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politicalbetting.com » Blog Archive » The Index Case. Dealing with Covid-19 inside our care homes
Regular readers of the comments on this site will know that over the weekend, my father died after contracting coronavirus in his care home.
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I am so sorry Nigel.
It must be especially difficult at this time. My mother's husband is being cremated this morning. The funeral was delayed and is happening far away from their home in London because of all the extra deaths, none of his family can attend because of coronavirus. It's very sad.
On the policy of sending people from hospitals to care homes without being sure that they aren't going to infect people with coronavirus, it really does seem to be completely stupid and I just can't get my head around what the reason might be - especially when we are told that there are empty beds in hospitals at the moment. I hope this issue urgently gets the attention it needs.
As I said on an earlier thread this is, to me, by far the very worst failing of this Government - and like others I say that as someone who thinks that generally they have performed as well as possible in most areas of this crisis. But for this there is no excuse and the consequences are so severe that someone - whether Hancock or ultimately Boris - must be held accountable.
It is not beyond the wit of man to have come up with a scheme that would prevent these deaths. Whilst it would have been disruptive, they could easily have arranged for specific care homes to be assigned as reception centres for those with, or suspected of having, CV with the other residents moved to other homes for the duration of the crisis. It might be too late to do this now given that so many homes are now infected and moving people around might make it worse. But in that case they need to sort out some other form of secure reception for those coming out of hospital with the virus.
And yes, they need to get a handle on testing in homes without which we are completely blind. If they can do that then perhaps more of these unnecessary deaths can be avoided.
My Trust swabs all patients going to Care homes 48 hours before discharge now. Paradoxically, we have plenty of beds because of the Covid-19 closure of nearly all planned surgery, so no particular issue holding on to patients.
I think this the most egregious but not the only consequence of government policy on testing. The return of Health and Social care workers who have self isolated without swabbing is another focus of transmission. Dr Rosena has been banging on about it for weeks, with no adequate response. We will never get the R number down with this sort of casual disregard to transmission.
https://twitter.com/DrRosena/status/1246113809632309262?s=09
It is going to be very hard to convince patients to return to non Covid-19 clinics and wards when hospitals are becoming the major source of infection.
The PPE crisis is not just about staff, it is about cross infection between patients.
This policy really is perplexing. When someone or some institution takes an action that seems obviously crazy, I try to understand why they did it: what information that might have that I don't, or how their goals differ from mine. Nothing makes sense here. I imagine it will be probed rather thoroughly in the inevitable public enquiry that will follow. In the shorter term it's only the Press and the Opposition who can hold to account, but both are unfocused.
--AS
This is a great debut piece. There’s much about the national policy that doesn’t make sense.
Inevitably the speculation about Hancock getting the heave-ho has now started, but that would be no more than a hollow gesture and worse than useless unless a replacement can be found who is capable of managing the fallout from this national emergency any better. I'm pessimistic about resolving the PPE problem, but at least that might ease once the benefits of various lockdowns around the world become evident and there are fewer CV patients left to deal with. Testing, on the other hand (along with the track and trace capability, as NigelB reminds us,) needs to be rolled out on a vast scale or else we are all stuck.
Once the total number of CV patients is reduced to a more manageable level, do you think it would be practical to segregate them into designated treatment centres (possibly by using the mostly empty Nightingale hospitals) so that other patients might feel more comfortable about coming back?
The assumptions were that Acute hospitals were going to be swamped, hence the requisition of private hospitals, building of the Nightingales, recruitment of NHS volunteers and retirees etc.
It was felt that the pressure on beds would be enormous and hence the need for speedy discharges, and the policy that is so eloquently written about in the header. There is normally such pressure on beds that there is a hospital culture aimed at speedy discharge, that doesn't seem to have changed.
The reality is that we have lots of beds. The private hospitals are hardly being used, nor the Nightingales
For the next phase we need to admit all cases and keep them for 14 days post symptom resolution in isolation hospitals (such as the Nightingales, or under used hotels). That is the way to break transmission.
