What have other countries taught us about COVID-19 in care homes?

By freelance social care writer Eleanore Robinson

“There are many lessons that the Government must learn”, was the conclusion of a scathing report from the House of Commons Public Accounts Committee published in July into the impact of the Covid-19 pandemic on care homes.

The report concludes: “Rather than seeking to give the impression that it has done so, the Government urgently needs to reflect, acknowledge its mistakes, and learn from them as well as from what has worked.”

To do this, the UK Government would need to look at the nations that took decisive and early action to keep their care home residents safe.

According to the report Mortality associated with COVID-19 outbreaks in care homes: early international evidence, at the end of June 5.3 per cent of UK care home residents had died from the virus or a related cause.

This compared to 0.4 per cent in Germany and no deaths at all in Hong Kong.

Adelina Comas-Herrera, assistant professorial research fellow at the Care Policy and Evaluation Centre and one of the report’s authors said that countries that had gone into lockdown very quickly in the full community appeared to have many fewer deaths from Covid-19 in care homes.

Those countries that understood that care homes could not act as isolation centres and those with a wide community testing programme to identify local hotspots also halted the spread, she said.

Arguably the biggest mistake the UK Government made was directing hospitals to discharge 25,000 patients into care homes without ensuring all were first tested for Covid-19, even after there was clear evidence of asymptomatic transmission of the virus.

Not admitting infected patients was critical to halting the spread in Germany’s care homes. Germany imposed a strict lockdown for four weeks in April with care homes not allowed to admit anyone who was not employed there and everyone wearing masks as well as full body cover by the end of March.

Any resident being admitted had to provide a negative test result or isolate for 14 days, either in a separate section of the care home or in healthcare facilities such as a rehab centre.

Isabell Halletz, CEO of the German Employers’ Association of Care Providers, told the House of Commons health select committee in May: “If it is in the residential home… it is very hard to stop the virus. When you detect it, it is already too late, so you have to do a lot of prevention to keep it out.”

An even stricter approach was taken in Hong Kong with care home residents showing symptoms sent to hospital and anyone they have come into contact with isolating for 14 days. The Government also require that one member of care home staff, usually a nurse, is trained to handle infection control. Nursing home operators in Hong Kong also carry out an annual drill for infectious disease control.

Professor Terry Lum, head of social care policy at Hong Kong University, told the committee: “It is extremely well practised in nursing homes. When anybody shows a flu-like symptom, they start the process right away.”

Halletz agreed, saying it was “very crucial and helpful to have pandemic planning” so everyone knew who was doing what and who to report to.

Professor Lum added that in Hong Kong, nursing homes are now designating a specific area solely for family visits. Before visitors can enter a nursing home, they must have their body temperature checked, follow strict protocol for hand sanitizer, and both relatives and residents need to wear face masks when meeting each other.

However, measures adopted by some UK care homes, such as staff staying onsite for up to two weeks and then being replaced with a new “shift” of tested workers, have been effective, according to Comas-Herrera.

Giving evidence to the committee she added: “We have not finished with Covid. It will still be around us for a while, so it is important that each care home now starts having good technical support for their isolation capabilities. By capabilities, I mean the fabric of the building, the facilities they have and the staff.”

A Department of Health and Social Care spokesperson said: “We keep our policies under continuous review based on the emerging international and domestic evidence.

“Our help has meant 55 per cent of England’s care homes have had no outbreak at all and the proportion of coronavirus deaths in care homes is lower in England than many other European countries.”

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