Proactive virus 'gatekeeping' for care homes

Skye has gone from no cases to over fifty in a single step. Enough understanding has been available for several weeks now to know that reactively managing cases when they appear is too late for vulnerable people with no control over their living circumstances such as care home residents.

By taking a proactive approach, the virus status of every care home in Scotland can be determined in the next few days, and those that are virus free can be moved to a new intensive virus exclusion regime to keep them virus free. Otherwise many more 'Skyes' are inevitable.

It is too late when the first case is tested positive, because transmission of the virus happens before symptoms show, some people never show symptoms, and in the close caring situations in care homes transmission is highly likely to occur. The typically 5 days, but up to 14 day incubation period means that transmission can be happening for many days before the first case shows, and by then as Skye shows, the virus can be very widespread indeed within the resident and care worker group.

Now that more testing capacity is available, every resident and every care worker associated with every care home in Scotland needs to be tested to get a baseline on the scale of the care home issue. No worker or tradesperson should be entering a care home unless they have been tested immediately prior and shown negative, and have isolated since their most recent test.

The consequences for the residents are too high to wait for the first case in a care home before taking action. The understanding of transmission is sufficiently developed to justify the above action under the precautionary principle.

Why the contribution is important

To be blunt, the reactive approach in the care home situation exposes residents in particular but also care workers to odds considerably less favourable than Russian Roulette.

Simple unacceptable given our current level of understanding, and newly expanded testing capacity.

by MatthewSlack on May 05, 2020 at 03:54PM

Current Rating

Average rating: 4.9
Based on: 40 votes

Comments

  • Posted by Lara May 05, 2020 at 16:39

    Can private companies really be trusted to enforce the safeguarding required?

  • Posted by Jane May 05, 2020 at 17:54

    This population should be treated as the most vulnerable and given the same level of support and resource as acute services.

  • Posted by Vicki May 05, 2020 at 23:14

    I agree that this sector should have been given the same priority as hospitals etc - it is totally unacceptable to expect any care worker - as with NHS staff - to go to work knowing they could get/transmit the virus. PPE, testing, the vaccine (once one exists) must be made as available to the care sector as the NHS. Care home residents of whatever age or disability are sitting ducks for this virus - my 90 year old mother is one. It is to the huge credit of the staff in her home that there are no CV cases yet but it may just be a matter of time

  • Posted by MsW May 06, 2020 at 17:02

    Too little has been done and too late. Human-to-human transmission has been known about for weeks if not months. Protection of care home residents now needs to improve massively to combat against this and both other existing and unknown infections.

  • Posted by Colin87 May 06, 2020 at 20:13

    Agreed. Covid must be controlled tightly given that this area is now the most significant transmission area

  • Posted by Arturo May 06, 2020 at 21:41

    Let’s have some honesty here. The Scottish Government have failed to control the spread of the virus in care homes in Scotland as have the UK government south of the border. Pro-active testing must be a priority. Np more waffle - action required

  • Posted by WorkingGlasgowMum May 07, 2020 at 01:19

    Everyone seems to agree that the lack of action has risked care workers and residents lives.

    All residents and staff need to be be tested. Action plans put in place to assist care homes where there is an outbreak.

    Private care homes prosecuted If they don’t follow guidance. Endure staff can speak up anonymously when things are going wrong.

    Anyone entering, only when absolutely necessary (doctors, ambulance) must wear full PPE.

    Residents mental health considered - family allowed to visit in open air space from a distance.

    Front line staff carers and NHS workers given priority to online shops and asked not to travel on public transport if possible (car pool with staff on the same shifts). Keeping a stricter isolation than others (which is a lot to ask). Floors of care homes staffed by the same personnel, so that each floor is isolated.

    Hand washing facilities installed at the door of care homes.

    PPE is a necessity, but also private care homes should be taking some responsibility for the cost and supply of this equipment.

  • Posted by rakrak May 07, 2020 at 07:49

    Infection control is the issue here. Care homes need to adhere to infection control procedures. They should not be reliant on testing to stop the spread of infection as this won’t work without action on stopping infection being brought into the home, or being spread within the home. As someone said previously, when someone tests positive, it’s too late. What separates care homes with and without infection, will come down to care homes who are stringent and follow the protocol of infection control.

  • Posted by dianec May 07, 2020 at 08:01

    Scotland has the opportunity to take the lead in championing and safeguarding care homes and our elders until such times when we have a solution

  • Posted by TeaSpoonFairy May 08, 2020 at 13:13

    This is a difficult ask - currently available tests (PCR) detect genetic material of SARS-CoV2, but cannot say whether an individual with a negative test is already "brewing" the disease, or whether an individual with a positive test is currently able to pass the disease on.
    An negative test on discharge therefore does not give the reassurance that this individual is "safe" to return to their social care setting, nor does a positive test that persists beyond the mandatory 14 day isolation mean they are "not safe".
    Conversely, this approach will lead to delays in discharges from hospital, putting individuals at risk of acquiring other infections while there, and still not prevent that patients about to develop COVID-19 are discharged back into their care setting.

  • Posted by rosemarym May 09, 2020 at 12:04

    New residents should not be admitted to a care home unless their test is negative. Test result times must be sped up.

  • Posted by JenTill May 09, 2020 at 20:29

    I agree with this in principle. However the practicalities of completing regular tests on our most vulnerable adults is not as simple as it sounds. Our residents also have the right to decline. They may also not have the capacity, due to dementia etc, to understand the procedure.

  • Posted by arendbayer May 11, 2020 at 14:05

    Yes, please! Currently care home workers have access to testing when they have symptoms, so that they can return from work if they test negatively. But it is much more important to keep asymptomatic (or pre-symptomatic) coronavirus carries from going to work! Testing care home workers every 3-4 weeks would already help. If that is not possible, at least everyone who has been in contact with someone with covid-19 should be tested.
    According to the NRS, more than a third of deaths have been in care homes. This is a tragedy, and one that could be significantly reduced by using testing to reduce transmission.
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