100 infected patients ‘led to care home Covid crisis’

Outbreaks from moving elderly with the virus out of hospitals ‘not ruled out’

ALMOST 100 hospital discharges may have led to Covid outbreaks in Scottish care homes or increased the number of existing infections, a major report has found.

New analysis has been carried out investigating cases where elderly people were admitted to care homes after they tested positive for Covid-19, during the first wave of the pandemic.

Public Health Scotland (PHS) said it showed that a link between patients being discharged from hospital and Covid outbreaks “cannot be ruled out”.

The virus was associated with 21.6 per cent of deaths within 30 days of discharge to a care home.

The report follows an earlier study by PHS, commissioned by Health Secretary Jeane Freeman in August last year, that was criticised for not being clear.

It found there were 3,595 discharges to care homes between March 1 and April 21, and the majority (82%) were not tested for Covid-19.

Of the 646 discharges tested, 75 had a positive result while in hospital. There were 106 people where the last test for Covid-19 before hospital discharge to care home was positive.

Of those, 79.2% of Covid infections had a definite community onset.

Fresh analysis has found five discharges were epidemiologically associated with care home outbreaks from March 1 to June 21, while a further five had an “uncertain association”.

A total of 87 people with a positive diagnosis were admitted to care homes which were already experiencing an outbreak.

Researchers said there is a possibility they caused further introductions of infection into care homes which already had an active outbreak.

However, the discharges took

place at a time when there was limited testing outside hospitals and testing of care home staff in the community was rare.

This means that scientists have very little genomic sequencing data to determine the cause of outbreaks between March and mid-june.

Data was only available for two out of the 10 cases which were linked to outbreaks, which found that there were “multiple introductions” into the care home.

“There was only sufficient sequencing data in two care homes to examine whether a person discharged from hospital before the start of a care home outbreak could have been responsible for starting the care home outbreak.

“These findings are not consistent with hospital introduction of infection in these care homes.”

Out of the 87 cases where patients were discharged to homes which already had outbreaks, there was sufficient sequencing data in five care homes to examine whether this led to increased cases.

“In all cases examined the viral lineages of the positive residents discharged from hospital were already present in the care homes before the person was discharged from hospital.”

Using laboratory confirmed cases, 348 (32.1%) of care homes in Scotland experienced an outbreak of Covid-19 in the home between March 1 and June 21.

The analysis did not include data submitted by care homes themselves or on people admitted to care homes from their own homes or transferred from other care homes. Staff data is also missing.

Researchers said it was impossible to model or predict what would have happened if everyone discharged to care homes had remained in hospital.

Nicola Sturgeon has acknowledged that it was a mistake to discharge Covid patients to care homes in the early stages of the pandemic and has called for a four-nations inquiry by the end of the year.

Scottish Conservative health spokesman Donald Cameron said: “This report confirms that our care homes bore the brunt of the devastating effects of this pandemic due to decisions taken by SNP ministers.

“While the First Minister said previously that there was no statistical evidence to back up the claims that discharges led to outbreaks in care homes, it is clear our most vulnerable individuals were put at increased risk as a result of this policy.

“Thousands of families are still grieving the loss of loved ones. They deserve answers from those who decided to discharge Covid patients, including those who had tested positive, into our care homes.

“The Scottish Conservatives have repeatedly called in Parliament for a judge-led inquiry to find out what truly happened in our care homes.

“That must happen immediately to guarantee our elderly and vulnerable will never be left unprotected in this way ever again.”

The Scottish Government introduced a new policy on April 21 requiring patients to have two negative Covid tests before leaving hospital, and to all new care home admissions to be isolated for 14 days.

A Scottish Government spokesman said: “These updated findings give greater insight into the outcomes from hospital discharges to care homes in the early stages of the pandemic. As with the last

PHS report, we will take forward all the recommendations in this updated report and we will use the report’s findings to better understand all the factors driving outbreaks in care homes.”

The revised report found there were nine discharges of Covidpositive people to eight care homes which did not experience any outbreaks between 1 March and 21 June 2020.

It also found that local authorityrun care homes were more at risk of an outbreak than those owned by private providers.