COVID-19 resources

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Coronavirus (COVID‐19) in the United Kingdom: a personality‐based perspective on concerns and intention to self‐isolate

British Journal of Health Psychology

Objectives: Public behaviour change is necessary to contain the spread of coronavirus (COVID‐19). Based on the reinforcement sensitivity theory (RST) framework, this study presents an examination of individual differences in some relevant psychological factors. Design: Cross‐sectional psychometric. Methods: UK respondents (N = 202) completed a personality questionnaire (RST‐PQ), measures of illness attitudes, concerns about the impact of coronavirus on health services and socio‐economic infrastructures, personal safety, and likelihood of voluntary self‐isolation. Results: Respondents most concerned were older, had negative illness attitudes, and scored higher on reward reactivity (RR), indicating the motivation to take positive approach action despite prevailing worry/anxiety. Personal safety concerns were highest in those with negative illness attitudes and higher fight–flight–freeze system (FFFS, reflecting fear/avoidance) scores. Results suggest people are experiencing psychological conflict: between the urge to stay safe (FFFF‐related) and the desire to maintain a normal, pleasurable (RR‐related) life. Ways of ameliorating conflict may include maladaptive behaviours (panic buying), reflecting reward‐related displacement activity. Intended self‐isolation related to FFFS, but also low behavioural inhibition system (related to anxiety) scores. Older people reported themselves less likely to self‐isolate. Conclusions: Interventions need to consider individual differences in psychological factors in behaviour change, and we discuss relevant literature to inform policy makers and communicators.

Last updated on hub: 07 November 2020

Producing ‘top tips’ for care home staff during the COVID-19 pandemic in England: rapid reviews inform evidence-based practice but reveal major gaps

Journal of Long-Term Care

Context: The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. Objectives: The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. Methods: Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. Findings: The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. Implications: This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.

Last updated on hub: 06 November 2020

Adult Social Care Infection Control Fund – round 2: guidance

Department of Health and Social Care

The purpose of this fund is to support adult social care providers, including those with whom the local authority does not have a contract, to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movements between sites.

Last updated on hub: 05 November 2020

Performance tracker 2020: how public services have coped with coronavirus

Institute for Government

This fifth edition of the Performance Tracker brings together data series with information gathered from interviews with more than 50 people to provide a picture of how five public services – general practice, hospitals, adult social care, schools and criminal courts – have coped with coronavirus. The analysis assesses the changes introduced to manage disruption, evaluates the success of each of these changes and makes recommendations about whether they should be kept or extended beyond the pandemic. The report finds that both general practice and hospital care have been heavily disrupted by coronavirus. In response, there has been a fundamental shift in how technology is used, and major changes to funding and working practices. All organisations involved in regulating, funding and delivering social care have made major changes at speed to respond to coronavirus. Some changes have been so beneficial that they should be kept in normal times. Widespread use of the Capacity Tracker app has provided central government, local authorities, NHS trusts and providers with useful data on capacity and the government should explore whether it is possible to create a capacity tracker to track demand and capacity in homecare as well. Greater use of technology has also improved communication between local authorities, providers and the families and friends of service users – and provided real comfort to the service users themselves at an unimaginably difficult time. The report calls on the government to commission an independent review to assess how to prepare social care to make greater use of digital technology safely and effectively in the future.

Last updated on hub: 04 November 2020

Young people leaving care, practitioners and the coronavirus (COVID 19) pandemic: experiences, support, and lessons for the future

Cardiff University

This study explored care experienced young people’s experiences during the coronavirus (COVID-19) pandemic and the support available to them during this time. A qualitative, mixed method study was undertaken featuring a survey for professionals and interviews, focus groups and creative activities with care experienced young people. Professionals who responded to the survey were on the whole positive about the support that they had provided to care leavers and none raised concerns about poor practice or an inability to offer support. Professional efforts to maintain communication with young people, combat loneliness, isolation and boredom, as well as ensure access to resources was consistent with previous good practice recommendations. However, it was noted that efforts to respond to the needs of young people were constrained by the absence of additional funding. The perspectives of young people sometimes stood in sharp contrast to those of professionals and concerns remain about parity of support within and across areas, and the alignment between support needs and available provision. The findings did not suggest consultation and inclusion of young people in decision making about new ways of working, and the focus appeared to be on immediate and short-term crisis needs, as opposed to transition planning or taking a rights-based approach. Of particular concern were reports of young people anxious about basic provisions, living in inappropriate accommodation and struggling with absence of mental health support.

