COVID-19 resources on infection control

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Lockdown. Rundown. Breakdown. The COVID-19 lockdown and the impact of poor-quality housing on occupants in the North of England

Northern Housing Consortium

This report has been produced to document the experiences of households living in poor-quality, ‘non-decent’ accommodation in the UK – with a specific focus on households in the North of England – during the height of the UK lockdown. It draws on rapidly produced primary research undertaken between May and July 2020. It involved semi-structured interviews with 40 residents from privately rented housing, ten residents from owner-occupied housing and eight key actors/professionals. The study also used a short survey to capture the views and experiences of people who preferred not to be interviewed. The findings reveal that: households were living with longstanding repair and quality issues – lockdown had ultimately worsened such conditions and impaired people’s ability to live with those conditions; many longstanding repair and quality issues were described as worsening throughout lockdown because social distancing measures prohibited contractors from entering the home; renters were having to draw on their own incomes, savings and credit to cope with the costs associated with their poor conditions, which further entrenched people in the private rented sector; the vast majority of renters had not considered the possibility of asking landlords for rent reductions when questioned during interviews; private renters were under-reporting the repairs that were needed to their homes; overcrowding was an issue most households were experiencing, with entire households living, working and spending time in the same housing space; conversely, people who lived by themselves discussed feeling isolated and lonely in the weeks when contact with family and friends was restricted to online video call facilities. There is an opportunity to learn from the first few months of the COVID-19 lockdown and take urgent action for the short, medium and long term to ensure that the housing crisis, which has been so frequently identified, does not lead to systemic or personal breakdown.

Last updated on hub: 10 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

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

Advice and guidance on discharging COVID-19 positive patients to care homes

Royal College of Physicians

A brief summary of current advice and guidance about discharging patients to care homes. The main points are that: patients should be discharged as soon as they are fit, whether they are COVID-19 positive or not; COVID-19 positive patients being discharged into a care home setting can only be discharged into care homes that have been designated safe by the CQC – if their own care home is not COVID-19 safe, they need to be discharged into alternative accommodation; it is the responsibility of the local authority to find alternative accommodation.

Last updated on hub: 09 November 2020

A country report: impact of COVID-19 and inequity of health on South Korea’s disabled community during a pandemic

Disability and Society

The South Korean media boasts of its leading success–during the escalation of the coronavirus outbreak–in flattening of the curve thereby mitigating the grave outcomes of the public health crisis. Much of the success is reportedly attributed to the rapid and advanced development of test kits, essential equipment and implementation of protocols in precautionary measures. However, it has been an arduous task to stay afloat for one particular vulnerable community. The disabled citizens of Korea were confronted by the realities of health inequity during this disastrous period. Pre-existing the pandemic onset, the disabled community have faced stigmatization and under many circumstances de-prioritization by their own society. Through the lens of a visiting physician, my hope is to poignantly and respectfully share personal experiences and thoughts on these realties impacted by the COVID-19 pandemic in South Korea.

Last updated on hub: 07 November 2020

Reducing SARS‐CoV‐2 transmission in the UK: a behavioural science approach to identifying options for increasing adherence to social distancing and shielding vulnerable people

British Journal of Health Psychology

Purpose: To describe and discuss a systematic method for producing a very rapid response (3 days) to a UK government policy question in the context of reducing SARS‐CoV‐2 transmission. Methods: A group of behavioural and social scientists advising the UK government on COVID‐19 contributed to the analysis and writing of advice through the Government Office for Science. The question was as follows: What are the options for increasing adherence to social distancing (staying at home except for essential journeys and work) and shielding vulnerable people (keeping them at home and away from others)? This was prior to social distancing legislation being implemented. The first two authors produced a draft, based on analysis of the current government guidance and the application of the Behaviour Change Wheel (BCW) framework to identify and evaluate the options. Results: For promoting social distancing, 10 options were identified for improving adherence. They covered improvements in ways of achieving the BCW intervention types of education, persuasion, incentivization, and coercion. For promoting shielding of vulnerable people, four options were identified covering the BCW intervention types of incentivization, coercion, and enablement. Conclusions: Responding to policymakers very rapidly as has been necessary during the COVID‐19 pandemic can be facilitated by using a framework to structure the thinking and reporting of multidisciplinary academics and policymakers.

Last updated on hub: 07 November 2020

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

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. [Updated 15 January 2021]

Last updated on hub: 05 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

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

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