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7 May 2020updated 04 Sep 2021 12:23pm

Why England’s care homes could be the trigger for a second wave

Location data suggests the government's failure to protect care homes represents a risk not only to their residents, but to the wider population.

By Ben Walker

There are more than 15,000 care homes in England alone. Despite reports that many went into lockdown as early as the beginning of March, more than 4,500 (almost one in three) have reported outbreaks of coronavirus, while workers in others say that many cases are not being reported.

But while data shows that social distancing measures have slowed the pandemic in the general population, the growing number of outbreaks in care homes — many of which are far from the epicentres of infection in the wider population — suggests they could give rise to a second wave of coronavirus infections.

While the total number of hospital patients with Covid-19 has fallen by 7,000 since mid-April, the number of care homes in England to have reported an outbreak has increased by 808, from 3,708 outbreaks in the week following Easter to 4,516 the week after — an increase of 22 per cent. Scotland has already seen deaths from Covid-19 in care homes exceed the toll of the disease in hospitals. 

However, this is not just a question of how many infections are occurring in care homes, but where these outbreaks are occurring.

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We know that the pandemic spread outward across the UK from a number of epicentres, including London, Birmingham and Glasgow. From there, as the UK’s Chief Scientific Officer has described it, cases which came from other countries were “seeded right across the country”.

In general, then, we should expect the highest numbers of infected care homes to exist where there have been sizable numbers of Covid-19 cases and fatalities in other areas of life. But this is not case.

Instead, there is almost no correlation between contaminated care homes and the rate of cases in the local population. Most care homes that are experiencing outbreaks are not in Covid-19 hotspots. More than 1,000 of the outbreaks are in some of the least impacted parts of England and Wales. 

This should be cause for concern in areas such as the Sussex counties, South Gloucestershire, Windsor, Hartlepool and the Isle of Wight, which all have above-average concentrations of infected care homes, but below-average numbers of known Covid-19 cases.

The danger is compunded by the fact that all of these areas, and many others like them, have populations that are (due to their higher average age) more at risk from Covid-19 than the populations in the current urban epicentres.

Take Wiltshire, a county in the South-West that has one of the smallest concentrations of infections. It is geographically large, with its population thinly spread, and just 82 known cases for every 100,000 residents. It should be relatively optimistic. But 48 of its 179 care homes (more than 26 per cent) have reported outbreaks, and Salisbury has an average age that is, at 50, ten years higher than the UK average.

Wiltshire faces the risk that when lockdown is lifted, the virus that has been spreading through its care homes will be introduced to a population that is less well prepared to cope with its effects, compared with the urban populations affected by the first wave of infections.

The easing of lockdown is much anticipated across the country, especially by people in areas where the impact of the virus has been, so far, less obvious. The mental health impact of isolation on people in care homes is a serious concern, and families will be eager to see their loved ones after a long hiatus. Care workers themselves will understandably be eager to see their own friends and families.

But by relaxing lockdown measures without first attending to the urgent and growing problem of Covid-19 infections in these settings, the government risks unleashing a second wave — not in the cities that were epicentres of the first wave, but in towns and cities that have high numbers of contaminated care homes.

What’s evident from the current data on care home outbreaks is that little is happening to address this problem. While the most recent rise is smaller than that of the previous week, this may not indicate that the rate of infection in care homes is slowing; the latest weeks for Covid data are often revised at later stages.

We won’t know for some time, but the Director of the National Care Forum, Vic Rayner, has commented that care homes are, as yet, “nowhere near a peak”. To proceed as if we are would be to risk the health not only of people in care homes, but of everyone else, too.

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