COVID-19 resources

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Ethical decision-making in the face of Covid-19

International Federation of Social Workers

The coronavirus (COVID 19) crisis is challenging social workers as they continue to carry out their professional roles. In the context of a shortage of resources and a lack of safety equipment, social workers are having to make difficult decisions about in-person contacts with their clients. This document highlights ethical principles from the International Federation of Social Workers and provides a series of questions to guide social workers through resolving the dilemma of balancing public health directives and guidelines and ethical obligations to clients.

Last updated on hub: 11 May 2020

Ethical framework for adult social care in COVID-19: extended essay

University of Oxford

Essay published by the Journal of Medical Ethics, authored by Charlotte Bryony Elves and Jonathan Herring, University of Oxford. In March 2020, the Government produced a document entitled “Responding to COVID-19: The Ethical Framework for Adult Social Care” (‘The Ethical Framework’). This article, summarises the key features of the proposed ethical framework and subject it to critical analysis. This article highlights three primary issues. First, the emphasis placed on autonomy as the primary ethical principle. The authors argue if ever there was a context in which autonomy should dominate the ethical analysis, this is not it. Second, the authors examine the interface between ethics and law which is largely overlooked in the document. Finally, the authors explore the surprising lack of attention paid to the concept of responsibility and communal obligations within the framework.

Last updated on hub: 12 August 2020

Ethnic inequalities in Covid-19 are playing out again – how can we stop them?

Institute for Public Policy Research

This long read by IPPR and Runnymede Trust looks at how Covid-19 is set to continue to hit minority ethnic communities hardest as we enter the second wave. It proposes measures to help control the pandemic and mitigate immediate ethnic inequalities. including increasing access to treatment.

Last updated on hub: 26 October 2020

Evaluating perspectives of relatives of nursing home residents on the nursing home visiting restrictions during the COVID-19 Crisis: a Dutch cross-sectional survey study

Journal of the American Medical Directors Association

Objectives: Coronavirus disease 2019 (COVID-19) has caused many nursing homes to prohibit resident visits to prevent viral spread. Although visiting restrictions are instituted to prolong the life of nursing home residents, they may detrimentally affect their quality of life. The aim of this study was to capture perspectives from the relatives of nursing home residents on nursing home visiting restrictions. Design: A cross-sectional online survey was conducted. Setting and Participants: A convenience sample of Dutch relatives of nursing home residents (n = 1997) completed an online survey on their perspectives regarding nursing home visiting restrictions. Methods: The survey included Likert-item, multiselect, and open-answer questions targeting 4 key areas: (1) communication access to residents, (2) adverse effects of visiting restrictions on residents and relatives, (3) potential protective effect of visiting restrictions, (4) important aspects for relatives during and after visiting restrictions. Results: Satisfaction of communication access to nursing home residents was highest when respondents had the possibility to communicate with nursing home residents by nurses informing them via telephone, contact behind glass, and contact outside maintaining physical distance. Satisfaction rates increased when respondents had multiple opportunities to stay in contact with residents. Respondents were concerned that residents had increased loneliness (76%), sadness (66%), and decreased quality of life (62%), whereas study respondents reported personal sadness (73%) and fear (26%). There was no consensus among respondents if adverse effects of the visiting restrictions outweighed the protective effect for nursing home residents. Respondents expressed the need for increased information, communication options, and better safety protocols. Conclusion and Implications: Providing multiple opportunities to stay in touch with nursing home residents can increase satisfaction of communication between residents and relatives. Increased context-specific information, communication options, and safety protocols should be addressed in national health policy.

Last updated on hub: 07 December 2020

Evaluating the importance of scale in proposals for local government reorganisation

Pricewaterhouse Coopers LLP

The purpose of this report is to consider the importance of scale in proposals for local government reorganisation. Throughout the report, the implications for the organisation and delivery of children and adults’ social care services are discussed. The report identifies considerations relating to the costs associated with disaggregation; what this might mean in terms of risk and resilience of service provision; how service performance might be impacted; what it could mean for the place agenda; and issues arising from the response to Covid-19. It also sets out the financial implications of four unitary scenarios: establishing one unitary authority in every two-tier area in England; establishing two new unitary authorities in every two-tier area in England; establishing three new unitary authorities in every two-tier area in England; and establishing two new unitary authorities and a children’s trust in every two-tier area in England.

