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Care home outbreaks of Covid-like illnesses highest for a month

Outbreaks of Covid-like illnesses in care homes are at their highest levels in a month, data from Public Health England show.

In the week from July 13 to 19 there were 145 outbreaks of ‘acute respiratory infections’ in homes around the country, up from 128 the week before.

An outbreak constitutes two or more people having the same symptoms, such as coughing, wheezing or difficulty breathing.

Not all of the outbreaks are confirmed coronavirus cases because the category includes any types of infections that cause coughing and infections in the airways. But many are likely to be down to Covid-19 because it isn’t flu season.   

There were only 243 breakouts reported overall in that week, meaning that the care home incidents make up 60 per cent of the country’s total figure.   

Outbreaks in care homes are concerning because the elderly are most at risk of dying if they catch coronavirus, and thousands of home residents have died in coronavirus outbreaks in the past four months. 

Of all deaths involving Covid-19 registered up to July 10, 63.5 per cent occurred in hospital and a whopping 29.7 per cent happened in care homes. 

While the remainder occurred in private homes (4.6 per cent) and hospices (1.4 per cent).   

Care homes have seen the highest number of Covid-like illnesses for a month, according to data from Public Health England

Some care homes have allowed relatives to visit in a drive-through setup but none have been able to let family members inside the homes for fear they would carry Covid-19 in with them (Pictured: Residents receiving outdoor visits at a home in Banbury, Oxfordshire)

Some care homes have allowed relatives to visit in a drive-through setup but none have been able to let family members inside the homes for fear they would carry Covid-19 in with them (Pictured: Residents receiving outdoor visits at a home in Banbury, Oxfordshire)

The Office for National Statistics is working with the Care Quality Commission and Public Health England to better understand deaths that are occurring in care homes. 

Care homes haven’t seen such a high number of similar incidents since June 15-21, where there were 176 outbreaks. 

Numbers dropped every week in the three weeks after that but saw a spike in the week ending July 19.  

The high figures come amid fears that the Government’s decision to reopen care homes may be too hasty as they house the people who are most vulnerable to coronavirus.   

Health Secretary Matt Hancock gave care homes the green light to start arranging visits on Wednesday, as long as social distancing and protective equipment rules are followed. 

RAPID COVID-19 TEST TO BE TRIALLED IN LONDON CARE HOMES

New Covid-19 swab tests that give a diagnosis in under an hour are being trialled in London care homes. 

Queen Mary University researcherswill give the tests to up to 2,000 staff and residents in 50 care homes.

They want to see how effective rapid daily Covid-19 testing is at reducing rates of infection, hospitalisation and deaths in the sector. 

At the moment, outbreak control in homes and communities is hindered by limitations in testing. 

It can take days to swab a person suspected of having COVID-19, send the sample to a laboratory and receive the results.

The rapid PCR based testing system in this trial has been developed in the UK by Novacyt, and uses the Covid-19 PCR test already in use in NHS laboratories.

Residents, staff and visitors in 25 care homes will receive daily testing on the rapid testing machines which each have the capacity to process up to 100 samples a day. 

Meanwhile the other 25 care homes will receive the standard central laboratory testing once a week to serve as a control group to compare the results to.

The trial team comprises researchers, medical students and laboratory experts from Queen Mary and Novacyt, who are also using a new and more convenient simple nose swab for daily testing, instead of the more common and invasive nasopharyngeal swab which involve throbbing deep at the back of the throat.

Professor Jo Martin from Queen Mary University of London who is leading the study said: ‘This work has the potential to bring a new rapid COVID-19 testing system to those at highest risk, and help interrupt community transmission.

‘If found to be successful in care homes, it could be very useful in a wide range of settings, helping to make a quick diagnosis and keep an environment free of COVID-19.

‘With rapid daily testing, we can report back to the care home on the same day, so that they can take action to reduce transmission in their care home and prevent outbreaks into the wider community. By undertaking this study in the diverse East London community, we’re hoping to protect one of the most vulnerable groups in the UK, and the frontline staff who are caring for them.’

Henry Black, chief finance officer, NHS North East London Commissioning Alliance said: ‘Working with our partners in East London we are at the forefront of detecting COVID-19 infections. Rapid testing is essential if we are to reduce transmission of the disease in social care settings.

‘The testing equipment is also portable enough to be used in community situations and we believe it will be a valuable tool in tackling any local outbreaks.’

Each resident will only be allowed a single nominated visitor, who can visit regularly as long as they book in advance and wear a mask and extra PPE if required.

The move finally brings England in line with Scotland, Wales and Northern Ireland, where care home visits have been allowed for weeks. 

Local councils and public health officials in England will decide on a case-by-case basis which homes will be able to reopen, depending on levels of coronavirus in the area.

Charities and care providers said the move has been ‘long overdue’ and the lack of contact with families may have already caused irreparable harm to the mental and physical health of frail residents. 

Mr Hancock said: ‘I know how painful it has been for those in care homes not being able to receive visits from their loved ones throughout this period.

‘We are now able to carefully and safely allow visits to care homes, which will be based on local knowledge and circumstances for each care home.

