Care homes

Did Care Homes Achieve Focused Protection in the Second Wave?

Contrary to popular understanding, Britain’s second wave of COVID-19 was less deadly than the first: although there were more deaths within 28 days of a positive test, age-adjusted excess mortality was lower. 

One possible explanation is that fewer people were infected in the second wave (even though the infection fatality rate remained constant). However, data from the Coronavirus Infection Survey suggests that roughly the same number of people were infected in the two waves. About 7% of people had antibodies at the end of the first wave, and about 14% had antibodies toward the end of the second wave (before the vaccination program had gotten fully underway). 

Incidentally, some people may have been infected without developing antibodies. I’m using the number who developed antibodies as a proxy for the total number who were infected in each wave.

Another possible explanation is that we became better at treating the illness. Evidence suggests that thousands of lives were saved by corticosteroids like dexamethasone, but these may not have been widely used in the first wave. Yet another explanation is simply that there were fewer frail elderly people alive at the beginning of the second wave, meaning that the average elderly person who became infected was less likely to die from the disease. 

However, there’s possibly a fourth reason why the second wave was less deadly than the first, namely that care homes achieved a degree of focused protection.

In the first wave, a disproportionate number of those who died were care home residents. This is partly because elderly patients who’d caught the virus in hospital were discharged to care homes when they were still infectious, resulting in deadly outbreaks. Hence more effort was made to shield care home residents in the second wave. 

According to the ONS, there were 27,079 excess deaths in care homes during the first wave, but only 1,335 during the second wave:

This finding is supported by two recent academic studies. One study, published in Environmental Research, found that the percentage of COVID-19 deaths among care home residents was lower in the second wave in eight out of 11 countries with available data, including the UK. 

Another, unpublished study observed a major spike in excess mortality among care home residents last spring, but no increase during the final weeks of 2020.

While it’s too early to say exactly which factors explain the reduction in mortality between the two waves, the evidence presented here suggests that effective shielding of care home residents may have been a major contributor. Though it should be noted that care home occupancy was lower in the autumn and winter, which probably accounts for some of the disparity in excess deaths.

Perhaps if more attention had been paid to shielding in the first wave, Britain would have come through the pandemic with a lower death toll. 

This post has been updated.

U.K. Rights Watchdog Endorses Mandatory Covid Vaccination for Care Home Staff

The U.K.’s human rights watchdog admits that forcing care home staff to get vaccinated against Covid would be a “significant departure from current public health policy”, but has endorsed the move anyway. Support of the idea from the Equality and Human Rights Commission (EHRC) could tip the balance away from the likes of Health Minister Nadine Dorries who oppose the “no jab, no job” policy, towards the view – held by both the Prime Minister and the Health Secretary – that legislation on this matter is necessary “to reach a position of much greater safety for care recipients”. The Guardian has more.

Ministers are considering changing the law to make vaccination a condition of deployment for people in some professions that come into regular close contact with elderly and vulnerable people at high risk from the coronavirus.

In a report to the Government seen by the Guardian, the EHRC admitted that making vaccines compulsory for care home staff would be a “significant departure from current public health policy”.

But they judged that ministers were “right to prioritise protection of the right to life for residents and staff” and said it would be reasonable for care home workers to need a jab “in order to work directly with older and disabled people, subject to some important safeguards”.

The Guardian adds that the EHRC is likely to make a similar recommendation about healthcare workers. Vaccines Minister Nadhim Zahawi has suggested that NHS staff could also face mandatory vaccination, though the idea has received firm opposition from both the Royal College of Nursing, which has a membership of 450,000 registered nurses, and the Royal College of General Practitioners, representing over 50,000 British GPs.

Zahawi said no decisions had been made yet, and stressed there was a precedent: surgeons were required to be vaccinated against hepatitis B. He added: “It would be incumbent on any responsible Government to have the debate, to do the thinking about how we go about protecting the most vulnerable by making sure that those who look after them are vaccinated.”

A Government source said: “We think it would save lives.”

There is nervousness in Whitehall about making moves to force anyone to have a coronavirus injection, given the fear that this could make people who are already vaccine hesitant even more resistant.

[Whitehall is right to be nervous on this point: research suggests that health and social care workers who feel greater pressure from their employers to receive Covid vaccination are more likely to decline it.]

However, now that care workers had been eligible for vaccines for months due to their high position on the priority list, the EHRC said some demographic groups that were less likely to get vaccinated were “disproportionately represented in the adult social care sector workforce”.

