COVID-19 IN CARE HOMES – THE CATASTROPHE WHICH DID NOT HAVE TO HAPPEN
Our research clearly details the warnings senior officials gave and were given about the risks weeks before vital actions were taken to protect elderly people in care homes. Acting political editor Will Hayward and head of news David James report
BY ANY measure, the situation in Welsh care homes during the coronavirus crisis has been a disaster.
Up until June 19, a total of 717 of the most vulnerable people in our society had died with the virus after it got inside our care homes.
You may think that these deaths were inevitable during a pandemic.
But across the world other countries have demonstrated that it didn’t have to be this way.
Political decisions – or the lack of them – resulted in the virus being able to infiltrate our care homes. These are places which were identified as the most at risk before coronavirus even arrived on our shores.
Our research has shown that medical leaders and politicians did nothing to stop patients from hospitals being discharged into care homes without a test – even when the risk that people showing no symptoms could pose was being discussed.
As early as March 31, papers were being circulated on the UK’s core scientific advisory body Sage expressly recognising the contribution asymptomatic people posed to coronavirus’ spread within hospitals.
Yet it was not until April 29 in Wales that people being sent from hospitals into care homes started to be routinely tested – two weeks after England. In that time, 1,097 patients potentially carrying the deadly virus were discharged into the most vulnerable of communities without a test.
A Senedd committee last week was told patients being discharged into care homes in Wales are now tested twice, just in case the first test gives a bad result – emphasising the huge risk they pose.
It raises so many questions – why were our leaders so slow to act? Why did their scientific advisers not realise the risks to care homes?
There are scores of papers in the now-published minutes of the Sage committee on the effectiveness of social distancing measures, on face masks, on transmission to and by children, on the conditions that make people susceptible to coronavirus, on gender, on ethnicity and so much more – yet none in March or April on how to protect the tens of thousands of our most vulnerable people in care homes.
Did our leaders not ask the question – even as care home owners and their representatives were begging them to stop and think about what they were doing?
And what role did the lack of testing capacity really play? Health Minister Vaughan Gething has insisted it did not play a part in his thinking – yet our research paints a different picture.
The Western Mail has spoken to leading experts and care home owners as well as going through the data and scientific advice at the time to see whether Wales’ care home catastrophe could have been averted.
■ How does the loss of life in care homes in Wales compare?
When it comes to international comparisons, Wales did not do well.
There are more than 23,000 registered beds in Welsh care homes and the occupancy was about 92% going into the crisis. With the latest ONS figures showing 717 people have died with Covid-19 out of a care home population of 21,160, Wales lost 3.4% of all its care home residents.
This is far higher than New Zealand (0.04%), Germany (0.4%), Canada (1.5%) and Denmark (0.5%). Even Italy, whose health service was overwhelmed by the virus, performed better (3.1%).
Wales did manage to perform better than the UK as a whole, which lost an awful 5.3% of its care home population.
But this is perhaps not something of which we can be proud.
■ How did this happen?
In a recent press conference Mr Gething identified only three ways the virus could enter Welsh care settings:
1. Visitors
2. Staff
3. Residents
Visitors were stopped from entering homes early on in the crisis, so the only way for the virus to get in was through staff or residents. Residents being discharged from hospital posed a particular danger because in March and April our hospitals were full of Covid-19.
The best way to stop people bringing the virus in is to test them. Charles Musselwhite, co-director of the Centre for Ageing and Dementia Research at Swansea University, says this is something Germany did very well.
He told the Western Mail that “introducing tests early on” was particularly effective and “especially Germany” did this well.
When asked if it was advisable to test all patients coming from hospital into a care home, he said: “Yes, 100% yes! There have undoubtedly been people with symptoms placed back in care homes who have been unable to isolate them. We have seen breaches of older people’s rights in being able to choose where to reside and having input into their care plans go out the window.
“It is certainly my opinion that care homes have been ignored in the planning of patient healthcare. This needs urgently addressing. Testing should be happening regularly for every resident and for every member of staff and people who come into care homes.”
