WHY CARE HOMES FOR ELDERLY FELL SO RAPIDLY IN FIFTH WAVE
Large numbers of unvaccinated residents and lack of isolation facilities meant they could not cope
Care homes for the elderly managed to weather successive waves of Covid-19 infections over the past two years. Then the fifth wave hit and things fell apart rapidly.
The highly transmissible Omicron variant tore through the homes from early last month, leaving about 13,000 residents infected and at least 680 dead as of yesterday. About 3,450 staff were also infected.
Overall, 662 care homes for the elderly – more than four in five of facilities – have recorded cases.
“The infection and death rate of the elderly residents in care homes will keep rising, unless isolation and vaccination are implemented promptly,” said Dr Leung Chi-chiu, an expert in respiratory disease and public health.
“Omicron, the particularly low vaccination rate among residents and the unsuitable environment of care homes for on-site quarantine have led to where we are today.”
Infectious diseases expert Professor Yuen Kwok-yung estimated that only 20 to 30 per cent of care home residents remained uninfected, and expected the death rate to remain high.
With the city recording tens of thousands of new infections daily, the shortage of hospital beds and quarantine facilities has left many infected elderly people confined to care homes without proper isolation facilities, causing the virus to spread among residents.
The new wave of infections also worsened the staffing situation at the homes, which have long suffered a chronic shortage of care workers, as many carers caught Covid-19 or had to be quarantined.
According to the database Our World in Data, Hong Kong’s seven-day rolling average of 22.64 deaths per million people was the highest in the world as of Saturday.
The state of the care homes was an urgent issue, said Dr Lam Ching-choi, a member of Chief Executive Carrie Lam Cheng Yuetngor’s de facto cabinet and chairman of the Elderly Commission.
He said pandemic measures, including banning family visits, cutting volunteer services and vaccinating staff, had helped care homes fend off earlier waves of infection before Omicron broke through those defences.
The explosion of cases in the community resulted in infected staff members bringing the virus to care homes, where many elderly were not vaccinated.
Only about 20 per cent of elderly residents in care homes were vaccinated when the fifth wave began, although operators estimated that this rose to about 40 per cent after the vaccine pass was introduced on February 24, barring unvaccinated people from various premises.
William Chui Chun-ming, president of the Society of Hospital Pharmacists of Hong Kong, said many elderly faced a high risk of infection and complications as a result of advanced age and chronic medical conditions.
“They are the most vulnerable, but this group has the lowest vaccination rate,” he said.
Public health expert Leung said Covid-19 cases at care homes began spiralling out of control when authorities could no longer move out the infected, because there was no room at hospitals and quarantine facilities.
Infected residents should have had priority for quarantine but did not get it. Authorities also failed to increase hospital capacity at the start of the fifth wave by designating some hospitals for Covid-19 patients. As a result, Leung said, as more elderly residents became infected and hospitals could not take them in, patients had no choice but to remain at the homes.
“It formed a vicious circle,” he said. The situation led to continuous outbreaks with even more residents falling ill.
The government revealed last month that 88,000 community isolation units at eight venues, for residents with mild or no symptoms, were expected to be ready in the next few months. These facilities could not come fast enough for the explosion of cases, and given the current shortage, the Social Welfare Department asked care homes to keep infected residents isolated on their premises.
But Leung said the homes were not designed to isolate patients effectively. For that, they needed at least a separate floor for sick patients and dedicated carers to avoid cross-infection.
The Social Welfare Department requires care homes to have a designated isolation room for every 50 beds to isolate those with infectious diseases.
But Kenneth Chan Chi-yuk, chairman of the Elderly Services Association of Hong Kong, said these isolation rooms were merely separated from other rooms and did not meet standards needed to isolate Covid-19 patients.
“Care homes are not designed to be used as medical or quarantine facilities to handle infections,” he said. Chan pointed out that all along, care homes were not supposed to admit residents with infectious diseases, and had to report and evacuate any infected resident immediately. That was what helped them survive earlier waves of infections, he said.
The homes were not prepared for the Omicron onslaught and the overwhelmed medical system made it impossible for them to evacuate sick residents, he added.
Cheng Ching-fat, secretary of the Community Care and Nursing Home Workers General Union, said the situation was nothing short of a disaster. He said some homes isolated those with Covid19 in conference or therapy rooms, while others used only a folding screen to separate infected residents from others.
With sick residents still on the premises, thorough cleaning and disinfection became a challenge.
“Some put all residents on one side of the home while disinfecting the other side, and some just sterilised the beds of those infected,” he said.
Then homes began running out of workers as they became infected. Last Tuesday, the government said 1,000 temporary care workers would be brought in from the mainland.
Chan said many homes had lost half their staff, and the sector needed at least 5,000 more care workers. He revealed that some small homes were so strapped for help that they had asked infected workers to stay on the job.