COVID-19 resources on infection control

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Asymptomatic carriage rates and case fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes

Age and Ageing

Background: SARS-CoV-2 has disproportionately affected nursing homes (NH). In Ireland, the first NH case COVID-19 occurred on 16 March 2020. A national point-prevalence testing programme of all NH residents and staff took place (18 April 2020 to 5 May 2020). Aims: to examine characteristics of NHs across three Irish Community Health Organisations, proportions with COVID-19 outbreaks, staff and resident infection rates symptom profile and resident case fatality. Methods: in total, 45 NHs surveyed, requesting details on occupancy, size, COVID-19 outbreak, outbreak timing, total symptomatic/asymptomatic cases and outcomes for residents from 29 February 2020 to 22 May 2020.Results: surveys were returned from 62.2% (28/45) of NHs (2,043 residents, 2,303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1,741 residents, 1,972 beds). Median time from first COVID-19 case in Ireland to first case in these NHs was 27.0 days. Resident incidence was 43.9% (764/1,741)—40.8% (710/1,741) laboratory confirmed, with 27.2% (193/710) asymptomatic and 3.1% (54/1,741) clinically suspected. Resident case fatality was 27.6% (211/764) for combined laboratory-confirmed/clinically suspected COVID-19. Similar proportions of residents in NHs with ‘early-stage’ (<28 days) versus ‘later-stage’ outbreaks developed COVID-19. Lower proportions of residents in ‘early’ outbreak NHs had recovered compared with those with ‘late’ outbreaks (37.4 versus 61.7%; χ2 = 56.9, P < 0.001). Of 395 NH staff across 12 sites with confirmed COVID-19, 24.7% (99/398) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearman’s rho = 0.81, P < 0.001). Conclusion: this study demonstrates the significant impact of COVID-19 on the NH sector. Systematic point-prevalence testing is necessary to reduce risk of transmission from asymptomatic carriers and manage outbreaks in this setting.

Last updated on hub: 21 January 2021

The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Age and Ageing

Background: mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim: to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting: we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.Methodswe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results: survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions: the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Last updated on hub: 21 January 2021

Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect

Age and Ageing

In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

Last updated on hub: 21 January 2021

The need for improved discharge criteria for hospitalised patients with COVID-19 – implications for patients in long-term care facilities

Age and Ageing

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy—clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.

Last updated on hub: 21 January 2021

COVID-19 vaccinations for community-based social care workers

Department of Health and Social Care

Outline of plans for getting the COVID-19 vaccine to social care workers based in the community. Local authorities must work with the Care Quality Commission (CQC) and NHS partners to identify providers of social care services and the social care workers they employ and send employers of social care workers the appropriate national and local vaccination communications, including eligibility letters. Providers must support staff to make informed decisions about getting the vaccine; support staff to have the vaccine; and keep staff records of vaccinations.

Last updated on hub: 20 January 2021

Novel coronavirus (COVID19) standard operating procedure: COVID-19 vaccine deployment programme: frontline social care workers (JCVI Priority Cohort 2)

NHS England

This standard operating procedure (SOP) outlines the process for facilitating COVID-19 vaccination for frontline social care workers (excluding those working in care homes for older adults) as defined by the JCVI. This includes the identification of eligible care workers and the roles and responsibilities within local systems for enabling and supporting care workers to be vaccinated. The SOP also outlines how Hospital Hubs, Vaccination Centres and Local Vaccination Services should work to deliver COVID-19 vaccination to frontline social care workers at pace. It covers how they should work in partnership to match vaccination capacity to meet demand, support booking, on the day arrangements and data capture to monitor uptake. It does not cover the clinical delivery of the vaccine, which is covered in separate guidance.

Last updated on hub: 19 January 2021

Guidance to prevent COVID-19 among care home residents and manage cases, incidents and outbreaks in residential care settings in Wales

Public Health Wales

This public health guidance is intended for local authorities, Local Health Boards and registered providers of care homes or supported living arrangements where people share communal facilities. The majority of this guidance can be applied across a range of settings including residential homes for adults and children and supported living facilities where 24 hour care is provided. The guidance can also be applied to other settings such as retirement housing where there are communal facilities and additional care provided as well as other communal facilities such as those for people recovering from substance use, those experiencing mental health problems, the homeless and those seeking asylum. The guidance covers: prevention – keeping your setting coronavirus free; admission or placement of residents; caring for residents, depending on their COVID-19 status; advice for staff; incidents and outbreaks; and supporting existing residents that may require medical care.

Last updated on hub: 19 January 2021

The COVID-19 pandemic and long-term care: what can we learn from the first wave about how to protect care homes?

Eurohealth

The COVID-19 pandemic has highlighted and exacerbated pre-existing problems in the long-term care sector. Based on examples collected from the COVID-19 Health System Response Monitor (HSRM) and the International Long-term care Policy Network (LTCcovid), this article aims to take stock of what countries have done to support care homes in response to COVID-19. By learning from the measures taken during the first wave, governments and the sector itself have an opportunity to put the sector on a stronger footing from which to strengthen long-term care systems.

Last updated on hub: 15 January 2021

Children and COVID19: understanding impact on the growth trajectory of an evolving generation

Children and Youth Services Review

The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5–7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0–18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.

Last updated on hub: 15 January 2021

With 2020 Vision: lessons for health, care and well-being – social care

University of South Wales

This paper attempts to identify how social care has been affected operationally by the pandemic, the extent to which it has been perceived and presented as a key service, and the implications of Covid for the organisation and delivery of social care services in the future. All aspects of social care have been impacted and the attention of those involved in arranging and delivering care and support has had to switch to new and unprecedented challenges. The paper contends that it is disappointing that recognition of social care as an essential key service was not properly highlighted publicly until many weeks after the government’s response to the pandemic began. There is no greater example of how people receiving care and support have been affected by the response to Covid than the case of care homes. Why they were apparently not prioritised from the outset as an obvious high-risk setting remains a perplexing question. Furthermore, Staff working in all care settings have seen their caring roles affected by new risks for themselves and those in their care. The paper argues that the eventual assessment of Covid’s impact on social care must take account of how austerity has affected the strength and sustainability of the sector over the last decade or so and its resilience moving forward.

Last updated on hub: 13 January 2021

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