But the Welsh Government did not do this early on. It was not until April 29 that Mr Gething changed the policy to allow all residents coming into homes to be tested. Until that point, only those with symptoms were allowed to have a test. By April 29 it was too late to save many. The largest losses of life in care homes took place before the policy was brought in.
Compared to other places, Mr Gething was slow to change his policy. Even England was weeks ahead of him, with its Health Secretary Matt Hancock announcing on April 14 that everyone going into care homes could be tested. This meant that for weeks the virus was able to be seeded into the heart of Welsh care homes, with some seeing as many 15 deaths – many of which were never attributed to Covid-19.
“The people I have got in my care home are very frail and if they get coronavirus it is a death sentence,” Brian Rosenberg, owner of Tregwilym care home in Newport, told the Western Mail. Mr Rosenberg lost almost 20 residents from his home, 12 of whom died in a matter of days.
■ So why was Vaughan Gething so slow to change the policy?
That is a very good question. There were suggestions that the reluctance stemmed from Wales’ very limited test capacity in April, with Mr Gething being forced to abandon a target of 9,000 tests a day by the end of the month.
When the Western Mail questioned the Health Minister in a recent press conference, he replied furiously “you are wrong” and that testing had nothing to do with it.
He went as far as to say that even if he’d “had treble the amount of testing capacity” he would still have not allowed testing of people without symptoms in care homes.
He said the reason for the delay was that they “based our decisions on advice and evidence. The advice and the evidence changes”.
So Mr Gething says he was advised that there would be no point in testing people without symptoms, and that he changed this on April 29 because the advice changed.
However the Health Minister’s version of events was totally contradicted by the First Minister a week later when Mr Drakeford said in Plenary: “The reason why we changed the guidance was not because the clinical advice had changed, but because we recognised the need to give confidence to people in the sector.”
What Mr Gething says is also hard to reconcile with a close reading of the papers published with the minutes of the UK’s core scientific advisory body Sage.
On this group, and its subcommittees, sit the most eminent public health scientists in the UK from the top institutions and public health bodies. All the UK’s devolved administrations are represented. The research done by Sage informs the advice which Wales’ technical advisory cell and Scotland’s own Covid19 advisory group tailor to the situations in their respective countries
and give to their ministers.
The Sage minutes of March 31 include an NHS England paper written by Professor Stephen Powis dated March 31 which looked specifically at the risk of “nosocomial transmission” – the extent to which transmission within hospitals from patients to healthcare workers and vice versa had become one of the key sources of the UK outbreak.
He was absolutely clear about the risk that people in hospital with no symptoms posed, saying: “A key additional risk is transmission of coronavirus from non-diagnosed Covid19 positive patients or staff, ie those who are asymptomatic or paucisymptomatic.”
He was also absolutely clear about why these patients were not being tested.
“We must consider public perception and workforce expectations of testing,” wrote Prof Powis.
“In most Trusts there remains insufficient testing capacity to test NHS and other critical staff away on sickness absence with suspect Covid19 or self-isolating, and all sectors are under significant pressure. With the current pressure on the NHS and social care it could be perceived as inappropriate to prioritise those apparently well.”
People with no symptoms in hospital were not being tested because there was not enough capacity to test all the doctors and nurses and care workers self-isolating at home – and health bosses thought it would be inappropriate. Lack of testing capacity was clearly at the heart of this issue.
This is an NHS England document.
But it was seen by the advisors of all the devolved administrations on the Sage committee. And on March 31, significant divergences in lockdown policies between England, Wales, Scotland and Northern Ireland had not yet emerged – and would not for several weeks. The four nations had gone into lockdown together just a week earlier. The chief medical officers and top NHS officials were acting in concert as they tried to prepare their hospitals for the huge demands they knew were days away from almost overwhelming the healthcare system in early April.
Even if we accept Mr Gething’s version of events, there are still enormous questions for him to answer.