Last updated on hub: 04 November 2020

International examples of measures to prevent and manage COVID-19 outbreaks in residential care and nursing home settings

International Long-term Care Policy Network

This document provides examples of policy and practice measures that have been adopted internationally to prevent COVID-19 infections in care homes and to mitigate their impact. The evidence shows that: while both the characteristics of the population in care homes and the difficulties of physical distancing in communal living mean that care home residents are at high risk of dying from COVID-19, these deaths are not inevitable; countries with low-levels of infection in the population typically also have low shares of infections in care homes; the response to COVID-19 in care homes needs to be coordinated across all relevant government departments and levels, and with the acute health sector response; timely data on the impact of COVID-19 in care homes is essential to ensure that opportunities for preventing large numbers of deaths are not missed; evidence of asymptomatic transmission and atypical presentation of COVID-19 in geriatric populations should be reflected in guidance documents and testing policies; while there are infections local to care homes, regular testing of residents and staff will be essential, ideally followed by contact tracing and effective isolation; most countries have restricted visitors but this policy alone has not protected care homes from infection; staff pay and living conditions may be an important barrier to effective infection controls, particularly if staff do not have access to sick pay or need to work in multiple facilities (or live in crowded accommodation); access to healthcare and palliative care (in terms of personnel, medicines and equipment) needs to be guaranteed, particularly for homes without nursing or medical staff; measures to address the psychological impact of the pandemic on both staff and residents need to be put in place.

Last updated on hub: 04 November 2020

COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

medRxiv

Background: Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC. Methods: We report findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 26 June 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively. Findings: A total of 54 study reports for 49 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 0.4% and 64.0% among staff at affected facilities. Mortality rates varied from 0.0% to 17.1% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies of outbreaks, no LTC staff members had died. Studies of wider LTC populations found that between 0.4% and 40.8% of users, and between 4.0% and 23.8% of staff were infected, although the generalisability of these studies is limited. There was limited information on the impact of COVID-19 on LTC in the community. Interpretation: Long-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.

Last updated on hub: 04 November 2020

Mortality associated with COVID-19 in care homes: international evidence

International Long-term Care Policy Network

This document focuses on mortality associated with COVID-19 in care homes, summarising information from three types of sources: epidemiological studies, official estimates and news reports; and relies on national experts for confirmation of sources and definitions. Key findings include: official publicly available data on the numbers of deaths among care home residents linked to COVID-19 is not available in many countries; international comparisons are difficult due to differences in testing capabilities and policies, different approaches to recording deaths, and differing definitions of what constitutes a “care home”; there are three main approaches to quantifying deaths in relation to COVID-19: deaths of people who test positive (before or after their death), deaths of people suspected to have COVID-19 (based on symptoms or epidemiologically linked), and excess deaths (comparing total number of deaths with those in the same weeks in previous years); another important distinction is whether the data covers deaths of care home residents or only deaths in the care home; based on the data gathered for this report, the current average of the share of all COVID-19 deaths that were care home residents is 46% (based on 21 countries); the share of all care home residents who have died (linked to COVID-19) ranges from 0.01% in South Korea to over 4% (which would mean that over one in 25 care home residents have died linked to COVID-19) in Belgium, Ireland, Spain, the UK and the US; currently, there is limited evidence from anywhere in the world on how individuals who receive care in the community have been directly or indirectly affected by COVID-19.

Last updated on hub: 04 November 2020

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.

Last updated on hub: 04 November 2020

International evidence on care home COVID-19 outbreak responses: summary of key findings

International Long-term Care Policy Network

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.

Last updated on hub: 04 November 2020