The EHRC said mandatory vaccination could risk further excluding these groups “from access to employment”, so a proportionate approach with important safeguards was needed.

Worth reading in full.

Letter in the Telegraph Says Modellers Are Partly to Blame for Care Home Fiasco

There was a good letter in the Telegraph yesterday, pointing out that SAGE and its modellers need to accept some of the blame for the care home fiasco. After all, if the Government and the NHS hadn’t been persuaded by their apocalyptic models that hospitals would be overwhelmed if they didn’t clear out elderly, care home residents, they wouldn’t have been in such a hurry to get rid of them.

SIR – Matt Hancock, the NHS and the Prime Minister have all been blamed by Dominic Cummings for the appalling care-home Covid deaths at the start of the pandemic, but I feel none of these are the real culprits.

At the time, pandemic data modellers were forecasting huge numbers likely to need hospitalisation. So the Government, using the Armed Services, built Nightingale emergency hospitals in double-quick time.

The NHS, spooked by alarmist modellers, cleared the hospitals of all the non-Covid patients they clinically could, anticipating a deluge of Covid patients. Unfortunately, no one knew of non-symptomatic carriers, and the care homes were infected, with devastating results.

The hospital deluge predicted by modellers didn’t materialise, nor anywhere near it. The Nightingale hospitals were hardly used.

So, in apportioning blame for the horrendous care-home deaths, excitable modellers and their statistics, based on unrealistic assumptions, must be the primary culprits. It was a case of “following the science” that led policy-makers astray.

Steve Male
Highampton, Devon

Health Minister Nadine Dorries Opposes Mandatory Vaccination for Care Home Staff

Health Minister Nadine Dorries says she opposes the idea of care home staff being forced to take Covid vaccines. MailOnline has the story.

The Government last month launched a consultation into whether mandatory vaccines for carers would work and be ethical, with a final decision expected by July.

Ms Dorries’ boss, Matt Hancock, has publicly endorsed the proposal, arguing that care home staff have a “duty of care” to elderly residents most vulnerable to Covid. 

Quizzed about the plans on LBC radio this morning, Ms Dorries said: “Would I force people to be vaccinated? No I wouldn’t force people to be vaccinated.”

… Latest NHS England figures released last month suggested about 78.9% of care home staff nationwide have had the jab. But in 17 local authority areas, fewer than 70% have received a first dose.

When the consultation was announced on April 14th, Mr Hancock claimed care home bosses were united in their calls for a “no jab, no job” policy.  A final decision on whether to force staff to be vaccinated is expected by July. 

Boris Johnson’s official spokesman previously accepted it would be “discriminatory” to force anyone to be vaccinated. 

Documents leaked in March revealed that both the Prime Minister and the Health Secretary “agreed – in order to reach a position of much greater safety for care recipients – to put in place legislation to require vaccinations among the workforce“. Similar requirements are being considered for healthcare workers, such as those who work on hospital wards, according to reports – but there has been a good amount of opposition to the idea within the health profession.

The Royal College of Nursing, which has a membership of 450,000 registered nurses, said last month that health and social care staff should not be “coerced” into having a Covid vaccine, and the Royal College of General Practitioners, representing over 50,000 British GPs, said a mandatory rollout would only lead to “resentment and mistrust”.

The MailOnline report is worth reading in full.

Deaths at Home Rise by a Third as Patients Stay Away From Hospital

There were more deaths from all causes in homes in each month of 2020 than in a normal year, according to new data from the Office for National Statistics (ONS), as treatment waiting lists and the “protect the NHS” drive kept patients away from hospitals. The Times has the story.

A total of 166,576 deaths in private homes from all causes were registered in 2020, compared with an average of 125,255 between 2015 and 2019, according to the ONS.

This means there were 41,321 extra deaths, or “excess deaths”, in private homes during the year, although Covid was responsible for 8% of the total.

The majority of deaths in 2020 where coronavirus was the main cause occurred in hospitals and care homes. In contrast, many deaths from other causes, such as breast cancer and prostate cancer, happened in private homes, to people who in a non-pandemic year would probably have died elsewhere, such as in hospital.

The figures show that deaths from diabetes in private homes were 60% higher in 2020 compared with the average for 2015-19, while those from heart disease and Parkinson’s disease were both up 66%.

For dementia and Alzheimer’s disease, deaths were up 65%, with increases of 44% and 37% for prostate cancer and breast cancer respectively…

The rise in deaths in private homes comes amid concern that during the pandemic people have not been receiving the medical attention for serious illnesses they would have in normal circumstances. In the early stages of the pandemic GPs and hospitals reported a drop in the number of patients and urged people to contact their doctor if they had a health issue.

