Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

COVID-19 in Care Homes: Atypical Presentations and High Mortality Rates Mean Outbreak Management Needs to Include Health and Social Care - Early Identification of Atypical Clinical Signs, and Complete Segregation of Cases, Not Cohorting, Is Essential

Version 1 : Received: 4 June 2020 / Approved: 7 June 2020 / Online: 7 June 2020 (05:49:04 CEST)

How to cite: Down, A.; Dhillon, A.; Stretch, G. COVID-19 in Care Homes: Atypical Presentations and High Mortality Rates Mean Outbreak Management Needs to Include Health and Social Care - Early Identification of Atypical Clinical Signs, and Complete Segregation of Cases, Not Cohorting, Is Essential. Preprints 2020, 2020060060 (doi: 10.20944/preprints202006.0060.v1). Down, A.; Dhillon, A.; Stretch, G. COVID-19 in Care Homes: Atypical Presentations and High Mortality Rates Mean Outbreak Management Needs to Include Health and Social Care - Early Identification of Atypical Clinical Signs, and Complete Segregation of Cases, Not Cohorting, Is Essential. Preprints 2020, 2020060060 (doi: 10.20944/preprints202006.0060.v1).

Abstract

Watching the international COVID-19 epidemics unfold during February and early March 2020, we began to highlight how outbreaks in care homes were inevitable, given the vulnerable patients in close proximity, and pressures on social care to help relieve pressure on the NHS. We suggested public health measures would significantly impact on care homes. Specifically we felt all homes would have multiple individuals isolated within days of introduction of guidance requiring isolation of new cough (or fever), and that a clear definition of an outbreak would be needed that differentiated COVID19 from influenza. We share the experiences of a GP practice looking after 900 nursing or dual registration care homes in the London Borough of Ealing in the early stages of the COVID19 Pandemic 2020. We believe that the altered presentation of cases of COVID19 in care homes contributed to the size of outbreaks, and that keeping COVID19 out of homes is the only way to manage this disease, with early isolation and complete segregation of positive and negative cases. We have seen over 300 suspected cases resulting in four fold (n=175) average monthly death rates, three fold usual issue of anticipatory medications, and approximately 32% mortality rate (up to 43% in over 90’s). Discharge pathways from hospital and admissions to care homes must be clear and robust. COVID19 naïve patients should not be admitted to units with outbreaks and COVID19 positive patients should not be admitted to anything other than a designated “hot” home until risk of contagion is passed. Some patients are testing positive at over 30 days since initial mild symptoms.

Subject Areas

COVID-19; care homes; general practice; hospital discharges

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