“He might think he has done the right thing but I don’t think he has,” said care home owner Brian Rosenberg. “And I don’t think a lot of other people think he has either.”
According to Mr Rosenberg, the decision not to test directly led to the death of many of his residents.
“What [Mr Gething] is saying is clearly against the evidence. Obviously my home as well as many others have suffered a catastrophic amount of deaths.
“The people that were discharged from hospital were not tested because they only displayed the symptoms once they got to us. By the time they are in the care home, it is too late, it has spread.
“It is always easy to be wise after the event, but it is pretty fundamental to test people before they leave hospital.”
Throughout the crisis politicians from across the political spectrum have said they are “following the advice”. But science, especially on new and developing diseases, is not exact. There are judgement calls to be made and these are political decisions to be taken by elected politicians.
There was plenty of advice from early on that suggested that everyone going into care homes should be tested – regardless of symptoms. This was advice many care homes had seen and taken on board. In many ways, they were miles ahead of the Welsh Government.
Glyn Williams owns Gwyddfor care home in Bodedern, near Holyhead on Anglesey. In February he read an article on coronavirus that guided his entire attitude towards the virus.
“In February when I read the Lancet medical journal I came across some evidence about protecting healthcare workers. It actually stopped me dead in my tracks,” he told the Western Mail. “I thought, ‘Jesus, this is a biological threat’. We have to treat this like biological warfare.
“The evidence in the article cited an example of a pre-op patient who within hours managed to infect 14 healthcare professionals before the onset of symptoms.
“It was at that point I thought that this was a very dangerous virus because it could be transmitted during the incubation phase, which was so unusual.”
That article in the Lancet and the study was by no means the only piece of evidence.
There was a lot of advice from the World Health Organisation around testing in care homes. This guidance talks about prioritising testing for care homes.
Mr Williams added: “The scary thing is the government must have seen this advice, because I had seen it. In February the doctors and the researchers were suggesting that basic PPE was not good enough against Covid-19. I am sure that the government would have seen that but wouldn’t have had the levels of PPE they needed.
“They wrote their guidance around what they could provide.”
This perception that guidance on PPE and testing was written to fit around available resources was echoed by all the care providers contacted by the Western Mail.
The theme of care providers being ahead of the Welsh Government when it came to the virus also comes up again and again. One letter seen by the Western Mail from Public Health Wales to a south Wales care home owner summed this up.
When asked about whether they should be testing all people coming into their homes, the PHW expert said: “There is no test to see if the patient is ‘incubating’ Covid after exposure until they develop symptoms, which may be up to 14 days post-exposure”.
Whereas many care homes took it upon themselves to try to isolate all patients coming in, the PHW official said: “I wouldn’t advocate this as routine practice for any patient coming out of hospital.”
Homes were under real pressure to take people from hospital. One Port Talbot care home owner told the Western Mail he was pushed by the local authority to take in residents without a test. A demand he refused.
Care home owners are furious they were not protected by testing until, in many cases, it was too late.
Mr Rosenberg said: “We had to do the very best we could but my staff were on their knees. For the Health Minister then to turn around and glibly say that he was acting on advice, I think that is absolutely outrageous.
“If somebody advises me something, I want to test that advice against the evidence that I have got in front of me as to whether that is a rational approach. All of this was completely irrational.
“The only way the virus could come into my home was through staff and residents being moved in. Staff couldn’t be tested either until they were symptomatic. Once someone develops a symptom, it is too late and they have probably spread it.”
The results were catastrophic for Mr Rosenberg. “The undertakers was so overwhelmed that they were slow to clear the deceased from our homes, so we had dead bodies in the home for longer than we ought to have.”
■ This is not just about tests
It wasn’t just the lack of testing that left care homes feeling abandoned. There was also chronic problems with sourcing the right PPE for staff so they could both stay safe and avoid passing the virus to other residents.
On April 10, the Western Mail published a leaked letter from Royal College of Nursing Wales director Helen Whyley to Mark Drakeford in which she described the chaotic situation in Welsh care homes.