Worth reading in full.

Government Backs Down on Rule Forcing Care Home Residents to Self-Isolate After Trips in England

The Government has backed down on a rule forcing care home residents who go on outdoor visits to self-isolate for two weeks afterwards. But the new guidance, which has yet to be released in full, may vary for different areas. The Guardian has the story.

A rule forcing care home residents who go on any sort of outside visit to then spend two weeks in their room is being scrapped, the Government announces today. Campaigners have hailed the reversal, with one group saying the regulation had turned “care homes into prisons”.

Under new guidance to begin from Tuesday, people living in care homes in England will not have to self-isolate if they leave the home to be in the garden of a relative or friend, or to visit outdoor spaces such as parks and beaches.

They must be accompanied by either a care worker or a named visitor, and must socially distance when away from the home. They cannot meet in groups, as currently permitted for others outside, and can go indoors only to use toilets.

The full guidance has not yet been set out, and could vary for areas with high or fast-rising levels of coronavirus infection, or the presence of variants of the virus being monitored by the Government.

John’s Campaign, which pushes for better visiting rights, launched a legal challenge arguing that the mandatory self-isolation brought in three weeks ago, regardless of the age or health of the individual, was discriminatory and unlawful.

Nicci Gerrard from John’s Campaign said the change of stance, announced by the Department of Health and Social Care (DHSC), was “a chink of light for residents of care homes and their families, and a victor for all those people who have been eloquent in their campaign against the 14-day rule”.

She said: “But why did this rule ever exist in the first place – depriving people of their liberty, turning care homes into prison, treating one group of people with such cruelty?”

Worth reading in full.

Stop Press: The latest issue of Private Eye (1546) has discovered why Dr Éamonn O’Moore, who leads the Public Health England (PHE) social care response to Covid, favoured self-isolation rules in the first place.

A look at Dr O’Moore’s LinkedIn profile offers an explanation: he writes that he also leads PHE in “other places of detention”, including prisons. No wonder he’s so keen on solitary confinement…

Most Care Home Vaccine Rates below Government Guidance

The Government has launched a consultation into making Covid vaccinations mandatory for care home staff working with elderly residents, as NHS England data has revealed that vaccine rates among staff at older adult care homes are below SAGE’s recommended level in more than half of England’s local authorities. Sky News has the story.

The Department of Health and Social Care (DHSC) today announced the five-week consultation on making a jab a “condition of deployment”.

Staff, care providers, residents and their families, and other stakeholders are being asked to take part, with officials hoping to find out potential impacts on staffing and safety.

The DHSC is also looking to see how the scheme could be implemented and who could be exempt.

Vaccines minister Nadhim Zahawi told Sky News: “Our consultation is very focused on the condition of deployment.” …

Some providers have already made a coronavirus vaccine a requirement.

Following the report, a decision is expected to be made this summer.

SAGE has said that 80% of carers and 90% of residents need to be vaccinated for a minimum level of protection against outbreaks of the virus.

Nearly half of care homes for older people in England have not hit this target, according to the Government.

The latest numbers show that 78.9% of care staff for elderly people have had a jab in England.

The Telegraph has more on vaccination rates among care home staff in England.

Figures published by NHS England… show that 86 out of 149 local authorities have not reached an 80% immunisation threshold for employees, and in 22 areas less than 70% of staff have had a first jab.

Lambeth in south London had the lowest uptake at 50.1%. The figures show the proportion of employees in older adult care homes who have been vaccinated has risen just 10 percentage points in two months.

More than 96,000 eligible staff have not received a vaccine, the figures suggest.

Last month, leaked Cabinet plans revealed that both the Prime Minister and the Health Secretary had requested a change in the law to make Covid vaccination mandatory for care home staff. The leaked document read:

The Prime Minister and the Secretary of State [Mr Hancock] have discussed on several occasions the progress that is being made to vaccinate social care workers against Covid and have agreed – in order to reach a position of much greater safety for care recipients – to put in place legislation to require vaccinations among the workforce.

The document noted that similar requirements were also being considered for healthcare workers, such as those who work on hospital wards.

The Sky News report is worth reading in full.

What Would a Focused Protection Strategy Have Looked Like?