There have been many tedious and repetitive questions asked of the Health Secretary at the regular press briefings. At none of them I can recall has he been asked “in how many care homes with Covid outbreaks, has the index case been a patient recently discharged from hospital ?”
One of the side effects of following this site is that I sometimes lose track of what's happening on here and what's happening in the MSM. Care homes are being talked about by journalists, but only in terms of the statistics.
Hopefully some of the MSM read your piece and start talking about this issue.
Question. Everywhere else seems to understand that mass testing would be a Good Thing. Here we seem to be doing less than even the most minimal emergency testing.
Why?
The other issue is PPE. This is not just important in protecting staff. It is critical for it to be changed between patients to prevent cross infection. That requires vast quantities. Wearing the same kit all session protects the workers but not the patients.
https://twitter.com/benatipsosmori/status/1252476096735580160?s=21
I've been out of the field for a long time, but in the late 90's and 00's I worked around Care Homes, and I was aware of the relationship between Homes and hospitals. It wasn't, in my experience one of co-operation; for whatever reason hospitals often didn't 'talk' to Homes, and often didn't take Home's concerns seriously when they did. Equally Homes would sometimes just pass problems to hospitals, on the grounds that whatever it was was outside their competence.
The position was made worse by the Lansley reforms, enacted in the early years of the Coalition, whereby 'Health' and 'Social Care' were even further separated. In my view, when all this is over, the State should have a good hard look at the relationship between Health and Social Care, particularly as it applies in later life.
In the meantime, Nigel, I wish you and your family well; you obviously cared a lot about your father; celebrate and be thankful for, his life. The time for any recriminations isn't now; it's when you've all had time to think.
The problem is worse in the areas without the confirmed cases, where people still might be infected. My wife's hospital tests every patient coming in for any reason, but if the level of (asymptomatic/very mild) infection in the general population is significant, then false negatives are going to be a problem in people coming in for other health issues.
People have to go out for food. If they do so and see reduced or no restrictions coupled with lots of people going out quite merrily then I imagine a lot of people's minds will change pretty quickly.
The exceptions would be those who are naturally more worried by things, and those with underlying medical conditions/old age (plus those sharing a home with such vulnerable people).
The story told is that the U.K. govt recognised the threat to PPE early and called for massive upstep in production under “contingency procedures”. So these supplies only actually existed due to early actions under the preparedness strategy. Actions which are now (presumably) keeping the French need well stocked.
But because the U.K. failed to anticipate the possibility that the supply might be insecure they didn’t take action to have backups (particularly from the U.K. - if we have potential U.K. capacity). And have been playing catch up ever since.
It has long been argued that there are significant benefits including cost savings to be had from integrating health and social care, but under current arrangements that is exceptionally difficult, even where local health and council authorities have good working relationships. Sadly, the incentives for both to leave problems and costs on the other side of the fence are sometimes just too strong.
I don’t think anyone would argue that local councils should manage the health service. Hence the solution must be to take social care outside of the local authority ambit, and find some structural way to run it alongside local health services.
That doesn’t mean I’ll be reckless or naive about ongoing social interaction, however.
I’d be nervous if I was a wet pub relying on high density footfall.
Gastropubs relying on booked sittings? I might have a bit more hope.
The other issue is common areas. Entrances, corridors, lift lobbies, lifts themselves. These are very hard to divide.
My top tip is never use a hospital lift, particularly one big enough for bed transfers. Always the stairs and never touch the bannisters or doors. It doesn't work for older or disabled people though.
https://twitter.com/xtophercook/status/1252479583519158273?s=09
The article that it comes from has some great data on regional breakdown. The hardest hit areas are touristy small towns, and touristy small university cities. The Ssouthwest, Cumbria and North Wales in particular.
https://twitter.com/xtophercook/status/1252478585409060864?s=09
We already had an entirely remote business, but we won't be doing our monthly meet-ups in London or any client F2F; and I'll be home schooling until we see what second and third phases look like (regardless of large scale availability of vaccine).
