Wednesday, May 06, 2020

Were the elderly expendable?

Even as the UK government was promising to protect the elderly and vulnerable from the coronavirus, its policies were putting them and their carers at risk. A Reuters investigation has found a dangerous lag between promises made by Prime Minister Boris Johnson’s government and the reality on the ground.

Even as the government was promising to protect the elderly and vulnerable from the deadly virus, local councils say they didn’t have the tools to carry out the plan, and were often given just hours to implement new government instructions. Policies designed to prevent hospitals from being overwhelmed pushed a greater burden onto care homes. With hospitals given priority by the government, care homes struggled to get access to tests and protective equipment. The elderly were also put at potentially greater risk by measures to admit only the sickest for hospital treatment and to clear out as many non-acute patients as possible from wards. 

Staff and managers of many care homes say they believe the British government made a crucial early mistake: It focused too much attention on protecting the country’s National Health Service at the expense of the most vulnerable in society, among them the estimated 400,000 mostly elderly or infirm people who live in care homes across Britain. So far, at least 32,300 people have died in Britain from the coronavirus, the highest toll in Europe, according to official UK data processed by 2 May. Out of those deaths, more than 5,890 were registered as occurring in care homes in England and Wales by April 24, the latest date available. These figures don’t include care home residents who were taken to hospital and died there. 

Many care home providers believe the figures understate the number of deaths among care home residents because, in the absence of testing, not all are being captured. During the 10 weeks prior to the outbreak, including the height of the flu season, an average of 2,635 people died each week in care homes in England and Wales. By April 24, that weekly death toll had risen to 7,911. According to Reuters calculations, the pandemic has resulted in at least 12,700 excess deaths in care homes.

Graeme Betts, acting chief executive of Birmingham City Council, which oversees the UK’s second-biggest city. “ I think early on care homes didn't get the recognition that perhaps they should have.”

Helen Wildbore, director of the relatives and residents association, a national charity supporting families of people in residential care, said, “I think it has taken too long for the government to turn its attention” to vulnerable people outside hospital. “I think it's fair to say that the sector has felt like an afterthought for quite a long time.”

On February 25, Public Health England, a government agency overseeing healthcare, stated it “remains very unlikely that people receiving care in a care home or the community will become infected.” The guidance was widely reproduced on care home websites and stayed in force until March 13. It meant that few care homes restricted visits and few families withdrew their relatives from homes. No plan was put in place for testing staff. 

On 26 March, the nation was urged to stand at their doorstep or window on a Thursday evening and applaud the NHS. Boris Johnson, by now already infected himself, led the cheering on the first occasion. For some workers in Enfield, the chants left them uneasy. Working 12 hours shifts for barely £9 per hour, below the non-statutory London Living Wage of £10.75, they wondered if those cheers for caregivers were also meant for them.

How did infection take hold in care homes? According to several care home managers, a key route for infection was opened up by an NHS decision taken in mid-March, as Britain geared up for the pandemic, to transfer 15,000 patients out of hospitals and back into the community, including an unspecified number of patients to care homes. These were not only patients from general wards. They included some who had tested positive for COVID-19, but were judged better cared for outside hospital.  

“Timely discharge is important for individuals so they can recuperate in a setting appropriate for rehabilitation and recovery – and the NHS also needs to discharge people in order to maintain capacity for acutely ill patients,” the plan said.  A Department of Health guidance note dated April 2 and published online further stated that “negative tests are not required prior to transfers / admissions into the care home, ” according to experts, an egregious and reckless policy “of sending COVID positive patients back into care homes and knowing that it's so infectious a disease.”  Care homes have few facilities to quarantine new arrivals.

One care manager explained, “It was just so reckless,” she said. “They were not thinking at all about us. It was like they were saying, let’s abandon the old people.”

 Lisa Coombs, manager of the Minchenden Lodge in Enfield, home to up to 25 residents, said “What the government says is a load of rubbish. I am angry because we are not being supported.”

The Royal College of Physicians declares a patient who scores five or more on a 20-point scale should be provided with clinical care and monitored each hour. A patient scoring five would normally be taken to hospital. The approach to hospitalisation led to London’s ambulance service raised the bar for COVID-19 patients from five to seven.

“I have never seen a score of seven being used before,” said one NHS paramedic interviewed by Reuters. Later the required score was lowered back to five.  A study of 17,000 patients admitted for COVID-19 to 166 NHS hospitals between February 6 and April 1. The study showed that one-third of these patients died, a high fatality rate.

Calum Semple, the lead author and professor of outbreak medicine at Liverpool University, said, in an interview with Reuters, this indicated, among other things, that England set a “high bar” for hospital admission. “Essentially, only those who are pretty sick get in.” But, he said, there was no data yet on whether that high bar ultimately made people in Britain with COVID-19 worse off.


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