COVID-19 resources on infection control

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Deaths of people identified as having learning disabilities with COVID-19 in England in the spring of 2020

Public Health England

This review analyses the available data on the deaths from COVID-19 of people identified as having learning disabilities. The review 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

Deaths of people with learning disabilities from COVID-19

University of Bristol

This report describes the circumstances leading to death for a representative sample of 206 adults with learning disabilities. The majority of the 206 deaths (79%, n=163) were attributable to COVID-19: 27% of the total number of COVID-19 deaths notified to the LeDeR programme from 2nd March 2020 – 9th June 2020. Forty-three (21%) of the 206 deaths were attributed to other causes and are included as a comparator group – 6% of the total deaths from other causes occurring during this period. The study finds that there is a striking difference in age at death between COVID-19 deaths in the general population compared with people with learning disabilities. In the general population of England and Wales, 47% of deaths from COVID-19 were in people aged 85 years and over. Of all deaths of people with learning disabilities from COVID-19 notified to the LeDeR programme, just 4% were aged 85 years and over. A third (35%) of those who died from COVID-19 lived in residential care homes, rising to almost half of those with Down’s syndrome. A quarter (25%) lived in supported living settings. Priority must be given to supporting measures to prevent the spread of COVID-19 in these settings. People who died from COVID-19 were more frequently reported to have respiratory conditions (72%), compared to those who died from other conditions (60%). Access to healthcare that was problematic for some people who died from COVID-19 included: the responsiveness of NHS111; access to COVID-19 tests; and access to specialist learning disability nurses. Ensuring that these services are fully accessible to people with learning disabilities, their families and paid carers would improve service provision.

Last updated on hub: 16 November 2020

Supporting wellbeing of older people when shielding / isolating

Public Health Wales Observatory

This summary outlines action that the evidence suggests may help to support the mental wellbeing of older adults at this time. It is intended for organisations involved in supporting older people. Four systematic reviews were identified from a search of the literature conducted in June 2019. Most provided data from qualitative research and captured the perceptions of older people on quality of life, meaningful occupations and experience of technology. Reflecting on the findings from these reviews, the analysis suggests a number of actions for consideration by those involved in supporting older people. These actions focus on: maintaining autonomy and control; occupation and social interaction; access to the internet; and money and resources.

Last updated on hub: 16 November 2020

Coronavirus and the social impacts on disabled people in Great Britain: September 2020

The Office for National Statistics

Indicators from the Opinions and Lifestyle Survey on the social impact of the coronavirus (COVID-19) pandemic on disabled people in Great Britain. This release uses two waves of survey results covering 24 September to 4 October 2020 and includes indicators broken down by impairment type. Insights from qualitative research commissioned by the Cabinet Office Disability Unit and conducted by Policy Lab with disabled people help illustrate how the survey indicators can be experienced by disabled people in day-to-day life. The data shows that over 8 in 10 (83%) disabled people compared with around 7 in 10 (71%) non-disabled people said they were “very worried” or “somewhat worried” about the effect that the coronavirus (COVID-19) pandemic was having on their life in September 2020. Around 5 in 10 (50%) disabled people who were receiving medical care before the coronavirus pandemic began, indicated that they were either currently receiving treatment for only some of their conditions (29%), or that their treatment had been cancelled or not started (22%), compared with less than 3 in 10 (27%) of non-disabled people who had a physical or mental health condition or illness and were receiving care before the pandemic. All well-being ratings of disabled people remained poorer in September 2020 compared with a similar period prior to the coronavirus pandemic; almost half (47%) of disabled people reported high anxiety (a score of 6 out of 10 or higher) in September 2020 compared with less than a third (29%) of non-disabled people. A larger proportion of disabled people (83%) than non-disabled people (77%) supported “strict” or “very strict” enforcement by police of government rules aimed at combatting the coronavirus such as social distancing.

