Why was Britain, at the height of the coronavirus pandemic, almost the most dangerous country in Europe for so many old men ?

This graph, based on figures from 26 June Report form the LSE confirms what dangerous places care homes in Britain were for old men and women at the height of the pandemic. Excluding, Scotland, Wales and Northern Ireland, almost 30,000 more care home residents in England and Wales died during the coronavirus outbreak than during the same period in 2019. Between the period 2 March to 12 June 2020, coronavirus was the leading cause of death of old men in care homes, accounting for 33.5% of all deaths and the second leading cause of death in old lady care home residents, after dementia and Alzheimer disease and accounting for 26.6% of all deaths.

So why did so many old people die in care homes?  The Health Secretary, Matt Hancock, claimed the Government “threw a protective ring” around care homes. So, what went wrong?

In late January, as the coronavirus death toll ticked up in Wuhan, China, care operators in Britain grew nervous. The Care Providers Association asked contacts at the Department of Health and Social Care if there was any specific action they needed to take ? Word came back : 'There was nothing to advise'. A week later, the industry group tried again. How should it isolate infected residents and restrict visits, and who would supply 'personal protective equipment', PPE

Government guidance that finally came on 25 February bore a relaxed tone.
Face masks : 'Do not need to be worn by staff'.
There was no block on visits.
 'No need to do anything differently in any care setting at present'
'It remains very unlikely that people receiving care in a care home will become infected.'

Prof Martin Green, Chief Executive of the industry association 'Care England' said : “We should have been focusing on care homes from the start. What we saw was a focus on the National Health Service and that meant that care homes often had their medical support from the NHS withdrawn.”

There were warning signs that care homes would suffer. In early February, the Government’s own 'Scientific Pandemic Influenza Group on Modelling' reported that infections were doubling at least every five days in China and there was probably already sustained transmission in Britain and 'severe cases are more common in older age groups'. However, the message continued that there was no rush.

When, on 3 March, England’s Chief Medical Officer, Chris Whitty, defended a lack of specific measures to protect care homes, saying : “One of the things we are keen to avoid is doing things too early”, it was already too late for many old men and women. When, in the following week, the NHS pushed to discharge sick elderly patients into care homes, the first care home outbreaks were reported in London, Nottingham, Stockport and Tameside. Thirty-three outbreaks in the first week of March turned into 793 by the end of the month but data tracking the spread was not made public by Public Health England  until 29 April.

On 12 March, around the time the pandemic took off, the Government decided to reduce testing for coronavirus in the community and are homes desperate to know more about infection felt they suddenly knew less. They were spotting puzzling symptoms like loss of appetite and sudden confusion, which differed from the standard advice to watch for coughs and a fever. Testing, though, was limited. After someone in a home tested positive, managers reported that no more tests would be offered. Research from the USA was already showing the importance of testing widely in care homes. Research into an outbreak near Seattle, in Washington state, found that only judging by symptoms may miss half of infected residents.

At this point he Government was not stopping visits to care homes by family and friends, which “surprised” the former Conservative Health Secretary, Jeremy Hunt. In fact, Public Health England Guidance on 13 March asked homes only to :
Keep out unwell visitors and those with suspected Covid-19. 

When an outbreak hit Wren Hall Nursing Home in Nottinghamshire, Anita Astle, the Manager tried to handle it using Department of Health and Social Care guidance to separate symptomatic residents in a single room with a separate bathroom, where possible. She said : “We did that for 10 days and it was still spreading. I decided I’m not doing this anymore. If you followed their advice, you could have someone in a bedroom with symptoms, someone next door without symptoms.” Dementia sufferers often like to walk around their homes and, as the homes don’t lock residents in, the virus spreads.

Wren Hall created an isolation unit and a 'Red Team' of dedicated care workers, but the virus still killed 10 residents in three weeks. Anita said : “If the Government were an employee of mine, I would have sacked them for gross negligence.”

On 27 March, to protect the NHS from the devastating situation that emerged in Italy with the near collapse of hospitals, Government Ministers ordered 15,000 hospital beds to be vacated, making beds available was part of the 'national effort' and 'will help to save thousands of lives' they told care homes. Despite the fact that care homes lacked clinical expertise and medical equipment, the Guidelines said there was no need to test discharged patients because coronavirus sufferers 'can be safely cared for in a care home'. Their presence was now put others at risk in residential homes designed for communal activity, not isolation. With staffing stretched by absences and a chronic lack of protective equipment, infections spiralled upwards.

It wasn’t until 16 April that the Government announced NHS patients being discharged into care homes would be first tested for coronavirus. By that time almost 1,000 homes in England had suffered outbreaks. By the end of April, 6,500 old, care home residents in England were dead from coronavirus.

Research published in April by Nicholas Grassly, a member of the Government’s 'Scientific Pandemic Influenza Group on Modelling' and a Professor at Imperial College, found weekly screening of healthcare workers, irrespective of symptoms, reduced their contribution to transmission by between a quarter and a third. Yet current Government policy, announced by Matt Hancock on 28 April, was still to test care home staff and residents only once unless the person subsequently developed symptoms. 

Sam Monaghan, Chief Executive of 'MHA', the largest charitable provider of care homes, which has lost hundreds of residents to coronavirus, said the policy at that time was : “outrageous in the face of the evidence that is now available” and “one single asymptomatic staff member or resident through no fault of their own can cost lives.” 

In the second week of July and 5 months after the start of the pandemic in Britain, old men and women in care homes in England who were over 65 and residents with dementia, started to receive monthly coronavirus tests. Staff were now tested weekly. Any care home dealing with an outbreak, or at increased risk of an outbreak, will be more intensively tested.

Care home death toll for men and women :

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

      + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +      

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

x 30

It is difficult not to conclude that the 30,000 who died, did so, not because they were old and more susceptible, nor because they were old and unprotected in a care home, but essentially, simply because they were old and living in Britain in the 21st century.