‘It is really important that we don’t undo all of the hard work of care homes over the last few months while ensuring families and friends can be safely reunited so we have put in place guidance that protects everyone.’  

Local public health officials will decide whether visiting should be allowed at homes in their community, in a sign the government is moving away from its top-down approach to the crisis.

Visitors will need to wear a face covering and wash their hands thoroughly before and after putting it on and taking it off.

They will be asked to give up their contact information so they can be tracked down by NHS Test and Trace if someone tests positive in the home.  

If there is a pick-up in community transmission then some visitors may need to wear extra PPE, including gloves and aprons. 

Providers will decide whether visits should take place in a communal garden or outdoor area, where the fresh air and heat make it hard for the virus to spread. 

It is expected care homes will tentatively start relaxing visiting rules, with family members of residents nearing the end of their life taking priority.  

Charities have said the restriction on family visits has had ‘damaging consequences’ on the mental and physical health of residents with dementia.

Care homes in Wales that are virus-free have been allowing visits from relatives since June 1. Scotland followed suit on July 3, while Northern Ireland allowed visitors into its homes on July 13.

All three nations are still only allowing one single nominated visitor, which limits the number of potentially infected people bringing the disease into he homes. 

Lisa Lenton, chair of Care Providers Alliance, said the measures had been ‘long overdue’ in England.

She added: ‘The impact of the Covid-19 pandemic has taken its toll in many ways. The effect of not being able to see friends and family has been very difficult and very upsetting for many – both for the people who access care and support, and for their loved ones who have been isolated.  

‘The Care Provider Alliance welcomes this overdue guidance – the CPA has been calling for Government guidance for many weeks and released its own visitors protocol last month in its absence.

‘People need people and this is such an important step for the wellbeing of individuals and their relatives.’ 

A LACK OF TESTING AND INADEQUATE PPE SUPPLIES: HOW CARE HOMES HAVE BEEN AN ‘AFTERTHOUGHT’ IN THE PANDEMIC  

The government has faced a barrage of criticism for failing to protect care homes from the virus, from a lack of testing to inadequate supplies of PPE.

LACK OF TESTING

Official testing policy in care homes during the peak of the outbreak was to only swab a small sample in the home — until mass testing became available in April.

If positive cases were found, the home was assumed to have an outbreak and other residents with similar symptoms were classified as having coronavirus.

Ministers finally caved into pressure last week and announced staff and residents in care homes will be tested every month for coronavirus.

Experts believe one of the reasons why the infection spread early is because of asymptomatic staff who were unaware they had the virus but weren’t spotted because they were not being tested.

Staff with tell-tale symptoms may well have self-isolated but they may have been replaced by asymptomatic ‘bank’ employees who worked at more than one location. 

INADEQUATE PPE SUPPLIES

A damning National Audit Office report last month revealed ministers had ignored warnings to stockpile essential PPE in June 2019.

Health chiefs only supplied a fifth of the gowns, a third of the eye protectors and half of the aprons that government advisers recommended.

Care home bosses were still struggling to source PPE in May, well after the brunt of the pandemic had passed.

One provider even added a £6.47-a-day surcharge on top of £4,000 monthly fees to pay for masks, gowns and gloves for staff.

And one home in Wales was forced to warn in April that staff may have to resort to wearing bin bags unless they could urgently source PPE.

INFECTED PATIENTS DISCHARGED FROM HOSPITALS INTO HOMES

The NAO report also claimed around 25,000 hospital patients were discharged into care homes during the peak of the pandemic without all being tested for Covid-19.

Critics said the move, ordered to free up beds for an anticipated surge in seriously ill virus patients, was ‘extraordinary’ and showed care homes were an ‘afterthought’.

Hospitals may have broken the law by sending patients with Covid-19 back to care homes without telling their managers they had the virus, it was revealed in May.

The Care Quality Commission (CQC) was told that several hospitals returned people despite suspecting – or even knowing – they were infected.

Staff at the care homes would have not realised they had the virus so may not have been wearing adequate protective clothing or taken other infection control precautions.

NHS bosses are furious to have been criticised for discharging infected patients into care homes. 

Among the reasons why care homes were so badly hit by coronavirus are:  

  • At least 25,000 people were discharged from hospitals into care homes without being tested for the coronavirus in March and April, which bosses say triggered outbreaks;
  • The Department of Health did not supply adequate personal protective equipment (PPE) for care staff, according to managers who accused senior officials of overseeing ‘shambolic’, ‘haphazard’ and ‘paltry’ attempts to provide it;
  • Routine testing for people living in care homes was not available throughout March and April and only small samples of people living in homes could get tests if there was a suspected outbreak;
  • Department of Health did not publicly count the numbers of people dying of Covid-19 in care homes until April 29, by which time there had been more than 3,500 fatalities. Many victims are still uncounted because they never got tested;
  • Public Health England’s advice that care homes were not at risk of Covid-19 outbreaks remained in place until March, by which time thousands of people nationwide were infected after the virus came into the country in people returning from February half-term trips to Europe.