Last updated on hub: 16 November 2020

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

Dealing with COVID-19 outbreaks in long-term care homes: a protocol for room moving and cohorting

Article published in the journal Infection Control & Hospital Epidemiology by Kain, D. et al, October 2020. A letter to the editor that sets out some principals of room movements in long-term care homes during the COVID-19 in the context of Canadian care homes.

Last updated on hub: 13 November 2020

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Citation: Burton, J. K. et al. (2020). Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK. The Lancet Healthy Longevity, 1(1), e21-e31.Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This study aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: The researchers did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. This study obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and the researchers analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. This study calculated excess deaths (both COVID-19-related and non-COVID-19-related), defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Findings: Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. Interpretation: The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from the findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

Last updated on hub: 13 November 2020

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

medRxiv

This article is a preprint and has not been peer-reviewed. Background Draconic 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), where in parts of the US, 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 in order to protect immobile resident risk groups in closed facilities. The reduction in the number of infections and deaths within the risk group are investigated as well as the potential economic gain resulting from savings in COVID-19 related treatment costs in comparison to costs resulting from the testing interventions. Our simulations are adjusted to reflect the situation of LTCFs in the Federal Republic of Germany. The probability is nearly one that COVID-19 spreads into closed facilities due to contact with infected employees even under strict confinement of visitors in a pandemic scenario without targeted protective measures. Regular screening of all employees by PCR tests provides a significant reduction of COVID-19 cases and related deaths in LTCFs. While the frequency of testing (testing rate) and the quality of tests have noticeable effects, the waiting time for obtaining test results (ranging from 12 up to 96 hours) hardly impacts the outcome. The results suggest that testing every two weeks with low-quality tests and a processing time of up to 96 hours yields a strong reduction in the number of cases. Rough estimates suggest a significant economic gain. Conclusions The introduction of COVID-19 in closed facilities is unavoidable without thorough screening of persons that can introduce the disease into the facility. These measures provide an economically meaningful way to protect vulnerable risk groups characterized by an elevated risk of severe infections in closed facilities, in which contact-reducing measures are difficult to implement due to imminent unavoidable close human-to-human contacts.

Last updated on hub: 13 November 2020

Risk factors associated with SARS-CoV-2 infection and outbreaks in long term care facilities in England: a national survey

medRxiv

This article is a preprint and has not been peer-reviewed. This study aimed to identify risk factors for SARS-CoV-2 infection and outbreaks in Long Term Care Facilities (LTCFs). It was a cross-sectional survey of all LTCFs providing dementia care or care to adults >65 years in England with linkage to SARS-CoV-2 test results. Findings: 5126/9081 (56%) LTCFs participated in the survey, with 160,033 residents and 248,594 staff. The weighted period prevalence of infection in residents and staff respectively was 10.5% (95% CI: 9.9-11.1%) and 3.8% (95%: 3.4-4.2%) and 2724 LTCFs (53.1%) had ≥1 infection. Odds of infection and/or outbreaks were reduced in LTCFs that paid sickness pay, cohorted staff, did not employ agency staff and had higher staff to resident ratios. Higher odds of infection and outbreaks were identified in facilities with more admissions, lower cleaning frequency, poor compliance with isolation and “for profit” status. Interpretation: Half of LTCFs had no cases suggesting they remain vulnerable to outbreaks. Reducing transmission from staff requires adequate sick pay, minimal use of temporary staff, improved staffing ratios and staff cohorting. Transmission from residents is associated with the number of admissions to the facility and poor compliance with isolation.

Last updated on hub: 13 November 2020

Long-term care facilities and the coronavirus epidemic: practical guidelines for a population at highest risk

Journal of the American Medical Directors Association

Editorial. Considers why long-term care preparedness for COVID-19 is important. Comments on the practical considerations for reducing the risk of transmission in the workplace; ensuring protection of healthcare workers; maintaining health care infrastructure; the assisted living experience; the blame game and what next? Suggests that appropriate preparedness includes five key elements: 1) reduce morbidity and mortality among those infected; 2) minimize transmission; 3) ensure protection of health care workers; 4) maintain health care system functioning; and 5) maintain communication with worried residents and family members

Last updated on hub: 13 November 2020

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