We’re publishing a new piece by Dr Noah Carl today, this time one looking at ‘Focused Protection’, the strategy recommended in the Great Barrington Declaration. Noah thinks it would have resulted in fewer deaths than locking everybody down. Here’s an extract:

At any point during the pandemic, deciding which measures to implement represents a trade-off between their effects on the epidemic’s trajectory and their effects on society at large. Measures that substantially reduce cases or deaths, while having only a small impact on society, are worth putting in place. By contrast, those that barely reduce cases or deaths, while having a large impact on society, are best avoided. Mounting evidence indicates that measures like stay-at-home orders and closures of non-essential businesses are of the latter kind; they have large costs and relatively small benefits. In just the past week, two new studies casting doubt on the efficacy of lockdowns have been published. Vincent Chin and colleagues analysed data from 14 European countries, and found that “lockdown had no consistent impact”. Likewise, Christopher Berry and colleagues examined shelter-in-place orders in the United States, but did “not find detectable effects of these policies on disease spread or deaths”.

However, this is not to say there aren’t any restrictions worth implementing. One measure whose efficacy is supported by a number of studies, and which makes sense intuitively, is restricting large gatherings. For example, Vincent Chin and colleagues found in one of their analyses that “the simple banning of public events was beneficial”. Nicolas Banholzer and colleagues have reported a similar finding. In an unpublished study, they compared the impact of different non-pharmaceutical interventions, and found that “event bans were most effective… whereas stay-at-home orders and work bans were least effective”. Another measure that makes a great deal of sense is telling symptomatic individuals to self-isolate at home.

Worth reading in full.

Legal Action Launched Against Ban on Trips for Older Care Home Residents

A legal letter sent to the Department of Health and Social Care (DHSC) says that the blanket ban on older care home residents going on trips to see family or friends violates human rights legislation. Campaigners say that residents are being treated like “a different species”. The Telegraph has the story.

A ban on care home residents taking trips is facing a legal challenge amid claims they are being treated like “a different species” and denied “simple freedoms”.

Government guidance, updated on March 9th, says trips to see family or friends “should only be considered” for under-65s while national Covid restrictions apply.

Visits out for residents, whatever their age, “should be supported in exceptional circumstances such as a visit to a friend or relative at the end of their life”, it adds – but on returning to the home, the resident must self-isolate for two weeks.

The Government said its current guidance provides a “range of opportunities” for visitors to spend time with loved ones, however, John’s Campaign, which represents those lobbying for extended visiting rights of family carers in hospitals and care homes, argue that the ban is unlawful.

Julia Jones, co-founder of the John’s Campaign, has said that care home residents have been “comprehensively ignored” over the past year of lockdowns.

The 440,000 people living in care homes include some who moved in through their own volition, with full mental capacity, never guessing that this simple freedom, enjoyed by everyone else in the population, apart from prisoners, could so easily be denied them.

Those who cannot make their own choices have relatives and friends who would normally be glad to take responsibility but have been excluded choices.

Are the Vaccines Really “62% Effective” For Care Home Residents?

A new study from University College London published yesterday claims to find that a single vaccine dose provides 62% protection against COVID-19 for care home residents.

The Government-funded study looked at data from more than 10,000 care home residents in England with an average age of 86, between December and mid-March, comparing the number of infections occurring in vaccinated and unvaccinated groups (as determined by a PCR test). It found that a single vaccine dose was effective at preventing 56% of infections after four weeks, rising to 62% of infections after five weeks.

It is the first major study to show vaccine efficacy in the most vulnerable, with Minister for Care Helen Whately saying it is “brilliant to see this [vaccine] is having the positive effect the science suggested, not only by preventing death, but also reducing the chance of infection”.

But have we been given the full picture? Below is the table the 62% figure comes from. It’s the 0.38 after 35-48 days (5-7 weeks) among the figures circled in red. The 56% protection is the 0.44 above it.

Notice two things. First, what the story on the UCL website and in newspaper reports doesn’t mention is that the protection figure drops from 62% to 51% (0.49) after seven weeks (circled red), which is somewhat less impressive. Secondly, the infection rate in the three weeks following vaccination rises significantly (circled orange), with the rate at 2-3 weeks hitting 26.21 vs 21.39 in the unvaccinated, a 22.5% increase. As Lockdown Sceptics has reported before, this increased infection rate post-vaccination has also been found in other studies, with a PHE study finding a 48% increase in infection risk in the over-80s group 4-9 days after receiving the first dose of the Pfizer vaccine, the American FDA Emergency Use Authorisation for the Pfizer vaccine finding 40% higher “suspected Covid” in the first week after vaccination, and a large Danish study finding a 40% increase in infection risk among nursing home residents in the 14 days following the first Pfizer dose.