COVID-19 resources

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Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: a retrospective observational study

Lancet

Background: People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of COVID-19-related outcomes in older inpatients in psychiatric units, who comprise people from these high-risk groups. This study aimed to describe the period prevalence, demographics, symptoms (and asymptomatic cases), management, and survival outcomes of COVID-19 in the older inpatient psychiatric population and people with young-onset dementia in five National Health Service Trusts in London, UK, from March 1 to April 30, 2020.Methods: In this retrospective observational study, the researchers collected demographic data, mental health diagnoses, clinical diagnosis of COVID-19, symptoms, management, and COVID-19-related outcome data of inpatients aged 65 years or older or with dementia who were already inpatients or admitted as inpatients to five London mental health Trusts between March 1 and April 30, 2020, and information about available COVID-19-related resources (ie, testing and personal protective equipment). Patients were determined to have COVID-19 if they had a positive SARS-CoV-2 PCR test, or had relevant symptoms indicative of COVID-19, as determined by their treating physician. This study calculated period prevalence of COVID-19 and analysed patients’ characteristics, treatments, and outcomes.Findings: Of 344 inpatients, 131 (38%) were diagnosed with COVID-19 during the study period (period prevalence 38% [95% CI 33–43]). The mean age of patients who had COVID-19 was 75·3 years (SD 8·2); 68 (52%) were women and 47 (36%) from ethnic minority groups. 16 (12%) of 131 patients were asymptomatic and 121 (92%) had one or more disease-related comorbidity. 108 (82%) patients were compulsorily detained. 74 (56%) patients had dementia, of whom 13 (18%) had young-onset dementia. On average, sites received COVID-19 testing kits 4·5 days after the first clinical COVID-19 presentation. 19 (15%) patients diagnosed with COVID-19 died during the study period, and their deaths were determined to be COVID-19 related. Interpretation: Patients in psychiatric inpatient settings who were admitted without known SARS-CoV-2 infection had a high risk of infection with SARS-CoV-2 compared with those in the community and had a higher proportion of deaths from COVID-19 than in the community. Implementation of the long-standing policy of parity of esteem for mental health and planning for future COVID-19 waves in psychiatric hospitals is urgent.

Last updated on hub: 09 November 2020

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Lancet

Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This research aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: This study did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. This study obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and this study analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. This study calculated excess deaths (both COVID-19-related and non-COVID-19-related), which this study defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Findings: Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. Interpretation: The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from the findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

Last updated on hub: 09 November 2020

Triggers of mental health problems among frontline healthcare workers during the COVID‐19 pandemic in private care homes and domiciliary care agencies: lived experiences of care workers in the Midlands region, UK

Health and Social Care in the Community

COVID‐19 was first reported in China and later spread across the world causing panic because there is no cure for it. The pandemic has adversely affected frontline health workers and patients, owing to poor preparedness. The study explored the triggers of mental health problems among frontline healthcare workers during the COVID‐19 pandemic. An exploratory qualitative approach was utilised in the study. Forty individual semi‐structured interviews were held with frontline healthcare workers. A thematic approach underpinned by some aspects of interpretive phenomenological analysis (IPA) and the Silences Framework (SF) was utilised. The research found that triggers of mental health problems among frontline health workers in private care homes and domiciliary care agencies are fear of infection and infecting others, lack of recognition/disparity between National Health Service (NHS) and social care, lack of guidance, unsafe hospital discharge, death and loss of professionals and residents, unreliable testing and delayed results and shortage of staff. It is important to support frontline workers in private care homes and domiciliary care agencies.

Last updated on hub: 09 November 2020

Covid-19 and community development

Community Development Journal

This is a brief response to Rosie Meade’s editorial in the Community Development Journal (55, 3), which identifies challenges to community development presented by the Covid-19 pandemic. As Rosie comments, while the implications of the pandemic are unpredictable, the crisis is infiltrating every aspect our lives. This response was written at the beginning of May, 2020, when we were still living in a context of fear and panic. In this short piece the author reflects further on some of the implications of the pandemic for community development, focussing on the Global North.

Last updated on hub: 09 November 2020

Community development ‘yet-to-come’ during and post the COVID-19 pandemic: from Derrida to Zuboff

Community Development Journal

The contours of this article, written as a dialogue between two authors, one in Australia (Westoby) and one in South Africa (Harris), outline a Derridean deconstruction of community development ‘yet-to-come’ during and post coronavirus disease 2019. Reflecting on the two countries’ experiences, drawing on theorists such as Zuboff (surveillance capitalism), Freire (critical literacy), Foucault (biopower), Escobar (pluriversality) and Berardi (semio-capitalism), this paper argues for transformational critical digital literacy work that enables greater community awareness of the consequences of digital lives and also transformative praxis. Riffing off many experiences that readers will be familiar with (lockdown, social distancing, tracing apps, virtual meetings and so on), the dialogue also suggests a soulful community development yet-to-come, foregrounding embodied lives, slowness, place, relationality and connection.

