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Spread of COVID-19 across Norfolk care homes linked to "inadequate access" to PPE

The University of East Anglia's study found a link between insufficient PPE and a surge in coronavirus cases at Norfolk care homes.

New research from the University of East Anglia (UEA) has found a direct correlation between a surge in coronavirus cases at care homes across Norfolk and insufficient amounts of Personal Protective Equipment (PPE).

UEA's study also found that there was a higher chance of COVID-19 entering residential care homes, when more non-care staff were present, such as maintenance people, cooks and those in administrative roles.

The study hasn't yet been peer-reviewed due to the rapid-response of it, but the team behind the study hope it will have a say in implementing new strategies on controlling the spread of the virus and other contagious diseases in care homes.

Infectious diseases expert Prof Paul Hunter, from UEA’s Norwich Medical School, said:

“Covid-19 has disproportionately more severe outcomes among the elderly and it has swept through residential care homes in the UK and abroad, with a high number of deaths.

“About 40 per cent of all Covid-19 deaths in the UK in early May 2020 were among care home residents.

“But preventing and controlling infectious disease outbreaks in care settings has many challenges.

"The sector is under-funded in many countries and staffed by low-paid workers who may have insufficient training or experience in infection control.

“It’s well known that here in the UK, care home workers were not supplied with sufficient personal protection equipment (PPE) such as masks, gloves and protective gowns early in the Covid-19 outbreak.

"This lack of PPE was widely suspected to have contributed to the spread of the disease and deaths in care homes.

“We wanted to see if lack of PPE could be linked to spread of Covid-19 in a real dataset of Norfolk care homes, and if any other factors seemed to be at play. 

"We found that once Covid-19 was in a care home then the outbreak was worse where more care staff were employed, but this was much less important than whether they had shortages in certain types of PPE.”

In total, 248 care homes across Norfolk were studied between April and early May using data in the Capacity Tracker database, which is used to flag up any shortages in PPE.

UEA researchers compared how widespread the virus was, in comparison to the availability of equipment such as aprons, eye protection, gloves, masks and hand sanitiser, while also taking into consideration the number and types of staff at the homes, such as nurses and face-to-face care workers.

Lead researcher Dr Julii Brainard, also from UEA’s Norwich Medical School, said:

“Of the 248 care homes in Norfolk with complete data, 25 had definite or suspected cases of Covid-19 – about 10 per cent.

“We found that the number of non-care staff - such as cooks, maintenance people, and administrative staff - was linked with a higher risk of Covid-19 entering a care home.

“This is really interesting because these are not the people who are directly involved in the care of residents. We don’t know exactly why this is the case, but it may have been down to low use of PPE among these employees, which means they were more likely to pass on the infection to other staff or during brief time spent near residents. 

“Alternatively, non-care workers may be more likely to work part time and possibly work across several locations.

“We also found that once introduced into the home, the subsequent spread of Covid-19 was largely associated with inadequate access to PPE, particularly facemasks and eye protection.

“Supplies of PPE to UK care homes have increased since our study monitoring period and we hope this has changed the balance of future risk factors.

“Although our research clearly indicated the importance of PPE to reduce disease spread, we believe that infection prevention and reduction needs to be more multi-faceted than simply supplying adequate PPE and training to use it. 

“Low pay and job insecurity means that many people who work in care homes may need to work across multiple settings to have income security. 

“Each setting they work in can mean more chances for exposure to infectious people, and higher chances of infection transfer between settings. This is a problem for infection control across the entire care sector.” 

The study found the risk of contracting the virus was over six times higher in care homes that employed between 11 and 20 non-care workers, nearly 10 times higher in those employing 21-30 non-care workers and a whopping 19 times higher in homes employing over 30.

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