COVID-19 resources on infection control
Learning from the impacts of COVID-19 on care homes: a pilot survey
International Long-term Care Policy Network
Findings of an anonymous online pilot survey of care home managers and directors across England, surveyed between May 15th and June 1st to understand the challenges care homes faced during the COVID-19 pandemic, what strategies they used to mitigate them and what they would need in future to strengthen their response. The survey covered four key themes, including partnership working, infection control, workforce and wellbeing of residents. Care home providers described marked differences in the support offered to them by local government and NHS organisations. While many had received supportive offers from local authorities, NHS Clinical CCGs and the CQC, this was not universal, and many received conflicting advice from different organisations, often sensing that their NHS colleagues were sometimes unable to identify with the daily challenges in care homes. Three quarters of managers and directors expressed concerns about staff wellbeing and reported how staff shortages had increased pressures on care staff, leading at times to an unavoidable reliance on agency staff. Residents had been impacted adversely by the prolonged absence of their loved ones, with reports of residents experiencing resulting deterioration in mood from 84% of managers and of reduced oral intake from 30%. Despite these challenges, it was clear that some providers had gone to great lengths to implement stringent infection control measures such as enhanced cleaning and restructuring or rearranging their homes to facilitate appropriate segregation of residents. Others closed to visitors and required facemasks in all communal areas before these were formally advised. Measures were also taken in many homes to support staff, while local communities and relatives also helped by providing food and Personal Protective Equipment (PPE) and letters of support. Yet the pandemic has revealed clearly a deep divide between health and social care that must urgently be addressed.
International evidence on care home COVID-19 outbreak responses: summary of key findings
This note summarises emerging evidence on COVID-19 outbreak responses in care homes, obtained from a "living" systematic review that focused on COVID-19 mortality and spread of disease in long-term care more broadly (Salcher-Konrad & al. (2020). COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence). The review found that outbreaks in long-term care settings varied widely in terms of the number of people affected, and that evidence on the reasons behind this variation is still emerging. It identifies four measures that may have worked in containing COVID-19 outbreaks in care homes: early detection and rapid response after detection of index case; systematic testing of all residents and staff – high prevalence of asymptomatic and presymptomatic cases that would not be detected by a) symptoms screening, and b) one-off testing (if infection has already spread beyond index case); moving high-risk contacts of cases out of the facility; and isolating cases by removing them from the facility or creating separate wards within the facility.
Detrimental effects of confinement and isolation on the cognitive and psychological health of people living with dementia during COVID-19: emerging evidence
This report contains a short review of the emerging evidence on the impact of COVID-19 on the cognitive and psychological health of people living with dementia and the reported mitigating measures. Three papers describing the effects of lockdown on people with dementia living in the community show a worsening of functional independence and cognitive symptoms during the first month of lockdown (31% of people surveyed) and also exacerbated agitation, apathy and depression (54%), along with the deterioration of health status (40%) and increased used of antipsychotics or related drugs (7%). People with frontotemporal dementia (FTD) and their family caregivers seem to be particularly struggling to comply with protective measures. Only 2 case studies reporting strategies to support people with dementia in care homes have been produced so far. One describes a quarantine care plan for a person with FTD and the other, a mitigating strategy to ease the distress experienced by a man when his family stopped visiting during the pandemic. People living with dementia in care homes have experienced a particularly harsh version of lockdown – the ban on visits from spouses and partners in care is believed to be causing a significant deterioration in the health and wellbeing of residents with dementia. It is worth noting that a study involving 26 care homes proved that it is possible to implement successful infection control measures at the same time that visits are permitted. Learnings from this first COVID-19 wave can help the home care and day care sector prepare to minimise the disruption of their services in future waves so support can continue for people with dementia in the community. In care homes, evidence-based compassionate protocols should contribute to mitigating the detrimental effects of isolation and quarantine in residents with dementia (and their families).
Mitigating the impact of the COVID-19 outbreak: a review of international measures to support community-based care
This report provides a brief overview of the policy responses and practice measures used internationally to respond to the impact of COVID-19 on the provision of community-based care. The data provided is largely collected from the country reports on the COVID-19 long-term care situation, including Australia, Austria, Brazil, China, England, Germany, Hong Kong, Ireland, Israel, Italy, Netherlands, Slovenia, South Korea, and the United States. Key findings include: community-based care faces unique challenges during the COVID-19 pandemic compared to other parts of the long-term care continuum; several countries have taken steps to prevent the spread of COVID-19 infections in community-based care including the closure of adult day centres and other service providers; continuity of care is of upmost importance – a disruption of care and support could have serious negative impacts on individual health and well-being due to increased risk of loneliness and social isolation; the dispersed nature of community based care suggests that direct governmental action and oversight may be more difficult to provide than for residential care settings such as care homes or nursing facilities; efforts to maintain continuity of care in community-based care include government financial support to home care workers; recruitment of volunteers and family members to act as paid carers; and the provision of remote psychological supports to home care workers; some countries have taken steps to move patients and home care workers to residential care settings; few countries are specifically reporting data on infections and deaths among users of home care – an exception to this is Australia; overall evidence of national measures to support community-based care is still lacking for most countries.
Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic
This is a pre-print article (not yet peer-reviewed). The researchers carried out a rapid review of evidence to address three questions: What is the evidence on the impact of visitors in terms of infections in care homes? What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents? and What has been the impact of restricting visits on quality of care? Findings: the review found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions. The review also found that there is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans. In addition, there is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff. Conclusions: Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections. Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning. In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.
Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK
Journal of Interprofessional Care
The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.
Discharges from NHSScotland hospitals to care homes between 1 March and 31 May 2020
Public Health Scotland
This publication presents management information statistics on people aged 18 and over who were discharged from an NHS Scotland hospital to a care home between 1 March and 31 May 2020. The first section of this report describes the methods used to identify the 5,204 discharges of 4,807 adults to care homes and describes their characteristics and COVID-19 testing status during their hospital admission. The second section focuses on the adult care homes that individuals were discharged to. It describes laboratory-confirmed care home outbreaks of COVID-19 across Scotland where the first positive test occurred between 1 March and 21 June. It then examines associations between care home characteristics and COVID-19 outbreaks, including examining association between hospital discharge to care homes and outbreaks. The data shows that: 843 of the 1084 care homes received 5,191 discharges between 1 March and 31 May (13 of the discharges identified were to English care homes or the care home could not be identified); using laboratory confirmed cases, 348 (32%) of care homes experienced an outbreak of COVID-19; the percentage of care homes with an outbreak increased progressively with care home size; almost all outbreaks (336/348) occurred in care homes for older people; COVID-19 associated mortality was concentrated in its impact, more than half of COVID-19 deaths were in 64 homes and a quarter of all COVID-19 deaths were in just 25 homes; 13.5% of care homes with no discharges from hospital had an outbreak, compared to 38% of care homes with one or more discharges.
An avoidable crisis: the disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities
A report of a review into how people from Black, Asian and minority ethnic backgrounds have been impacted by Covid-19. The pandemic is having a disproportionate and devastating impact on ethnic minority communities. Not only are Black, Asian and minority ethnic people dying at a disproportionate rate, they are also overexposed to the virus and more likely to suffer the economic consequences. The report argues that, despite repeated warnings, the Government has failed to take sufficient action. Covid-19 has thrived on inequalities that have long scarred British society. Black, Asian and minority ethnic people are more likely to work in frontline or shutdown sectors which have been overexposed to Covid-19, more likely to have co-morbidities which increase the risk of serious illness and more likely to face barriers to accessing healthcare. Black, Asian and minority ethnic people have also been subject to disgraceful racism as some have sought to blame different communities for the spread of the virus. The virus has exposed the devastating impact of structural racism. The report makes both immediate and long-term recommendations to protect those most at risk and tackle structural inequalities in several key areas including the machinery of government, health, employment and in the education system.
COVID-19 and care homes: update paper, 23 September 2020
This paper reviews the latest evidence on the transmission of Covid-19 in care homes. It focuses specifically on the relative risk of each of four routes of ingress of infection to the care home (hospital discharge, staff, visitor (professional or domestic) and community admissions) as well as the route of transmission within care homes once infection has entered, for which more detailed genomic studies are critical. Key findings include: although staff-to-staff transmission has been observed to have been a contributory factor in specific outbreaks, it is important not to generalise to all outbreaks and emphasise one route over another without clear evidence – studies undertaken so far indicate that multiple introductions are common; retrospective genomic analysis and seropositive studies in care homes find evidence for multiple routes of virus ingress to care homes, but are not systematic enough to quantify the relative frequency of different routes of ingress; evidence of staff to staff transmission has emerged in the genomic analysis (high confidence); weak evidence on hospital discharge and modelling the impact of visitors does not suggest a dominant causal link to outbreaks from these sources; public health measures that reduce community incidence could be effective in reducing ingress into care homes; asymptomatic or atypically symptomatic presentation in residents and staff mean that ingress may be hidden for a number of generations of disease; sequencing community tests to understand the comparator population is critical for the future.
Rapid review for care homes in relation to Covid-19 in Wales
This rapid review aimed to ensure that the lessons from best practice are learned and shared by Local Authorities and Health Boards who were involved in working with care homes during the initial period of the Covid-19 pandemic in the spring and summer of 2020. The work for the review has included reading some research studies, reading many submitted reports by Health and Social Care leaders from Wales and a series of interviews with stakeholders including a number of Care Home managers and owners. The report includes sections summarising the context for care homes, the initial impact of the virus and the response, and the best practices that were found in helping care homes to address the pandemic. The final section draws together a set of considerations that health and social care partners could use to assist them in completing their action plans for the winter. The review highlights the importance for health and care to work in partnership with care home managers to ensure that: every care home has an effective Infection Control Plan that is put into place; every care home has an effective plan for business continuity that includes ensuring that there are staff available to meet residents' needs; every care home should be supported to ensure there are meaningful and helpful day to day activities for residents and that the wellbeing of both staff and residents are taken into account in all the decisions that are made; every care home has the right protective equipment; every care home has access to tests for residents and staff to know who may have the virus; and every care home has good access to primary health services including GPs.