My fear is spontaneous parties breaking out in the large parks in cities, and I think it would be difficult for the authorities to prevent this without crazy footage of the police dragging people into vans.
I am generally inclined to be supportive of the Government's handling of this crisis. Covid-19 does not come with an Operating anual on how to deal with it. You have to forgive some trial and error. But this aspect, of care homes, has always looked to be the weakest link. An ongoing failure is and will continue to costs lives. Most egegriously, it is costing the lives of the very vulnerable that the lockdown was meant to protect. It fundamentally undermines the point of us having been stuck in our homes for four weeks and three more to come before it starts to be lifted. Boris, Hancock - get this sorted, if you don't want "care homes" to be what does for you with the voters.
I commend NigelB for his self-control and candour in writing this piece. I feel very fortunate in many ways that my mother died from pneumonia in her care home in December. If she hadn't, I have no doubt that I too would be going through the constant worry of awaiting for her demise from Covid.
It’s like those people who argued against Osborne’s pension reforms on the basis that the newly retired would go straight out and irresponsibly buy a Porsche.
They didn’t. People (vast majority) are far more sensible than you give them credit for.
Yet it is starting to emerge that the "when" will be 'not for some time' and the "normal" wont be normal 'as we previously knew it'. When the penny of the likely longevity of economic disruption drops into the markets, they will surely fall again.
As I suggested at the weekend, investors are probably looking at a second chance to sell out, adopt defensive positions, and/or trade on a fall, according to preference and your own research.
Not sure what the trigger would be for the latter.
Public transport is back to normal this week, and larger funeral gatherings are allowed again.
Schools will start to reopen the week after next, but not kindergartens. My five-year-old hasn't seen another child in 5 weeks (children don't start school until they are 6), so will start accidentally meeting a friend in a local park soon. The advice from central govt is not to reopen kindergartens until august, but there is going to be a LOT of pressure to open them earlier. Yes, I don't want to get, or spread, coronavirus, but my son not seeing any other children is starting to affect him badly. I actually think it might be easier for older children who are more used to contacting friends via technology. And usually easier for children with siblings to play with.
The alternative case is that QE and other forms of money printing will drive up asset values such as equities.
I was 90% cash at the end of Feb, but am about 80% in equities now, but not in consumer facing stocks, house builders or oil.
There may well be another dip, but I am pretty confident that buying at a 40-50% discount on the beginning of the year will serve me well when I cash out.
Anecdotally each side seems to play tennis, with the patient as the ball.
This PPE company, wasn't actually a PPE company. It seems until a few weeks ago, it was a property company. They appear to have seen a business opportunity and have somehow got into the business of acting as a go-between for importing a shipment of PPE from China.
I am betting that the government thought they had another chancer on the phone, claiming they could get PPE from China. If they searched them online, all they would get is a property company.
Doing a google of the lady behind the company, there is zero evidence she has any experience in PPE procurement. It is 100% property development and having been on a reality tv show.
They have been inundated with chancers offering stuff and already got burned. When they said they needed ventilators, they had a load of people telling them well I know somebody in China who can get you 5,000. Can you? Do you know exactly what type of ventilators are? What spec? etc? Well....
The position also varies considerably by sector. Shares in bombed out sectors such as transport and travel are still hugely down, but there are other sectors where the recent recovery has made up a lot of ground.
https://www.bbc.com/news/business-52364811
I also am only speculating with savings. I need not rely on them for a pension.
But, yes, I am at heart an optomist. I think that the combination of Covid-19 and No Deal Brexit (or minimal deal) will be brutal for parts of our domestic economy.
Most of my equities are in companies with strong balance sheets, and earning in Forex, so the domestic economy won't bother them too much. I also think the Far East recovery is already underway, albeit a bit patchy.
I think it will be at least 2022 before we see equities back to what they were in Jan 2020, but I think that I bought some good value stocks these last few weeks.
