COVID-19 resources

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Real-time digital contact tracing: development of a system to control COVID-19 outbreaks in nursing homes and long-term care facilities

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. Citation: Wilmink G et al. (2020) Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities. JMIR Public Health Surveill 2020;6(3):e20828

Last updated on hub: 13 November 2020

Rebuilding the NHS: resetting outpatient services for the 21st century in the context of COVID-19

Royal College of Physicians

In this document, the Royal College of Physicians (RCP) and the Royal College of General Practitioners (RCGP) set out principles and recommendations for resetting outpatient services in the context of the ongoing pandemic. The paper recommends that services should make sure that all relevant organisations, patients and carers are involved in the coproduction and implementation of reset plans; further the integration of primary, secondary, social and community care; systematically consider the impact of their reset plans on inequality; work towards a system in which patient records are available to everyone involved in decision making and provision of care; design new clinical processes to maximise the benefit of new technology to patients, carers and clinicians; and make sure that everyone involved has access to the education, training and support they need to adapt to and use new systems. The paper argues that payment must incentivise the reduction of inequality, greater integration and the increased use of technology and calls for the introduction of a blended payment model for the outpatient system, combining a fixed payment based on the likely needs of the population with a payment based on outcomes, including patient-reported quality of communication and experience.

Last updated on hub: 16 July 2020

Recasting social workers as frontline in a socially accountable COVID-19 response

International Social Work

The COVID-19 pandemic has seen the engagement of a wide range of professionals in responding to clinical, social and economic issues. While the clinical expression of the pandemic has generated strong media portrayal of physicians and nurses as frontline workers, social workers – who play a key role in helping individuals and families in crisis – have not been similarly highlighted. The pandemic within a social accountability framework highlights important roles of both public officials and civic society in containment efforts. This article recognizes social workers as important actors in their representative and supportive role for civil society during COVID-19.

Last updated on hub: 19 November 2020

Recommendations for safe visiting in care homes during the Covid-19 pandemic

Dementia UK

This flowchart describes the steps residential care providers need to take to ensure safe visiting during the pandemic.

Last updated on hub: 08 October 2020

Recommendations for the management of COVID-19 pandemic in long-term care facilities

Zeitschrift fur Gerontologie und Geriatrie

Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. The authors are confident that their recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

Last updated on hub: 15 March 2021

Recommendations for welcoming back nursing home visitors during the COVID-19 pandemic: results of a delphi panel

Journal of the American Medical Directors Association

Objectives: Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. Design: A modified 2-step Delphi process was used to generate consensus statements. Setting and participants: The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. Methods: State and federal reopening statements were collected in June 2020 and the panel voted on these using a 3-point Likert scale with consensus defined as ≥80% of panel members voting "Agree." The consensus statements then informed development of the visitor guidance statements. Results: The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made 5 strong recommendations: (1) maintain strong infection prevention and control precautions, (2) facilitate indoor and outdoor visits, (3) allow limited physical contact with appropriate precautions, (4) assess individual residents' care preferences and level of risk tolerance, and (5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial well-being of residents. Conclusions and implications: The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.

Last updated on hub: 10 December 2020

Recommendations in covid-19 times: a view for home care

Brazilian Journal of Nursing (Revista Brasileira de Enfermagem)

Objective: To suggest recommendations for the practice of Home Nursing in the context of COVID-19. Method: Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. Results: Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. Final considerations: the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.

Last updated on hub: 19 October 2020

Recovering from Covid-19: supporting children and families

County Councils Network

This short report draws on research on the funding of Children Social Care carried out by the County Councils Network, highlights some of the key findings which are likely to impact the ability of County Authorities to respond to the needs of children and families which is anticipated will arise from the Covid-19 crisis. The research found that declining funding and rising demand has meant councils have had to decrease spending on preventative services and early intervention services in order to ensure they meet their statutory duties. Local authorities have also become increasingly reliant on the Troubled Families Programme to support their preventative work with families. The report argues that as lockdown starts to lift, it is preventative services which councils will need to help support recovery in their communities. It makes recommendations to Government which include: reform of the Troubled Families programme beyond 2020/1 centred on helping families to recover from the Covid-19 emergency; and renaming the Troubled Families programme to become less stigmatising and more inclusive as the nature of the families targeted by the programme change due to the impact of Covid-19.

Last updated on hub: 01 June 2020

Recovery plan: children in care and care leavers

The Children's Society

This briefing sets out key concerns about children in care and care leavers and the systems and structures that have been affected by COVID-19. It outlines the short-term and long-term actions that national and/or local government should prioritise when planning their support for children in care and care leavers in the context of COVID-19. The extent of the impact of the pandemic and ‘lockdown’ on the care system and care experienced young people is yet to be fully understood but emerging concerns include: placement breakdowns; safeguarding of children and young people in unregulated accommodation; children missing from care; impact on children and young people’s mental health; contact with families; out of area placements; care leavers; sufficiency and operational capacity. To address the impact of the pandemic on care experienced young people now and in the future, the briefing recommends that the Government: protect the rights and entitlements of care experienced young people; ensure care experienced young people can access education; support mental health and wellbeing of care experienced young people, ensuring trauma-informed approaches underpin the support children in care receive; be ambitious for, and supportive of, the needs of care leavers; put children’s interests, wishes and experiences at the heart of the Care Review, addressing early support work with families, sufficiency and commissioning of care placements, use of unregulated accommodation, trauma-informed practice, and support for social care professionals and carers.

Last updated on hub: 29 July 2020

Recovery plan: safeguarding and child protection

The Children's Society

This briefing sets out the principle concerns about the impact of COVID-19 on the safety and wellbeing of children and the ability of agencies to respond to situations where children are at risk of harm within their family unit, or from others online and in communities. It outlines short-term and long-term actions that national and/or local government should prioritise to protect children in the context of COVID-19 pandemic. There is very limited evidence on the full impact of the pandemic and lockdown on children and families but the available data and evidence from practitioners working directly with families and children highlight a number of emerging concerns, including: low visibility of children during lockdown; impact on the child protection services; lack of support for families under stress; children in domestic abuse situations; victims of child sexual abuse; child victims of criminal exploitation; children missing from home; young carers; increase in online risks; and pressures on the family justice system. To address the impact of COVID-19 on safeguarding children now and in the future the briefing recommends that the Government: ensure that all children at risk are reached with an offer of help; invest in children’s services capacity to safeguard children; ensure that all vulnerable children are supported to go back to education; put experiences of children and families at the heart of future responses; be ambitious in national policy changes.

Last updated on hub: 29 July 2020

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