID-19 in care homes because there are differences in how deaths are recorded, how data is published and testing. 

There have been large numbers of deaths in care homes in Italy, Spain, the UK and the US but official data for these countries is either incomplete or difficult to interpret, LSE say. 

The percentage of COVID-related deaths – suspected or confirmed – among care home residents ranges from 19 per cent in the UK to 62 per cent in Canada, where care homes have been hard hit.

The lower total deaths a country has, the lower the care home deaths tends to be.  For example in Singapore, two per cent of its 18 deaths have been in care homes.

There have been no infections or deaths in care homes in Hong Kong – only four deaths in total and 1,040 cases of infections in the total population.  

Singapore, where there are 18,700 cases, there has been relative success at preventing infection from reaching care homes, LTC Covid report.

Data for Germany suggests that 36 per cent of deaths would have happened in communal establishments. This includes care homes, prisons and other group living settings. 

The Office for National Statistics (ONS) provides weekly updates of deaths registered in England and Wales. 

But there is a delay in reporting because the ONS figures are slower to prepare. They have to be certified by a doctor, registered and processed. 

The most recent report said there were 22,351 deaths registered in England and Wales involving COVID-19 up until April 17.

Three quarters (75 per cent) occurred in hospitals, 19 per cent (4,168) in care homes and five per cent (1,083) in private homes.  

Deaths in the week April 11-17 were double the five year average, according to an ONS analysis showed.  

National Records of Scotland (NRS) publishes a weekly analysis of death registrations which mention COVID-19 on the death certificate.

Of the 2,272 deaths that occurred in all settings up until April 26, 886 COVID-19 deaths occurred in care homes – a rate of 39 per cent. 

Ms Comas-Herrera said she believes care home deaths account for half the total death toll. 

That would suggest the UK’s total of 28,000 – which is hospital deaths plus around 2,000 of care home deaths reported – is in fact in the region of 50,000.

Thousands of care home deaths are reported weeks after they occur, according to ONS data. 

Experts fear that because of this, the sheer scale of the problem in UK homes is misunderstood.

The UK’s total fatalities has reached 28,446. The Government added deaths outside hospital, such as in care homes, in their tallies only until April 30

Last week, Sir David Spiegelhalter, a highly regarded statistics expert and an OBE recipient, said he believes the numbers of care home deaths are still climbing as Government statistics show hospital fatalities are trailing off.

HIDDEN EPIDEMIC OF CORONAVIRUS IN CARE HOMES MAY HAVE KILLED THOUSANDS ALREADY, EXPERTS WARN 

A ‘hidden epidemic’ of coronavirus in care homes may have already cost  more than 4,000 lives, experts warned earlier this month. 

They believe deaths are being hugely under-reported because of a lack of testing.

GPs may also have been reluctant to write COVID-19 on death certificates in the outbreak’s early stages and figures from care homes are not included in the official daily toll. 

By the time official sources had confirmed 217 care homes deaths, up to April 3, industry figures were saying the true count was much higher – potentially 4,000 between that date and the start of the outbreak. 

Campaigners and MPs warned of an ‘unfolding horror’ that could end up with tens of thousands of forgotten victims. 

Ministers faced urgent calls to get a grip and get virus tests for all staff and residents with symptoms, more protection gear and a Cabinet minister to deal with the crisis.   

Care home operators complained they were being overlooked, left desperate by shortages of testing and staff safety equipment, which made it difficult to stop the disease.

He spoke of a ‘massive, unprecedented spikes’ in the number of people dying in nursing homes.

Care Quality Commission (CQC) reports suggest care homes are now seeing around 400 coronavirus deaths each day, on average – a number on par with hospitals in England.

Government ministers, pressured on claims they didn’t do enough to help care homes, insist they were ‘not overlooked’ while they scrambled to protect the NHS from collapsing.   

While warnings about hospitals sparked a ‘protect the NHS’ mantra and a rush to buy ventilators and free up beds, nursing homes saw no such efforts. 

Britain’s chief scientific adviser, Sir Patrick Vallance, revealed he and other senior scientists warned politicians ‘very early on’ about the risk COVID-19 posed to care homes.

The Scientific Advisory Group for Emergencies (SAGE) has been meeting approximately twice a week since its first coronavirus discussion on January 22.

Sir Patrick, who chairs the group along with Professor Chris Whitty, said they had ‘flagged’ the risk of care home and hospital outbreaks at the start of the epidemic. 

Environment Secretary George Eustice said on April 29 ‘we have always recognised there was more vulnerability there’. He denied that more testing would have saved lives. 

The number of residents dying of any cause has almost tripled in a month, from around 2,500 per week in March to 7,300 in a single week in April – more than 2,000 of the latter were confirmed COVID-19 cases.

Vanessa Chalmers


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