COVID-19 resources on Infection control

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Covid-19 infection and attributable mortality in UK long term care facilities: cohort study using active surveillance and electronic records (March-June 2020)

medRxiv

This article is a preprint and has not been peer-reviewed. The lead researcher was Peter F Dutey-Magni. Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. This study used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. This study modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection.

Last updated on hub: 31 August 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 the female health and care workforce: survey of health and care staff for the Health and Care Women Leaders Network, August 2020

NHS Confederation

This report sets out the findings of a survey to understand the impact the Covid-19 pandemic has had on women working across health and care services. A total of 1,308 women responded to the survey. While the overwhelming majority of respondents to the survey were white, there were some key differences in the findings in relation to participants from black and minority ethnic (BME) backgrounds. The survey found that most respondents – almost three-quarters – had reported that their job had a greater negative impact than usual on their emotional wellbeing as a result of the pandemic, and more than half had suffered a negative impact on their physical health. Staff from BME backgrounds also reported feeling traumatised by the disproportionate impact of the virus, compounded by concerns over risk assessments not being performed in a timely manner, if at all. In addition, the analysis shows that PPE availability and training have been broadly adequate, but could be stronger; managerial support has been strong, but some issues emerge over sharing concerns; struggles with work-life balance since lockdown started; some respondents had safety concerns when working from home. The report also draws out some of the positive experiences, such as opportunities for learning and the strength of support many have received from their managers. Recommendations to improve the working conditions for women in health and care services are included.

Last updated on hub: 27 August 2020

Overview of adult social care guidance on coronavirus (COVID-19)

Department of Health and Social Care

Brings together information for adult social care providers on COVID-19 guidance and support. The resource covers help with infection prevention and control; what to do when you suspect an outbreak; reporting an outbreak; caring for patients discharged from hospital or another social care facility; visits to care homes and other care settings; information for providers of care in supported living and domiciliary settings; how to get social care workers and people in care homes tested; managing care workers during COVID-19; securing PPE and related supplies; help for holders of direct payments, commissioners and care providers; information for social care providers on mental health and wellbeing and financial support; Capacity Tracker and guidance on using it; information for unpaid carers; easements of the Care Act; COVID-19 ethical framework for adult social care; caring for people who are protected by safeguards under the Mental Capacity Act 2005, including the deprivation of liberty safeguards; steps to take following a coronavirus-related death of a person who worked in adult social care. [First published 25 August 2020; Last updated 23 June 2021]

Last updated on hub: 27 August 2020

Impact of infection outbreak on long-term care staff: a rapid review on psychological well-being

Journal of Long-Term Care

Context: Older people and people with an intellectual disability who receive long-term care are considered particularly vulnerable to infection outbreaks, such as the current Coronavirus Disease 2019. The combination of healthcare concerns and infection-related restrictions may result in specific challenges for long-term care staff serving these populations during infection outbreaks. Objectives: This review aimed to: (1) provide insight about the potential impact of infection outbreaks on the psychological state of healthcare staff and (2) explore suggestions to support and protect their psychological well-being. Method: Four databases were searched, resulting in 2,176 hits, which were systematically screened until six articles remained. Thematic analysis was used to structure and categorise the data. Findings: Studies about healthcare staff working in long-term care for people with intellectual disabilities were not identified. Psychological outcomes of healthcare staff serving older people covered three themes: emotional responses (i.e., fears and concerns, tension, stress, confusion, and no additional challenges), ethical dilemmas, and reflections on work attendance. Identified suggestions to support and protect care staff were related to education, provision of information, housing, materials, policy and guidelines. Limitations: Only six articles were included in the syntheses. Implications: Research into support for long-term care staff during an infection outbreak is scarce. Without conscious management, policy and research focus, the needs of this professional group may remain underexposed in current and future infection outbreaks. The content synthesis and reflection on it in this article provide starting points for new research and contribute to the preparation for future infection outbreaks.

Last updated on hub: 21 August 2020

Efficacy of a test-retest strategy in residents and health care personnel of a nursing home facing a COVID-19 outbreak

Journal of the American Medical Directors Association

Objective: To assess the American Testing Guidance for Nursing Homes (NHs)—updated May 19, 2020—with a new COVID-19 case. Design: Case investigation. Setting and Subjects: All 79 residents and 34 health care personnel (HCP) of an NH. Methods: Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay–based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. Results: A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2–positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. Conclusions and Implications: This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.