Last updated on hub: 01 September 2020

Evaluation of the CAMHS In-Reach to Schools Pilot Programme: pilot progress and the impact of Covid 19, supplementary paper to the interim report

Welsh Government

This paper supplements the evaluation of the CAMHS In-Reach to Schools pilot, a programme that aims to build capacity (including skills, knowledge and confidence) in schools to support pupils’ mental health and well-being and improve schools’ access to specialist liaison, consultancy and advice when needed. It presents the data gathered through the second round of qualitative case-study research with a sample of school clusters, services, such as Child and Adolescent Mental Health Services (CAMHS), school counselling, educational psychology and voluntary sector services, working with them, and interviews and discussions with CAMHS In-Reach Practitioners. The report aims to present the position for schools and services at the approximate midpoint of the pilot programme (early spring 2020) and provides a ‘snapshot’ of the impact of Covid-19 and the lockdown upon schools, pupils and services in late April and May 2020. These latter findings are drawn from a small sample at a period in time, when schools were responding to a fast-moving and challenging situation. The report finds that there is a clear need, and strong support, for the pilot, and the impact of Covid-19 is expected to increase this need. The pilot programme allows schools to be better prepared than they would otherwise have been for the return of pupils and, to a lesser degree, staff. Nevertheless, they still want support from the pilots to help them prepare for schools increasing their operations, and the difficulties pupils and staff may experience when they return.

Last updated on hub: 30 July 2020

Ever more needed? The role of the Leeds Neighbourhood Networks during the COVID-19 pandemic

Centre for Ageing Better

This report draws on the findings of a ‘real time evaluation’ (RTE) of the Leeds Neighbourhood Networks (LNNs) during the pandemic, as a way to understand and share learning about their response. The LNNs aim to support older people to live independently and participate in their communities as they grow older, through a range of activities and services that are provided at a neighbourhood level. The networks have developed over the past 30 years and there are now 37 of them covering the whole city of Leeds. The form, function, activities and services of the networks are diverse, but they share some key characteristics, such as running with the involvement of older people. Prior to the COVID-19 pandemic there was a city-wide ambition for a symbiotic relationship between the LNNs and the health and care sector. This was linked the city’s strategic vision to make Leeds the ‘best city in the UK to grow old in’ and recognition of the need for a ‘left shift’ of resources toward prevention and the development community-based resources and assets. Although the outbreak of the COVID-19 pandemic meant that this progressive policy agenda was placed on hold out of necessity as city partners focussed on addressing the acute needs brought about by the crisis, the pandemic also provided an opportunity for the LNNs to demonstrate their value by being part of this response at a city and neighbourhood level.

Last updated on hub: 10 December 2020

Evidence summary for lateral flow devices (LFD) in relation to care homes

Department of Health and Social Care

A summary of published research papers on lateral flow device (LFD) efficacy and preliminary findings from the evaluation of the Department of Health and Social Care (DHSC) care home visitor testing pilot November 2020. The summary follows the release of visitor testing guidance that supports friends and relatives to visit care home residents and provides clarity on the available evidence to support safe visiting as part of our overall approach to promote the health and wellbeing of care home residents. Friends and relatives tested immediately before their visit can demonstrate they are likely to be free of risk of transmitting COVID-19 by having an LFD negative result. Testing must be done directly before the visit takes place and must be undertaken in combination with other infection prevention and control measures.

Last updated on hub: 11 January 2021

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

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

Citation: Burton, J. K. et al. (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. The Lancet Healthy Longevity, 1(1), e21-e31.Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This study aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: The researchers 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 the researchers 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), 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: 13 November 2020