Care home bosses were still struggling to source PPE in May, well after the brunt of the pandemic had passed.

One provider even added a £6.47-a-day surcharge on top of £4,000 monthly fees to pay for masks, gowns and gloves for staff. 

And one home in Wales was forced to warn in April that staff may have to resort to wearing bin bags unless they could urgently source PPE.

The report also claimed around 25,000 hospital patients were discharged into care homes during the peak of the pandemic without all being tested for Covid-19.

Critics said the move, ordered to free up beds for an anticipated surge in seriously ill virus patients, was ‘extraordinary’ and showed care homes were an ‘afterthought’.

Mr Johnson’s comments sparked immediate backlash last night, with Vic Rayner, of the National Care Forum, rejecting the criticism and urging the Prime Minister to start ‘turning the dial up on reform and down on blame’.

She added: ‘Mr Johnson’s comments in relation to care homes’ following of procedures are neither accurate nor welcome.

The Independent Care Group’s chairman Mike Padgham said: ‘We should not be getting into the blame game and it is wrong to criticise care and nursing homes at this time.’

He added: ‘Care providers may not have got everything perfect but neither has the Government.

‘For much of this pandemic, providers were operating in the dark over what they ought to do and with one arm behind their backs in terms of the support they were given. In those circumstances, they have worked miracles.’

No 10 last night tried to calm the row, saying Mr Johnson had not been criticising care homes but had merely been highlighting the difficulties they faced.

‘Throughout this crisis care homes have done a brilliant job under very difficult circumstances,’ a spokesman said.

‘The PM was pointing out that nobody knew what the correct procedures were because the extent of asymptomatic transmission was not known at the time.’

It comes after damning figures last week revealed a care home resident died every minute in England and Wales at the peak of the Covid-19 crisis in mid-April. 

WHAT WENT WRONG FOR CARE HOMES? A TIMELINE OF FAILINGS

FEBRUARY – SAGE scientists warned Government ‘very early on’ about the risk to care homes

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

He said: ‘So very early on we looked at a number of topics, we looked at nosocomial infection very early on, that’s the spread in hospitals, and we flagged that as something that the NHS needed to think about. 

‘We flagged the fact that we thought care homes would be an important area to look at, and we flagged things like vaccine development and so on. So we try to take a longer term view of things as well as dealing with the urgent and immediate areas.’

The SAGE committee  met for the first time on January 22, suggesting ‘very early on’ in its discussions was likely the end of January or the beginning of February. 

MARCH – Hospital patients discharged to homes without tests

In March and April at least 25,000 people were discharged from NHS hospitals into care homes without getting tested for coronavirus, a report by the National Audit Office found.

This move came at the peak of the outbreak and has been blamed for ‘seeding’ Covid-19 outbreaks in the homes which later became impossible to control.

NHS England issued an order to its hospitals to free up as many beds as they could, and later sent out joint guidance with the Department of Health saying that patients did not need to be tested beforehand. 

Chair of the public accounts committee and a Labour MP in London, Meg Hillier, said: ‘Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences.’ 

MARCH – Public Health England advice still did not raise alarm about care home risk and allowed visits

An early key error in the handling of the crisis, social care consultant Melanie Henwood told the Mail on Sunday, was advice issued by Public Health England (PHE) on February 25 that it remained ‘very unlikely’ people in care homes would become infected as there was ‘currently no transmission of Covid-19 in the UK’.

Yet a fortnight earlier the UK Government’s Scientific Pandemic Influenza Modelling committee had concluded: ‘It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.’

On March 13, PHE advice for care homes changed ‘asking no one to visit who has suspected Covid-19 or is generally unwell’ – but visits were still allowed.

Three days later, Mr Johnson said: ‘Absolutely, we don’t want to see people unnecessarily visiting care homes.’

MARCH/APRIL – Testing not readily available to care home residents

In March and April coronavirus swab tests – to see who currently has the disease – were rationed and not available to all care home residents suspected of having Covid-19.

Government policy dictated that a sample of residents would be tested if one showed symptoms, then an outbreak would be declared and anyone else with symptoms presumed to be infected without a test.

The Department of Health has been in control of who gets Covid-19 tests and when, based on UK testing capacity. 

MARCH/APRIL – Bosses warned homes didn’t have enough PPE 

Care home bosses were furious in March and April – now known to have been the peak of the UK’s epidemic – that their staff didn’t have enough access to personal protective equipment such as gloves, masks and aprons.

A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’. 

Adass said it was facing ‘confusion’ and additional work as a result of mixed messaging put out by the Government.

It said the situation around PPE, which was by then mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.

A shortage of PPE has been a consistent issue from staff in care homes since the pandemic began, and the union Unison revealed at the beginning of May that it had already received 3,600 reports about inadequate access to PPE from workers in the sector.

APRIL – Care home deaths left out of official fatality count

The Department of Health refused to include people who had died outside of hospitals in its official daily death count until April 29, three weeks after deaths had peaked in the UK. 

It started to include the ‘all settings’ measure from that date and added on 3,811 previously uncounted Covid-19 deaths on the first day.

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