She wrote: “Our members are telling us of their increasing frustration in not receiving any information on the testing process. It is critical that we act together to provide reassurance.
“Personal Protective Equipment (PPE) provision is directly affected by the lack of testing, as with asymptomatic patients or staff it is unclear whether the individual nurse or HCSW [healthcare support worker] should be wearing PPE or not – and this uncertainty leads to stress.
“Our members in care homes are under particular pressure because in homes with a small number of staff, having several staff off work has a negative impact on the care that can be provided to vulnerable older people.”
All the providers we spoke to confirmed this situation. Mr Rosenberg said that he had managed to get by because he sourced PPE from another of his care homes in England.
■ Have lessons been learnt?
Even now, with the virus more under control, many care homes are well ahead of the Welsh Government when it comes to protecting their residents.
“If you look at the European Centre for Disease Control recommendations for recovering Covid patients, it clearly states that at least two negative tests are required within 48 hours of discharge,” said care home owner Mr Williams.
“So we have implemented that policy ourselves. We are implementing a higher standard. We have said to Betsi Cadwaladr Health Board that they must provide us with two negative tests within 48 hours of discharge and they must have been isolated during that period or we simply won’t take them.
“What we have found is that they have now complied with that because they have no choice. They are so desperate for beds. We are actually driving the policy based on real safety as opposed to the government, which is driving policy based on what they can do.
“It is being driven by Care Forum Wales, not by the Welsh Government. That is the only way we have managed to weather the storm.”
Mario Kreft MBE, who has eight care homes in north Wales and is also chair of Care Forum Wales, criticised the UK and Welsh governments’ lack of engagement with the care sector.
He said: “At the earliest stage, if only the governments of the UK had brought in the nations’ representatives in early February we would have had a much better result than we had. But because homes have acted so well, got ahead of the game and being so protective of their residents and staff, we have had far less than would otherwise have been the case. But as you know, we have still had absolute carnage in some places.”
Speaking to care home owners and staff, it is clear the virus has exposed an already underfunded and creaking system.
Some local authorities pay as little as £80 a day for people in residential homes. As one home owner said: “You would struggle to get a hotel for that, let alone care.”
On top of that there is a fragmented and disjointed system, with 22 local authorities, seven health boards, Public Health Wales, the Older Persons Commissioner and Care Inspectorate Wales.
Ultimately the people who suffer are the residents of these care homes. Even those who did not get the virus were subject to lower standards of care, as staff were forced to self-isolate for lack of testing.
It didn’t have to be this way – the international comparisons bear this up. Politicians are not just elected to follow advice. They are elected to interrogate it, to test it, to question everything that doesn’t make sense. Saying “that was the advice at the time” when everyone working in the sector at the time could see the catastrophe coming, does not look good on them.
There are still serious questions to answer – and very probably a lot of lawsuits.
ENGLAND Health Secretary Matt Hancock said the vast majority of people who went out on so-called Super Saturday did the right thing.
Ahead of the easing of lockdown restrictions in England on Saturday, Mr Hancock had warned that people could end up “behind bars” if they got too carried away.
Speaking on Sky’s Ridge On Sunday, Mr Hancock said: “Well I think that from what I’ve seen, although there’s some pictures to the contrary, very, very largely people have acted responsibly.
“The large proportion of people, the vast majority of people are, I think, doing the right thing”.
However, he added: “But of course we’ll take action when we need to, when... if the minority break the rules.”
On those who did not social distance, Mr Hancock said: “Well we’ll of course keep this very closely under review, and you’ve seen for instance in Leicester but also in other places that we don’t shirk from bringing in more drastic measures if that is what’s needed to control the virus.”
The Metropolitan Police said there were “no significant issues” across London on Saturday.
Commander Bas Javid said: “Yesterday saw lockdown restrictions lifted further and many Londoners attended pubs and bars last night to enjoy themselves.
“The majority of the public complied with social distancing guidelines and remained vigilant.