If it is negligence it is nigh on off the scale and other reasons are available.
I have been wondering what should have happened to care homes at the beginning. Completely locking them down, banning all visitors and requiring the staff to sleep on the premises? Is there an alternative approach that would have kept the virus out of care homes?
You police and make an example of a small proportion of the 350k and let social approval do the rest.
It’s how societies work. You can’t keep them all locked down in purgatory “just in case”.
I found Swedens Statistics Offic page and they do deaths per day and they currently go up to the 17th of April.
Here is the delta of 2020 deaths vs 2015-2019. I have removed the leap year anomaly which resulted in a massive spike on the29th of Feb as the Swedish data averaged the 2016 29th Of Feb over 5 years
I haven't trimmed the left hand side of the data so the massive drop is reporting lag. With a weeks worth of trim, so taking to the 10th of April looks like
If someone chucks me a tenner I'll slap any trend line you want over both those graphs.
BBC News - Coronavirus: Masks for public 'could put NHS supplies at risk'
https://www.bbc.co.uk/news/uk-52363378
https://youtu.be/IaR1StKajvY
I think i read they mask 160 million a day, but well over half are being taken up domestically.
Thank you for writing this. A really powerful piece written in a measured and mature manner - something I would have failed to do.
I hope your experience ensures that change does happen.
This whole thing is an utter shitshow. I bought my mask literally 3 months ago today. The Government are a shambles.
This is probably area where the experts are saying one thing and the politicians (like Sadiq) are tempted by populism.
Society wants a silver bullet, masks fit the bill.
Alternatively: infect university students under 24 (with no health issues) and once they have recovered get them to work in care homes. personally I think spending a little bit of time doing this kind of work would be an important part of any citizen's education. especially people who are going to go on make decisions for the whole of society (so no oxbridge graduation without working one term in a care home?)
I read that the government's ratings on the handling of this crisis have continued to defy political gravity in the midst of a litany of incompetance and wonder why. Whereas a couple of weeks back I was willing to accept ministerial assurances at face value I now listen to their pathetic attempts to assure us that everything is fine with utter contempt as failings are tackled with weasel words and promises are proven worthless within days. The public mood surely has to turn. I share your anger.
My opinions: 1) the 7-day quarantine advice has to change; 2) we need a half-way house for those who are recovering but still infectious; 3) patients should only be sent home, or to a Care Home, after the due number of 'clear' tests; 4) newly-infected people also need a half-way house facility both to stop further transmission and to ensure they are sent to hospital in good time if they don't recover; 5) the NHS and the Care sector must become more integrated somehow; 6) the policy of disposable everything needs to change to one where facilities for sterilisation enables re-use of more durable materials.
I could go on but that's possibly my longest post ever already.
Good morning, everybody. OGH, I hope the fund-raising last night was a great success.
Thanks NigelB for a powerful and moving piece. Let's hope this helps gain attention to what is happening.
Once again, it seems to me, carers, care homes and social care is the forgotten service.
As I have said before if this advice were true NHS staff would not be getting infected by those on ventilators because they would already no longer be infectious.
This is a tragic story, so avoidable, so unnecessary. My heartfelt sympathy to @Nigelb and his family for their loss.
At the moment they have always made the best possible decision in all circumstances, and it if it didn't turn out exactly right, well the circumstances subsequently changed.
Bit lake Patterson and the badgers moving the goal posts.
German authorities have vowed to crack down on coronavirus-related fraud amid mounting evidence that scam artists, many of them based in eastern Europe, were hijacking the country’s generous aid programme for businesses hit by the pandemic
Also thanks for your comments over the past few weeks. I don't know whether I've replied to or liked many, but you've been posting a lot of interesting studies (direct to pre-pub papers, rather than tabloid fluff) with brief well written summaries for those of us too busy to read the source material in full. I've found that very informative.
https://twitter.com/Politics_Polls/status/1252472017510707204?s=20
https://twitter.com/Politics_Polls/status/1252469215556251650?s=20