COVID-19 resources on infection control

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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

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

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

Detrimental effects of confinement and isolation on the cognitive and psychological health of people living with dementia during COVID-19: emerging evidence

International Long-term Care Policy Network

This report contains a short review of the emerging evidence on the impact of COVID-19 on the cognitive and psychological health of people living with dementia and the reported mitigating measures. Three papers describing the effects of lockdown on people with dementia living in the community show a worsening of functional independence and cognitive symptoms during the first month of lockdown (31% of people surveyed) and also exacerbated agitation, apathy and depression (54%), along with the deterioration of health status (40%) and increased used of antipsychotics or related drugs (7%). People with frontotemporal dementia (FTD) and their family caregivers seem to be particularly struggling to comply with protective measures. Only 2 case studies reporting strategies to support people with dementia in care homes have been produced so far. One describes a quarantine care plan for a person with FTD and the other, a mitigating strategy to ease the distress experienced by a man when his family stopped visiting during the pandemic. People living with dementia in care homes have experienced a particularly harsh version of lockdown – the ban on visits from spouses and partners in care is believed to be causing a significant deterioration in the health and wellbeing of residents with dementia. It is worth noting that a study involving 26 care homes proved that it is possible to implement successful infection control measures at the same time that visits are permitted. Learnings from this first COVID-19 wave can help the home care and day care sector prepare to minimise the disruption of their services in future waves so support can continue for people with dementia in the community. In care homes, evidence-based compassionate protocols should contribute to mitigating the detrimental effects of isolation and quarantine in residents with dementia (and their families).

Last updated on hub: 04 November 2020

Mitigating the impact of the COVID-19 outbreak: a review of international measures to support community-based care

International Long-term Care Policy Network

This report provides a brief overview of the policy responses and practice measures used internationally to respond to the impact of COVID-19 on the provision of community-based care. The data provided is largely collected from the country reports on the COVID-19 long-term care situation, including Australia, Austria, Brazil, China, England, Germany, Hong Kong, Ireland, Israel, Italy, Netherlands, Slovenia, South Korea, and the United States. Key findings include: community-based care faces unique challenges during the COVID-19 pandemic compared to other parts of the long-term care continuum; several countries have taken steps to prevent the spread of COVID-19 infections in community-based care including the closure of adult day centres and other service providers; continuity of care is of upmost importance – a disruption of care and support could have serious negative impacts on individual health and well-being due to increased risk of loneliness and social isolation; the dispersed nature of community based care suggests that direct governmental action and oversight may be more difficult to provide than for residential care settings such as care homes or nursing facilities; efforts to maintain continuity of care in community-based care include government financial support to home care workers; recruitment of volunteers and family members to act as paid carers; and the provision of remote psychological supports to home care workers; some countries have taken steps to move patients and home care workers to residential care settings; few countries are specifically reporting data on infections and deaths among users of home care – an exception to this is Australia; overall evidence of national measures to support community-based care is still lacking for most countries.

Last updated on hub: 04 November 2020

Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic

International Long-term Care Policy Network

This is a pre-print article (not yet peer-reviewed). The researchers carried out a rapid review of evidence to address three questions: What is the evidence on the impact of visitors in terms of infections in care homes? What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents? and What has been the impact of restricting visits on quality of care? Findings: the review found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions. The review also found that there is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans. In addition, there is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff. Conclusions: Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections. Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning. In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.

Last updated on hub: 02 November 2020

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