Doctors have reported possible fresh outbreaks of Covid-19 in care and nursing homes in west London, two months after the area was a hotspot in the first days of the coronavirus crisis.
“Just when we thought there might be light at the end of the tunnel, two new or worsening care home outbreaks over the past 48 hours,” said Dr Anna Down, clinical lead at a GP practice with 1,000 residents on its books in 15 privately run nursing homes.
“Is this a whole new spike or just more evidence that this awful virus is way more pervasive and persistent than we thought?”
An increase in testing of residents and workers is exposing further cases, but there has also been a rise in the number of hospitalisations.
In addition, care home residents are testing positive for Covid-19 more than 30 days after showing first symptoms – 38 days in one case. It may be that the tests are picking up dead virus cells, but the discovery is causing uncertainty about how long people who have had the virus might remain capable of transmitting it.
The apparent resurgence of cases came as Downing Street said coronavirus outbreaks had been reported in almost four in 10 care homes in England. Data collected by Public Health England working with the Care Quality Commission revealed that 5,889 care homes had reported a suspected outbreak of symptomatic or confirmed coronavirus as of 17 May, the prime minister’s spokesperson said.
Care UK, which operates 122 private care homes, said it was dealing with at least one Covid-19 case in 71% of its facilities and had lost 586 residents to the disease so far. The death toll in English care homes from coronavirus is 12,409 up to 1 May, according to the Office of National Statistics, but an additional 10,000 deaths above the five-year average are unaccounted for, leading to concern the actual Covid-19 death toll among the most vulnerable could be far higher.
Down recorded 175 fatalities to Covid-19 among her patients in care and nursing homes in March and April, four times the usual death rate. Now its infection rates look like they may be picking up again, especially with greater testing.
Initially only patients in hospital could get tests in the UK. Then testing was expanded to NHS staff and care home staff. Now up to 10 million essential workers and their families who are showing symptoms of coronavirus can apply for a test via a government website.
The list of essential workers is the same as the one used to allow the children of key workers to carry on going to school during the lockdown. In addition to health and social care staff, the list includes teachers, judges, some lawyers, religious staff, and journalists providing public service broadcasting.
Also included are local civil servants, police, armed service personnel, fire and rescue service staff, immigration officers and prison and probation staff. Some private-sector staff also qualify including vets, those in food production, essential financial services and information technology, as well as those working in the oil, gas, electricity and water sectors.
One home, where 27 people have already died from confirmed or suspected Covid-19 but which had not recorded any new cases for a fortnight, diagnosed eight of 22 people living in one of its units with the virus, when testing was carried out. Five residents have also been hospitalised in the past few days.
“The unit looked like it had escaped but clearly it hasn’t,” Down said. “I am completely gutted about it. There are such characters in that unit and some of them are really unwell.”
She said the home had done a very good job on infection control, but still the virus got in.
In another home, nine out of the 15 residents tested positive on Thursday.
“It looks like a completely new outbreak that we have caught early,” she said. “We think it is potentially related to admissions from hospital in the last three weeks but are not able to confirm this.”
The manager of the home where 13 people have been diagnosed in a unit said widespread testing of asymptomatic patients – promised by the health secretary, Matt Hancock, on 28 April – had begun and was unearthing new cases.
“What we were seeing was the tip of the iceberg,” she said. “All of this was under water. The message we have given all of our staff is to treat everyone as if they are positive and take all the precautions. We are using PPE for everything.”
The manager, who asked not to be named, said her team were adjusting to the new reality. “There’s no panic anymore,” she said. “It’s now something we are living with. People have embraced the use of PPE.”
Down also said the lifting of lockdown restrictions more widely posed a threat to care homes, as families and relatives become more mobile and pressure grows for them to be allowed to see their loved ones in care.
