COVID-19 resources on Infection control

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COVID 19 deaths of people identified as having learning disabilities: summary

Public Health England

Summarises findings of a review that looked at: deaths from COVID-19 of people with learning disabilities; factors impacting the risk of death from COVID-19 of people with learning disabilities; deaths in care settings of people with learning disabilities. The key finding of this study was that people with learning disabilities had significantly and substantially higher death rates in the first wave of COVID19 in England than the general population. Making no allowance for the younger age and different sex ratio of people with learning disabilities, the rate of deaths notified to LeDeR in this group was 2.3 times the death rate in the general population. If this figure is adjusted to allow for the likely level of under-notification to LeDeR it was 3.5 times the general population rate. After standardisation for age and sex the rate calculated just from notifications to LeDeR was 4.1 times the general population rate. Adjusting for the likely level of under-notification it was 6.3 times the general population rate. The total number of deaths in adults with learning disabilities for the 11 weeks from 21 March to 5 June was 2.2 times the average number for the corresponding period in the 2 previous years. By contrast, the number of deaths in the general population was 1.5 times the average for the 2 previous years. Deaths with COVID-19 in adults with learning disabilities were spread more widely across the age groups than those in the general population. As in the general population, the COVID-19 death rate in people with learning disabilities was higher for men than for women. The overall increase in deaths was also greater in Asian or Asian-British, and Black or Black-British people. Residential care homes providing care for people with learning disabilities do not appear to have had the very high rates of outbreaks of COVID-19 seen in homes providing care for other groups, mainly older people. This appears to be related to their smaller number of beds.

Last updated on hub: 16 November 2020

Covid 19, low incomes and poverty

The Institute for Research and Innovation in Social Services

This summary provides an overview of recent evidence relating to Covid 19, low incomes and poverty. It is based on the findings of a search for academic research and grey literature using a wide range of search terms including: Covid-19, poverty, low incomes, deprivation, unemployment, health inequalities, housing, school closures, food poverty, fuel poverty, benefits system. The paper reveals that those living with socio-economic disadvantages and inequalities are more likely to experience poorer health, housing and education, lower income, and lack of access to quality outdoor space, all things most immediately affected by the Covid-19 pandemic. Poorer groups also have additional barriers as those who traditionally support them – friends and family, care groups and charities – may also experience a crisis or be unavailable. The report highlights the additional hardship for carers and those they care for – they are often already living on lower incomes so anything that stretches, reduces or removes it altogether will cause further deprivation. The need to maintain a focus on the gendered impact of the crisis is also highlighted – social isolation policies, and thus the current lockdown, increases women’s vulnerability to domestic abuse, with financial dependence and poverty as primary risk factors. The evidence also shows that structural inequalities put Black and Ethnic Minority (BAME) groups at much higher risk of illness from Covid-19, and facing harsher economic impacts from government measures to deal with the virus.

Last updated on hub: 28 July 2020

COVID 19: guidance for domiciliary care providers in Northern Ireland

This guidance sets out key messages to support planning and preparation as Northern Ireland moves into the delay phase of responding to the risk of widespread transmission of the coronavirus (COVID-19). Key messages highlight the need for co-ordination between care providers, the voluntary sector and PHA; making best use of the workforce; and access to PPE. It is aimed at HSC trusts and registered providers of care and support delivered to people in their own homes, including supported living arrangements. It also contains information about informal carers and about carers employed through Direct Payments.

Last updated on hub: 24 March 2020

COVID 19: how to work safely in care homes

Public Health England

This guidance provides advice for care workers working in care homes on the use of personal protective equipment (PPE) during the period of sustained transmission of the coronavirus (COVID-19). The guidance is also relevant for those providing residential supported living. This resource, which has been designed to be accessible to both care workers and providers, has four sections containing: recommendations on the use of PPE for a range of relevant contexts; explanation concerning recommendations and frequently asked questions; specialist advice relating to care for people with learning disabilities and/or autism; and case scenarios designed to illustrate appropriate use of PPE in practice. It should be read in conjunction with the full infection prevention and control (IPC) and PPE government guidance. [Published 17 April 2020; Last updated 7 October 2020]

Last updated on hub: 20 April 2020

COVID-19 - infection prevention and control in health and social care settings - an overview

Health Protection Scotland

To support health and social care staff involved in the COVID-19 response, Health Protection Scotland (part of Public Health Scotland), NHS National Services Scotland and NHS Education for Scotland have produced a short recorded webinar.

Last updated on hub: 22 July 2020

COVID‐19 and care homes in England: What happened and why?

Social Policy and Administration

In the context of very high mortality and infection rates, this article examines the policy response to COVID‐19 in care homes for older people in the UK, with particular focus on England in the first 10 weeks of the pandemic. The timing and content of the policy response as well as different possible explanations for what happened are considered. Undertaking a forensic analysis of policy in regard to the overall plan, monitoring and protection as well as funding and resources, the first part lays bare the slow, late and inadequate response to the risk and reality of COVID‐19 in care homes as against that in the National Health Service (NHS). A two‐pronged, multidimensional explanation is offered: structural, sectoral specificities; political and socio‐cultural factors. Amongst the relevant structural factors are the institutionalised separation from the health system, the complex system of provision and policy for adult social care, widespread market dependence. There is also the fact that logistical difficulties were exacerbated by years of austerity and resource cutting and a weak regulatory tradition of the care home sector. The effects of a series of political and cultural factors are also highlighted. As well as little mobilisation of the sector and low public commitment to and knowledge of social care, there is a pattern of Conservative government trying to divest the state of responsibilities in social care. This would support an interpretation in terms of policy avoidance as well as a possible political calculation by government that its policies towards the care sector and care homes would be less important and politically damaging than those for the NHS.