Last updated on hub: 09 November 2020

The Covid-19 catastrophe, authoritarianism, and refusing to get used to it

Community Development Journal

Editorial. Introduces the articles in the current issue. Makes the observation that public health efforts to curb the spread of COVID-19 coronavirus are accelerating many trends already underway, including the digitization of life in forms such as telemedicine, remote working, and online teaching. Comments about Sue Kenny’s invited Reflections piece ‘Covid-19 and community development’ published in this issue of the Community Development Journal, where Sue lists a number of urgent political actions that can be taken right now, actions that can be regarded as part of a politics of refusal to get used to it. First amongst these is to ‘join the chorus of those alerting the world to the threats and dangers of authoritarianism’. The editorial also suggests that that ‘we can point to the thousands of small scale initiatives that pre-figure very different ways of organising society’. The editorial suggests that these could form the basis of a ‘kit-bag of exemplars that demonstrate the value of how to organise using such principles as social and ecological justice, collaboration and deliberative democracy

Last updated on hub: 09 November 2020

Helping out: taking an inclusive approach to engaging older volunteers

Centre for Ageing Better

This guide is designed as a practical tool to support organisations working with volunteers to engage over 50s and widen participation among different types of people. The COVID-19 pandemic has prompted an outpouring of community spirit and volunteering, which has been critical to the local response. Many older people have made significant contributions to their communities during lockdown, with 30% of people aged 50 to 70 volunteering informally and 87% saying they wanted to continue. However, others have been prevented from helping during this time and may now require support. The guide sets out five actions to support organisations to re-engage volunteers and widen participation among those aged 50 and over in future. They include: connect and listen; focus on what matters to people; play to people’s strengths; remove barriers; and be flexible.

Last updated on hub: 09 November 2020

An inquiry into the lived experience of Covid-19 in the home care sector in Ireland: the experiences of home care provider organisations

Home and Community Care Ireland

This exploratory research into the health, social and economic impact of the covid-19 pandemic on the eighteen home care provider organisations who responded to a survey sheds light on how those on the forefront of home care coped during one of the largest viral outbreaks in modern history. A questionnaire consisting of ten open-ended questions was developed following a rapid literature review and internal consultations. These questions were categorised under five subheadings: management, service provision, relationships, health and wellbeing, and the future. Key findings include: The most significant problem was workforce shortage – specifically, two thirds of organisations indicated low staffing levels due to a lack of childcare brought about by the closure of schools and creches; almost every third organisation noted a decrease in home care services, ranging from 20-30 per cent, mostly due to clients cocooning and self-isolating; another issue that featured strongly across all responses was related to uncertainty surrounding the pandemic – stress, fear, worry and even panic; almost every other organisation identified Protective Personal Equipment (PPS) to be a significant cause for concern – supply and distribution was a considerably more prevalent issue than the actual cost of PPE; to ensure the smooth running of business at a very chaotic time, all the providers implemented a range of novel policies and procedures – this rapid development of new ways of delivering service safely took place on several interrelated levels; the crisis exposed any structural shortcomings within the home care sector, but equally it brought about a sense of togetherness, cooperation and mutual support within the sector – and beyond it.

Last updated on hub: 09 November 2020

Promising approaches revisited: supplementary case studies

Campaign to End Loneliness

This supplement is a companion piece to the report Promising Approaches Revisited: Effective action on loneliness in later life. That report sets out the different elements needed for effective action to reduce loneliness. These case studies show the framework in action, illustrating how each element may work in practice. They cover: connectors services, including social prescribing; direct solution including group-based interventions and one-to-one approaches; gateway infrastructure such as digital technology and the built environment; and neighbourhood approaches.

Last updated on hub: 09 November 2020

Home comforts: how the design of our homes and neighbourhoods effected our experience of the Covid-19 lockdown and what we can learn for the future

Place Alliance

This report summarises findings of a national survey of 2,500 households (representing 7,200 people) aimed at understanding how well or how poorly the design of their homes and their immediate neighbourhoods supported them during the period of coronavirus lockdown. The findings offer insights into how we should be designing or adapting them in the future in order that they are more resilient and better able to support happy and healthy lifestyles. Findings are grouped according to the following themes: about you during lockdown; your home during lockdown; your neighbourhood during lockdown; your community during lockdown. The findings show that two thirds of people felt comfortable or very comfortable during lockdown, but a sixth were either uncomfortable or very uncomfortable. Extrapolated across the UK this would represent 10.7 million uncomfortable people – social renters suffered the most and key workers were least comfortable. Access to private open space from the home was the strongest design-based predictor of comfort. A minority suffer poorly designed neighbourhoods and newer neighbourhoods come out worse. All categories of dwelling and neighbourhood saw an increase in community feeling and support during lockdown, but those with the strongest pre-exiting sense of community saw it reinforced most. Respondents reflected on a period in which people seemed friendlier (despite social distancing), in which the environment seemed to recover and even thrive, and in which they had more time for things that matter, the family, exercise, the garden, neighbours and the community.

Last updated on hub: 09 November 2020