Last updated on hub: 21 August 2020

Uncovering the devaluation of nursing home staff during COVID-19: Are we fuelling the next health care crisis?

Journal of the American Medical Directors Association

Editorial. As the COVID-19–related mortality rate of nursing home residents continues to rise, so too will the rates of mortality and morbidity of staff who care for them. The COVID-19 pandemic has also revealed and accentuated the ageism and devaluing of older people pervasive in many societies. The editorial suggests that we need to better protect and support the frail older adults residing in nursing homes, their relatives, and the workforce (staff and leadership) that provide care in these settings. The editorial goes on to provide some considerations for nursing home leaders and regulators to support the health and well-being of nursing home staff and residents. These are categorized into 4 main areas: clear direction and guidance, keeping staff healthy, human resource policies, and implementing new clinical changes. The editorial concludes that the key message for policy makers is that we need to bring to the forefront the critical role of leaders and their capacity to effectively lead in nursing homes, which are complex environments.

Last updated on hub: 21 August 2020

Opening schools safely in the COVID-19 era: school social workers’ experiences and recommendations: a research brief for policymakers

University of California

This policy brief presents data from a national survey of school social workers (SSWs) exploring the impacts of COVID-19 school disruptions in the United States. It highlights the need to address hunger, housing instability, health, mental health and other challenges that a high proportion of students are experiencing, especially low-income students. From a capacity perspective, SSWs in the study report that sizable proportions of students are suffering from difficulties due to discrimination, family discord, child abuse, language difficulties, and community violence; SSWs are called to perform the same Herculean tasks that face other educators and school staff in this pandemic but there are concerns that this work is being done with few resources, outside supports, or governmental guidance; greater supports, like the personal protective equipment (PPE) given to health care professions, are needed for educational staff and social workers who are on the front lines of the pandemic. The paper argues that given SSWs’ ecological view and historical commitment to under-served communities, their voices should be heard in planning school reopening. Based on the findings from the survey, the brief recommends the following actions: create a rapid-response team of school professionals from multiple fields to develop a systemic, national response to support schools; prioritise the response to the most hard-hit schools and communities; develop three evidence-driven national plans, one for in-person instruction, one for online, and one for a hybrid; provide additional supports and resources, including more trained social workers sent to the most stressed schools and communities.

Last updated on hub: 20 August 2020

Opening schools safely in the COVID-19 era: school social workers’ experiences and recommendations: technical report

University of California

This report summarises initial findings from a national survey of school social workers’ (SSWs) (n=1,275) practising across the United States. Findings highlight serious challenges facing schools, school staff, and students. Some of these challenges are specifically related to educational goals, but many are related to basic needs that are a prerequisite to academic and social emotional learning. Many SSWs reported having limited to no contact with some of their students because they couldn’t establish a connection with them during the shutdown; they expressed significant concerns about the motivation and engagement of the 81% of students with whom they did work; and reported that a majority of their students and families had profound, immediate, and urgent needs related to food insufficiency (62.4%), housing instability (42.8), health issues (61.6%), individualised student tutoring (62.3%), and mental health services (75.7%). While findings speak to the dynamism and creativity of SSWs in this pandemic, findings also revealed many troubling and serious issues that need immediate attention as schools plan how to re-open in the fall. Implications for professional development, district supports, university training, and a national effort to reconnect a potential “lost generation of students” are discussed and outlined. The report makes a series of recommendations, including a call to action for the various school social work organisations to join together to help SSWs and their school communities respond effectively as the pandemic continues to impact on the academic and social experience of children.

Last updated on hub: 20 August 2020

The neglect of adult social care during Covid-19

British Medical Association

An examination of the impact of Covid-19 on social care, focusing on failings in testing, namely hospital discharges of untested patients into care homes, and the inadequate provision of personal protective equipment. The article recognises the complex and fragmented structure of adult social care but argues that these complexities cannot be resolved by the NHS “taking over” social care; rather efforts should be renewed to achieve a lasting settlement for social care, understanding and valuing it in its own right, not just as an adjunct to the NHS.

Last updated on hub: 20 August 2020

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