COVID-19 resources on Infection control

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Discounting older disabled people in care homes during the COVID-19 pandemic: the English government’s breaches of care, equality and human rights laws

University of York

This article considers government responses to older people living in English long-term care and nursing homes during the COVID-19 lockdown in Spring/Summer of 2020. Care homes are total institutions, closed spaces from which residents rarely leave, and are occupied by some of the least powerful and most vulnerable people in our society. As such they always require attention, especially during national emergencies. However, during the initial COVID-19 lockdowns in 2020 many concerning acts of commission/omission occurred in relation to care homes. Specifically, there were: belated and inadequate social policies; excessive and unreported deaths; insufficient health protections (delayed lockdowns; insufficient protective equipment and testing; untested hospital transfers); family and friend exclusions; inadequate end-of-life planning (poor treatment and care; exclusion of loved ones a faith representatives; unlawful use of ‘Do Not Attempt Resuscitation (DNAR)’ Orders; potentially unlawful constraints upon freedom of movement; and insufficient regulatory scrutiny. This article considers each of these concerns in relation to care, equality and human rights legislation, arguing that the English government behaved unlawfully, reflecting wider systemic cultural devaluation of older and disabled lives.

Last updated on hub: 16 June 2021

Guidance on reopening of day services for older people in context of COVID 19 vaccination programme

Health Protection Surveillance Centre

In the context of the COVID-19 vaccination programme the reopening of key services that support older people is now being examined. Loss of access to these services has had a very significant impact on the health and wellbeing of older people. Vaccination has changed the balance of risk and benefit associated with access to these services so that resumption of these services is now appropriate. The aim of this guidance is to support reopening of services while acknowledging ongoing risk of COVID-19 and community transmission pending deployment of the full national COVID-19 vaccination programme. The guidance reflects: preparedness plans prior to opening; protocols to guide service user transportation to and from day centres; resumption of activities in the day centre with lowest practical risk; management of potential cases / outbreaks where identified.

Last updated on hub: 16 June 2021

National discussions on mandatory vaccination for long-term care staff in 24 countries

International Long-term Care Policy Network

Following the enormous impacts of Covid-19 among people who use long-term care, most countries have prioritised people who live and work in care homes for vaccinations. In some countries there is also a debate on whether it should be compulsory for people working in this sector (or particularly in care homes) to be vaccinated, or whether there are other measures that may be more acceptable and effective at increasing vaccination take-up and may not deter people from working in the sector. This post provides an overview of the situation in May 2021 in 24 countries. This review finds that most countries have stated that staff working in long-term care would be among the first groups to be prioritized for Covid-19 vaccinations but in many countries there have been practical difficulties in facilitating access to vaccination for this group which, added to some vaccine hesitancy, has resulted in lower vaccination rates for staff than ideal. Vaccines are mandatory for healthcare personnel in Italy. While many countries have debated whether to make Covid-19 vaccinations mandatory for certain groups, including people working in long-term care, none of the 24 countries for which we have information have adopted this as a national policy, although there are some local/regional examples where this has become the practice or where providers require that their employees are vaccinated. There are a few examples of other vaccinations (such as flu) being made mandatory for staff working in long-term care and/or health care. Most countries do not have data systems that support monitoring of vaccination rates among staff working in the long-term care sector.

Last updated on hub: 16 June 2021

The difficult balance between ensuring the right of nursing home residents to communication and their safety

International Journal of Environmental Research and Public Health

The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.

Last updated on hub: 15 June 2021

Preventing COVID-19 spread in closed facilities by regular testing of employees - an efficient intervention in long-term care facilities and prisons?

PLoS ONE

Background: Different levels of control measures were introduced to contain the global COVID-19 pandemic, many of which have been controversial, particularly the comprehensive use of diagnostic tests. Regular testing of high-risk individuals (pre-existing conditions, older than 60 years of age) has been suggested by public health authorities. The WHO suggested the use of routine screening of residents, employees, and visitors of long-term care facilities (LTCF) to protect the resident risk group. Similar suggestions have been made by the WHO for other closed facilities including incarceration facilities (e.g., prisons or jails), wherein parts of the U.S., accelerated release of approved inmates is taken as a measure to mitigate COVID-19. Methods and findings: Here, the simulation model underlying the pandemic preparedness tool CovidSim 1.1 (http://covidsim.eu/) is extended to investigate the effect of regularly testing of employees to protect immobile resident risk groups in closed facilities. The reduction in the number of infections and deaths within the risk group is investigated. The simulations are adjusted to reflect the situation of LTCFs in Germany, and incarceration facilities in the U.S. COVID-19 spreads in closed facilities due to contact with infected employees even under strict confinement of visitors in a pandemic scenario without targeted protective measures. Testing is only effective in conjunction with targeted contact reduction between the closed facility and the outside world—and will be most inefficient under strategies aiming for herd immunity. The frequency of testing, the quality of tests, and the waiting time for obtaining test results have noticeable effects. The exact reduction in the number of cases depends on disease prevalence in the population and the levels of contact reductions. Testing every 5 days with a good quality test and a processing time of 24 hours can lead up to a 40% reduction in the number of infections. However, the effects of testing vary substantially among types of closed facilities and can even be counterproductive in U.S. IFs. Conclusions: The introduction of COVID-19 in closed facilities is unavoidable without a thorough screening of persons that can introduce the disease into the facility. Regular testing of employees in closed facilities can contribute to reducing the number of infections there, but is only meaningful as an accompanying measure, whose economic benefit needs to be assessed carefully.

