Up to 10,000 Covid deaths among care home residents may have been missed off records, a study suggests.
University of Manchester researchers combed through data from the Care Quality Commission, which tracks outbreaks in England’s care homes.
Around 29,500 more care home residents died from April to August than expected — which are known as ‘excess deaths’.
Some 19,000 were reported to be caused by Covid-19. The remaining 10,000 were not flagged as being related to the disease.
However, because researchers found 99.6 per cent of all excess deaths occurred in the care homes that experienced Covid outbreaks, they believe a ‘high proportion’ of the remaining 10,000 deaths were caused by the infection.
The victims might not have been noted down as a coronavirus death due to a lack of testing or any clear signs they had the virus because symptoms in the elderly can be different to the typical cough and high temperature.
The Office for National Statistics, which has also counted Covid-19 deaths during the pandemic, has also reported 25,000 more deaths in care homes from March to October.
It’s figure does not include care home residents that died in hospital or elsewhere, as this study did.
The government-run agency has suggested some of these excess deaths may have been caused by undetected coronavirus in the first wave in the spring — but have never been able to put a number on it.
Some excess deaths could also be as a result of indirect harm caused by lockdowns, such as that GPs were only available online or because the health of elderly residents deteriorated as a result of spending months in isolation.
Up to 10,000 Covid-19 deaths among care home residents may have been missed off records, a study suggests
‘Excess deaths’ are those which occur that were not expected to, when compared to the average recorded over the past few years. Pictured are the deaths that happened (observed) compared to what was predicted in nursing homes – care homes with the most vulnerable people
These two graphs show the excess deaths in care homes with nursing services (for people who have complex needs that require regular attention). It might include elderly people with dementia. It shows thousands of excess deaths that were not attributed to Covid-19 (grey)
The University of Manchester study is the first independent analysis of data from the CQC.
The study used data from the 13,630 care homes in England which reported at least one death over the study period.
‘Excess deaths’ are those which occur that were not expected to, when compared to the average recorded over the past few years.
If 500 care home residents normally died each year but one year 520 fatalities were recorded, there would be 20 ‘excess deaths’.
Researchers led by Dr Marcello Morciano compared pre-Covid data from 2017 with data from 2020 to assess a change in care home excess deaths.
Using official data, they showed 29,542 more care home residents died during the first 23 weeks of the pandemic than would normally be expected.
Only 65 per cent of the fatalities — 19,128 — had Covid-19 noted as contributing to the death, either confirmed or suspected.
That means the remaining 35 per cent — 10,414 — have had their deaths flagged as non-Covid related.
Dr Morciano and colleagues believe a significant amount would have been due to coronavirus because almost all the excess deaths occurred in the quarter of care homes that experienced outbreaks.
Of the 29,542 excess deaths, 29,429 happened in a care home where residents had definitely died of Covid-19.
Dr Morciano told MailOnline: ‘This makes us to believe the 10,000 might be Covid-19 related.’
But Dr Morciano was unable to explain how many of the 10,000 excess deaths were, in fact, caused by Covid-19.
She said: ‘It’s very hard to make an estimate here. Unfortunately this is a question we can’t answer.
‘We believe it’s a high percentage because in many cases you cannot work out if the death was Covid-19 or not because we didn’t have the tests.’
These two graphs show the excess deaths in care homes without nursing services, called residential care, for example a home for over 65s. There were not as many as in homes with nursing services
Of the 29,542 excess deaths, 29,429 happened in a care home where residents had definitely died of Covid-19 (see left). Dr Morciano told MailOnline: ‘This makes us to believe the 10,000 might be Covid-19 related’
CARE HOME VISITS COULD ALLOW VISITS BY CHRISTMAS
Care homes will finally be able to allow in-person visits over Christmas by testing relatives for Covid-19, Health Secretary Matt Hancock announced today.
The Government is piloting rapid testing in 20 care homes in low-infection areas in Hampshire, Devon and Cornwall to see if it is safe to let family members visit vulnerable residents indoors.
Mr Hancock said, if effective, he plans to expand the programme across England within weeks. In a round of interviews this morning, the Health Secretary said: ‘I hope to have that in place for all care homes by Christmas.’
The move would finally allow families to visit loved ones in the flesh without the need for ‘prison-like’ windows for the first time in eight months.
Under current rules, relatives can often only see loved ones through plastic screens. A small number of care homes had been allowing garden or drive-through visits, though moving into winter these have been increasingly less practical.
The pilot will aim to assess whether indoor visits must still be socially distanced or whether relatives will be able to hug for the first time in months.
The trial schemes will use both standard PCR tests or new lateral flow tests, which give results within minutes but miss between half and 25 per cent of cases.
Relatives and campaign groups have warned for months that the current rules have taken a catastrophic toll on the wellbeing of vulnerable residents.
Testing shortages were a problem mostly at the start of the pandemic.
In March and April swab tests to see who had the disease were rationed and not available to all care home residents suspected of having the disease.
Dr Morciano said: ‘The reported lower rates of testing experienced in England during the first wave could lead to some relevant deaths not having Covid-19 listed as a contributory factor, leading to apparently higher non-Covid-19 excess deaths than officially recorded.’
The CQC only started collecting data on Covid-19 deaths in care homes from April 10, several weeks after the first Covid-19 case was detected in the UK, and the ‘peak’ of infections.
For that reason, Dr Morciano said many deaths even before April 10 would have been miscoded as unrelated to Covid-19.
It could have allowed outbreaks to spread further. But the capped testing would have made it impossible to link deaths to the virus.
Dr Morciano said: ‘Thousands of people have died from Covid-19.
‘This study shows in care homes mortality figures attributable to Covid-19 have been hugely underestimated.
‘The figure could be as high as 10,000 (more) people.’