“While some areas were notably busy such as Soho and Portobello Road, we are pleased there were no significant issues or incidents in the capital.
“A small number of premises decided to close early following advice from officers due to crowding and social distancing issues and we thank them for their responsible actions.
“There were well-versed plans for this weekend and we worked closely with our partners and licensed premises; this was demonstrated by compliance from the large majority of venues and members of the public.
“Officers were on patrol engaging with members of the public and hospitality venues to ensure a peaceful night and that will continue today. It’s vital that we don’t lose track of how far we have come and all act responsibly and play our part to minimise the spread of coronavirus.”
But one man who passed through the busy streets of London on Saturday told Mirror Online: “Walking down old Compton Street felt like wading through a petri dish.
“And that was at about 4.30pm. Not much chance to socially distance even just walking down the street.”
A woman wrote on Twitter : “Just seen scenes if Soho pubs... my heart goes out to those health care workers and their families who died of Covid to save the rest of us... disgusting lack of respect.”
And one man shared video of groups gathered in the streets, writing: “Soho lockdown is over.”
Another fumed: “Just seen the scenes in Soho.
“It’s as if the health care workers who risked their lives trying to deal with the pandemic were just wasting their time.”
The Welsh Government has announced that bars, restaurants and cafes can prepare to reopen outside only from Monday, July 13.
Meanwhile, when pressed on reports that NHS England has asked for an extra £10bn to cover costs of coronavirus, Mr Hancock said: “I just don’t recognise that story.
“We have been working very closely with the Treasury on making sure we have the funding that we need.”
Mr Hancock said the UK Government’s message to the public is “enjoy the new freedoms, but do so
safely”.
The Department of Health and Social Care said 44,220 people had died in hospitals, care homes and the wider community after testing positive for coronavirus in the UK as of 5pm on Saturday – up by 22 from 44,198 the previous day.
The UK Government figures do not include all deaths involving Covid-19 across the UK, which are thought to have passed 55,000.
The DHSC also said that in the 24-hour period up to 9am yesterday, there were 516 positive results. Overall, a total of 285,416 cases have been confirmed.
A further 27,000 excess deaths are “likely” between now and next April under the current approach to coronavirus, a former Government chief scientific adviser claimed yesterday. Sir David King told Sky News it looked as though the current UK Government policy was to “maintain” the current level of about 3,000 new infections per day across England.
He said: “What we are saying is 27,000 excess deaths are likely between now and next April if the expectation by the Chief Medical Officer is that he would be surprised and delighted if the UK is in the same place next spring.
“If he’s correct, we would still have about 2,000-3,000 new infections in England per day and that is the number of deaths that would follow from that.”
The comments came as Culture Secretary Oliver Dowden said selected international sporting events and major movie and television productions will get the green light in England despite the coronavirus outbreak.
The easing of rules in England will see some sports stars and their support teams, as well as international film and TV stars, directors and producers, exempt from quarantine if they are essential to the event or production.
Under the new rules, sporting authorities, event organisers and the screen industry will need to follow UK Government Covid-19 guidance and put in place “stringent protocols” to ensure that they have a minimal impact on public health.
Exempted individuals will have to live and work in controlled “bubbled” environments behind closed doors, according to the rules.
Mr Dowden said: “I’m very pleased that we’ve agreed exemptions from border health measures for a limited number of athletes and events staff, which means the British summer of sport is back on.
“I am grateful to the sports governing bodies who have worked closely with us to put in place stringent protocols to ensure these events can go ahead safely.
“It will mean that fans of the British Grand Prix, international cricket and Champions League football can look forward to yet more sporting action on home soil – a further boost to our national recovery.”
UK Government guidance will also be set out this week to allow small numbers of “essential cast and crew” to travel to the UK without having to quarantine for 14 days.
It was revealed that the Culture Secretary spoke to Hollywood superstar Tom Cruise last week about how the exemption will allow production to resume on Mission Impossible 7 and 8, which are shot at the Warner Bros Studios Leavesden in Hertfordshire.