Last updated on hub: 15 June 2021

How societal responses to COVID-19 could contribute to child neglect

Child Abuse and Neglect

Background: The ecosystemic approach to children’s needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children. Objective: The purpose of this study is to examine parents’ reports on the response their children received to their needs during the COVID-19 crisis. Methods: During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs. Results: Compared to parents of younger children, parents of older children reported less fulfilment of their child’s needs in three measured domains, namely cognitive and affective, security, and basic care needs. Conclusion: These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.

Last updated on hub: 14 June 2021

Adult social care in England, monthly statistics: June 2021

Department of Health and Social Care

This statistical bulletin provides an overview on a range of information on social care settings, with a focus on the impact of COVID-19. This report provides newly published information on: selected infection prevention control (IPC) measures in care homes at national, regional and local authority (LA) level; staffing levels in care homes at national, regional and LA level; personal protective equipment (PPE) availability in care homes at national, regional and LA level; testing for COVID-19 in care homes at national, regional and LA level. This report also includes previously published statistics on first and second dose uptake of COVID-19 vaccinations in adult social care settings. As of 25 May 2021, the proportions who had received both doses of the COVID-19 vaccine were: 88.0% of residents and 65.7% of staff of older adult care homes; 79.4% of residents of younger adult care homes; 61.1% of staff of younger adult care homes, 48.0% of domiciliary care staff and 22.7% of staff employed in other social care settings.

Last updated on hub: 14 June 2021

Adult social care in England, monthly statistics: May 2021

Department of Health and Social Care

This statistical bulletin provides an overview on a range of information on social care settings, with a focus on the impact of COVID-19. This report provides newly published information on: selected infection prevention control (IPC) measures in care homes at national, regional and local authority (LA) level; staffing levels in care homes at national, regional and LA level; testing for COVID-19 in care homes at national, regional and LA level. This report also includes previously published statistics on first dose uptake of COVID-19 vaccinations in adult social care settings. As of 27 April 2021, the proportions who had received the first dose of the COVID-19 vaccine were: 94.6% of residents and 81.0% of staff of older adult care homes; 89.8% of residents of younger adult care homes; 77.5% of staff of younger adult care homes, 72.8% of domiciliary care staff and 70.7% of staff employed in other social care settings.

Last updated on hub: 14 June 2021

How Brazilian therapeutic communities are facing COVID-19?

Therapeutic Communities: the International Journal of Therapeutic Communities

Purpose: This paper aims to reflect upon the findings of a fast-track study carried out in April 2020, by the Brazilian Federation of Therapeutic Communities, focused on the impact of the first measures taken by the Brazilian therapeutic communities (TCs) in response to COVID-19. Design/methodology/approach: An electronic survey was disseminated to TCs in the different regions of Brazil through online platforms. A total of 144 TCs responses were used in the final analysis. The survey collected the following information: suspected and confirmed cases of COVID-19 (only one case of COVID-19 was confirmed), changes in treatment protocols, the impact in admissions and daily activities and the safety measures adopted to stop or reduce the transmission between residents, families and staff. Findings: The survey successfully collected general data regarding interruptions (82.6% of TCs interrupted admissions, 100% of TCs interrupted volunteer’s activities, 94% of TCs interrupted family visits and 93% of TCs interrupted external activities). Research limitations/implications: The caveat of this study is the fact that there were tight deadlines for the TCs to generate their responses and the limited availability of staff to answer long surveys. Because of this, the study could not explore other important qualitative data. The results were shared in Brazil and Latin America with the staff of TCs, the national Federations of Therapeutic Communities and government agencies linked with them, in all Latin America. Originality/value: This research aims to contribute to the adoption of developed prophylaxis and prevention protocols in response to COVID-19.

Last updated on hub: 11 June 2021

Third quarterly report on progress to address COVID-19 health inequalities

Her Majesty's Government

This is the third quarterly report on progress to address the findings of Public Health England’s (PHE) review into disparities in the risks and outcomes of COVID-19. The report summarises work across government and through national and local partnerships, to improve vaccine uptake among ethnic minorities. A data-informed approach, targeted communication and engagement and flexible deployment models are the cornerstones of vaccine equalities delivery. This approach includes measures to support vaccinations during Ramadan, extending the use of places of worship as vaccination centres to around 50 different venues with many more acting as pop-up sites, delivering out of hours clinics, outreach into areas of lower uptake and encouraging family group vaccinations for those living in multi-generational homes who may be at increased risk of contracting and transmitting COVID-19 infection. This report also summarises progress with the Community Champions scheme that was launched in January, outlining activity across the 60 local authorities that received funding through this scheme. By the end of the second month, there were over 4,653 individual Community Champions working on the programme, who are playing a vital role in tackling misinformation and driving vaccine uptake. Communications and cross-government COVID-19 campaign activity over the last 3 months has continued to focus on encouraging vaccine uptake as the rollout expands. While positive vaccine sentiment has increased over time, there is still hesitancy to be addressed. The increase in the Black population is substantial but vaccine confidence is still lower in this group than any other. This remains a particular issue for Black healthcare workers.

Last updated on hub: 09 June 2021

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