Last updated on hub: 31 August 2020

COVID-19 and care homes: update paper, 23 September 2020

This paper reviews the latest evidence on the transmission of Covid-19 in care homes. It focuses specifically on the relative risk of each of four routes of ingress of infection to the care home (hospital discharge, staff, visitor (professional or domestic) and community admissions) as well as the route of transmission within care homes once infection has entered, for which more detailed genomic studies are critical. Key findings include: although staff-to-staff transmission has been observed to have been a contributory factor in specific outbreaks, it is important not to generalise to all outbreaks and emphasise one route over another without clear evidence – studies undertaken so far indicate that multiple introductions are common; retrospective genomic analysis and seropositive studies in care homes find evidence for multiple routes of virus ingress to care homes, but are not systematic enough to quantify the relative frequency of different routes of ingress; evidence of staff to staff transmission has emerged in the genomic analysis (high confidence); weak evidence on hospital discharge and modelling the impact of visitors does not suggest a dominant causal link to outbreaks from these sources; public health measures that reduce community incidence could be effective in reducing ingress into care homes; asymptomatic or atypically symptomatic presentation in residents and staff mean that ingress may be hidden for a number of generations of disease; sequencing community tests to understand the comparator population is critical for the future.

Last updated on hub: 27 October 2020

COVID-19 and Coronavirus evidence alerting. Rapid scan 1: effects on people in care/nursing homes (and other residential facilities) including approaches to protecting workers and residents

NHS Midlands and Lancashire Commissioning Support Unit

This rapid scan collates new and emerging evidence on implications for care homes and residential facilities and transferable lessons from previous pandemics and major incidents. It highlights key papers to inform decisions, policy and planning, and is intended to be pragmatic rather than exhaustive in its coverage. The resource summarises key messages and recurring themes emerging from the evidence – around PPE, reducing the spread, surge planning, staffing, communication, isolation and distancing, and technology – and signposts to expert commentary, key guidance, rapid reviews, lessons from previous pandemics, ongoing studies and other useful resources.

Last updated on hub: 24 June 2020

Covid-19 and early intervention: understanding the impact, preparing for recovery

The Early Intervention Foundation

This report explores the impact of COVID-19 on early help – the range of services that would ordinarily be supporting vulnerable children and families below the threshold for statutory local authority support, including targeted support provided by universal services. It considers the response of local services across England to the immediate challenges presented by COVID-19, and the challenges on the horizon. This work was undertaken by EIF and Action for Children between March and May 2020 and is based on 28 semi-structured qualitative interviews with heads of early help services, lead practitioners, and head teachers. Areas of focus include: risk assessment and referral in a virtual environment; virtual delivery of services; maintaining essential face-to-face delivery; closure of school and early years provision; and longer-term issues. The findings indicate that the pandemic has necessitated rapid adaptation of the way that services support vulnerable children and families, characterised by an almost wholesale transition to virtual or online contact while retaining some element of face-to-face provision when needed. There is a unique opportunity to improve the evidence base on virtual delivery of early intervention for children and families through seizing the opportunity for testing and evaluation. Conversely, the professionals recognise that there is a risk that some children and families who became vulnerable or became more vulnerable during the lockdown period could be missed without home visits. The research also identified a clear sense of apprehension among professionals about the longer-term impact of the pandemic and particularly the lockdown period on vulnerable children and families, and about the ability of services to cope with the demand that this will create.

Last updated on hub: 30 June 2020

COVID-19 and health inequality

Independent Scientific Advisory Group for Emergencies

This report examines Covid-19 mortality rates in the most deprived neighbourhoods in England and in the lowest income households – contextualising them within the wider issue of health inequalities. Firstly, the report provides an overview of socio-economic health inequalities in the UK. It then summarises epidemiological evidence of socio-economic inequalities in relation to Covid-19 (both in the UK and internationally) and examines the pathways linking Covid-19 and inequality. In part three, it examines inequalities and the impact of the emergency policy response to Covid-19, including the lockdown, the emerging parallel pandemic of restricting non-COVID NHS services, mental health impacts, rising homelessness and school closures. Part four examines the emerging evidence of an unequal Covid-19 economic crisis and the impact that it could have on future health inequalities. The report concludes by outlining some key recommendations whereby local government and devolved authorities, the NHS and national government can act to reduce these inequalities. Key messages include: Covid-19 has magnified and exacerbated health inequalities with higher rates of illness and death from Covid-19 in more deprived communities; Covid-19 has highlighted the importance of the social determinants of health namely – housing, income, nutrition, employment sickness benefits and financial support, social security and social care and health care; people in lower paid jobs or living in more deprived neighbourhoods are more likely to experience adverse outcomes from the virus because of co-morbidities and reduced immune response associated with poverty and stress, occupational exposures and inability to shield at home, overcrowding and homelessness, lack of sickness benefits and lack of access to and adequacy of health and social care services. While the UK government has taken steps to mitigate some of the distributional impacts of Covid-19, there is an urgent need for additional action to reinvest and rebuild capacity in all public services linked to a strategy for full employment and resource redistribution.

Last updated on hub: 24 November 2020

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