Professor Evan Kontopantelis, another one of the researchers, added: ‘At the beginning of the pandemic (care home) staff were left without PPE.
‘Testing regimes were poor, and care home residents who needed hospital treatment didn’t get it.
‘And in mid-March, hospital trusts discharged medically fit patients to care homes to free capacity.
‘Mandatory testing prior to discharge was only brought into effect a month later.
‘These factors have all played their part in the higher figure of deaths we have described.’
Dr Jonathan Stokes, who was also involved in the study, said: ‘The large excess of deaths in care homes shows England, and other countries, didn’t adequately protect this vulnerable group in the first wave of Covid.
‘Care home residents should be a clear priority for managing supply of rapid testing and other interventions in future waves, balancing protection from mortality with quality of life and other important outcomes.’
The Office for National Statistics calculated there were around 22,202 excess deaths in care homes in the first 24 weeks of the pandemic, according to data in its most recent report on November 10.
The 29,000 figure from Dr Morciano and colleagues is higher because it accounted for care home residents who died in hospitals or private homes as well.
The ONS has put non-Covid excess deaths during the first wave in a similar ballpark to this study, at around 10,000.
But the Government agency has said while some of these may be due to untested coronavirus, they could be indirectly caused by the pandemic.
GP appointments have moved to over the phone or video call for the majority of this year, and managing unstable conditions is much harder remotely than with face to face attention.
People with diabetes or high blood pressure may struggle to manage their condition if GPs were not seeing patients in real life, experts say.
There has been a lot of concern that elderly people in care homes have rapidly deteriorated both mentally and physically as a result of being isolated since March.
But Dr Morciano says he does not think this would have translated into deaths in the first wave of the pandemic because the process would have been more drawn out.
His study also found deaths were 13 times higher in large care homes than small ones, and in those who cared for dementia patients (five times higher).
The paper said this is probably because large homes have more people coming and going, and therefore risk of a visitor or agency worker bringing in the coronavirus.
It might also be easier to keep infection control tight in small care homes, they said.
But there was no significant difference between deaths in care homes that were private or NHS run.
Professor Kontopantelis said: ‘We believe that knowing the care home characteristics associated with Covid-19 outbreaks and excess deaths may help in designing rapid responses.’
The study is not yet peer reviewed and was published online as an early version. But the authors felt there was an urgency to pass on the information to the public and policy makers.
WHAT WENT WRONG FOR CARE HOMES? A TIMELINE OF FAILINGS
FEBRUARY – SAGE scientists warned Government ‘very early on’ about the risk to care homes
Britain’s chief scientific adviser, Sir Patrick Vallance, revealed in April that he and other senior scientists warned politicians ‘very early on’ about the risk COVID-19 posed to care homes.
He said: ‘So very early on we looked at a number of topics, we looked at nosocomial infection very early on, that’s the spread in hospitals, and we flagged that as something that the NHS needed to think about.
‘We flagged the fact that we thought care homes would be an important area to look at, and we flagged things like vaccine development and so on. So we try to take a longer term view of things as well as dealing with the urgent and immediate areas.’
The SAGE committee met for the first time on January 22, suggesting ‘very early on’ in its discussions was likely the end of January or the beginning of February.
MARCH – Hospital patients discharged to homes without tests
In March and April at least 25,000 people were discharged from NHS hospitals into care homes without getting tested for coronavirus, a report by the National Audit Office found.
This move came at the peak of the outbreak and has been blamed for ‘seeding’ Covid-19 outbreaks in the homes which later became impossible to control.
NHS England issued an order to its hospitals to free up as many beds as they could, and later sent out joint guidance with the Department of Health saying that patients did not need to be tested beforehand.
Chair of the public accounts committee and a Labour MP in London, Meg Hillier, said: ‘Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences.’
MARCH – Public Health England advice still did not raise alarm about care home risk and allowed visits
An early key error in the handling of the crisis, social care consultant Melanie Henwood told the Mail on Sunday, was advice issued by Public Health England (PHE) on February 25 that it remained ‘very unlikely’ people in care homes would become infected as there was ‘currently no transmission of Covid-19 in the UK’.
Yet a fortnight earlier the UK Government’s Scientific Pandemic Influenza Modelling committee had concluded: ‘It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.’
On March 13, PHE advice for care homes changed ‘asking no one to visit who has suspected Covid-19 or is generally unwell’ – but visits were still allowed.
Three days later, Mr Johnson said: ‘Absolutely, we don’t want to see people unnecessarily visiting care homes.’
MARCH/APRIL – Testing not readily available to care home residents
In March and April coronavirus swab tests – to see who currently has the disease – were rationed and not available to all care home residents suspected of having Covid-19.
Government policy dictated that a sample of residents would be tested if one showed symptoms, then an outbreak would be declared and anyone else with symptoms presumed to be infected without a test.
The Department of Health has been in control of who gets Covid-19 tests and when, based on UK testing capacity.
MARCH/APRIL – Bosses warned homes didn’t have enough PPE
Care home bosses were furious in March and April – now known to have been the peak of the UK’s epidemic – that their staff didn’t have enough access to personal protective equipment such as gloves, masks and aprons.
A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’.
Adass said it was facing ‘confusion’ and additional work as a result of mixed messaging put out by the Government.
It said the situation around PPE, which was by then mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.
A shortage of PPE has been a consistent issue from staff in care homes since the pandemic began, and the union Unison revealed at the beginning of May that it had already received 3,600 reports about inadequate access to PPE from workers in the sector.
APRIL – Care home deaths left out of official fatality count
The Department of Health refused to include people who had died outside of hospitals in its official daily death count until April 29, three weeks after deaths had peaked in the UK.
It started to include the ‘all settings’ measure from that date and added on 3,811 previously uncounted Covid-19 deaths on the first day.