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The Index Case. Dealing with Covid-19 inside our care homes

April 21st, 2020

A longstanding PBer tell his story

Regular readers of the comments on this site will know that over the weekend, my father died after contracting coronavirus in his care home.

The index case (colloquially, ‘patient zero’, but more accurately, the first documented patient in a disease outbreak within a particular population), was a patient recently discharged directly from hospital, into the care home.

In the ten days which marked the period of my father’s infection, I understand that somewhere just under half of the residents of the home, some familiar to me from visits, succumbed to the disease.

Over the previous week I had become aware that it appears to be government policy to discharge patients from hospital into care homes, seemingly irrespective of their Covid status, as referred to in a Telegraph article

Care homes cannot safely accept hospital patients suffering from coronavirus without risking the lives of residents, ministers were told on Wednesday.

Matt Hancock, the Health Secretary, said hospital patients who tested positive for Covid-19 would continue to be discharged into care homes despite growing evidence that the policy is fuelling outbreaks and deaths….

That policy was privately confirmed to me by someone who works for Public Health England, and is disgusted by the indifference shown to the safety of the vulnerable.

It ought to go without saying that it is utterly pointless isolating the most vulnerable, on whose behalf we are told we enduring the current lockdown, only then recklessly to expose them to infection. It appears to have happened without thinking.

And it is, of course, not only the residents themselves exposed to risk.
Care home staff in the middle of an outbreak are exposed to many of the same risks as health care workers in hospitals. They likely undergo this experience with considerably less specific training, or provision of specialised PPE.

The home is likely, as was the case with my father’s, to have staff absent, either infected themselves, or (quite understandably) out of fear for themselves and their families.

I have no complaints at all about the caregivers in my father’s home. All the staff working through the period were brilliant, working at considerable risk to themselves.

Like NHS workers they have been pulling twelve hour shifts, with little or no respite; one worked a full extra shift to sit with my father through his last night, for which I shall always be grateful. And like NHS workers, although accustomed to dealing with death, they have been traumatised by the experience of the last couple of weeks.

Staff have been infected themselves, which of course risks transmitting infection back into the community.

That is my personal experience, which while sad, one might argue is mere unfortunate anecdote. However, the figures recently reported suggest that this is far from an isolated case, see here and here.

They suggest the possibility of half as many deaths from coronavirus as have been reported in hospitals have happened in care homes across the country. There have been many tedious and repetitive questions asked of the Health Secretary at the regular press briefings. At none of them I can recall has he been asked “in how many care homes with Covid outbreaks, has the index case been a patient recently discharged from hospital ?”

It would be a pertinent question to ask, and I would be interested in the answer. There are, however, questions of far greater significance to all of us.

The testing and control of elderly and vulnerable patients discharged from hospital ought to be a relatively simple task compared to what will face the authorities once we come out of lockdown.

That involves a relatively small number of people, all of whom are by definition identified in advance as either infected, or potentially infected individuals. That they are to be moved back into confined communities of similarly elderly and vulnerable individuals ought to make assessment of their status via testing (and then potential temporary quarantining) a high priority.

For a Secretary of State not just to fail in this task, but to fail to recognise it as a task at all, gives me little or no confidence that he is up to the match larger task of ensuring the safety of the entire population as we come out of lockdown, whenever that might be.

It’s probable that there will be no real end to our current predicament until an effective vaccine is available for a large proportion of the population. Large scale antibody testing would be useful, but for now there is no sign of our having such a program ready.

In the meantime, we must manage as best we can. If we are to be Germany or South Korea, rather than a rerun of what we went through prior to the lockdown, then an effective track and trace program, coupled with plans to isolate and quarantine the newly infected, seems essential to control the disease and prevent another large scale outbreak.

Without that, we will almost certainly be forced into a second lockdown before this year is out, with the painful repetition of the crushing economic effects of the first.

Is the current team up to the task ?

NigelB

NigelB is a longstanding poster on PB and this is his debut piece.