2020-11-14NewScientistAustralianEdition

14 November 2020 | New Scientist | 23

R

ESTRICTIONS to stop the
spread of coronavirus are
tightening across the UK,
including a four-week lockdown
in England. Care homes, however,
may rightly start to go in the other
direction. The previous rules
made no scientific sense and have
harmed many vulnerable people.
Almost 14,000 deaths in
nursing and care homes in the
UK were attributed to covid-19
between April and July 2020, and
consequently residents in homes
had severe visiting restrictions
imposed. Many were isolated from
usual family contact for months.
In Scotland, for example,
visiting a care home is allowed
only if the entire home is free
of any covid-19 symptoms for
28 days, and even then there must
be approval from the local director
of public health. In Leeds, England,
it isn’t illegal to visit, but local
government guidance says you
must have a very good reason, and
the example given is if someone
is dying. The problem is that most
people in care homes are in the
last two years of life. The median
length of stay for people admitted
to nursing beds is less than a year.
Most people in care homes
have dementia, and for them, the
end-of-life phase can last weeks,
months or even years, according
to the Alzheimer’s Society, even
though the rules about visiting
often prevent family contact
until the last few days. It is well
documented that social isolation
accelerates deterioration in
MIpeople with dementia. So, these
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restrictions are killing people.

Last week, I and more than

60 experts and organisations

issued a call for action demanding

that restrictions on care home

visits in the UK be lifted.

The rules were mainly intended

to stop the spread of covid-19.

But as infections are measured

relentlessly, and many cases have

been recorded as covid-19 without

any test, this may mean the case

numbers in care homes have

been overstated. By comparison,

the risk of people’s conditions

worsening and them dying

because they are cut off from

family and friends isn’t measured.

The care minister, Helen

Whately, has now updated the

guidance for care homes in

England, in an attempt to better

facilitate visits. This gives the

care home operators and public

health officials who have the final

decision on local visiting rules

a real dilemma. Because of the

reputational damage and legal

risks that would arise from an

outbreak, they feel forced to apply

maximum visiting restrictions

even where it separates families

for months on end.

This isn’t just an issue in the

UK. International concern is

increasing about the negative

impact of visiting restrictions on

the health and well-being of care

home residents and their families,

and a review of covid-19 in care

homes led by the London School

of Economics, which involved

researchers in Australia and

Canada, found no evidence

of visitor impact on infections.

There is no scientific data

suggesting that visitors have

been the source of an outbreak

in a care home. Some research

is said to indicate that care home

risk is related to the size of the

care home, but more research is

needed before that can be proved,

including rigour in diagnostic

definitions of covid-19 deaths.

Governments have denied

that it is related to the discharge

of large numbers of untested or

covid-19 positive patients into

care homes, although this

seems intuitively probable.

In truth, all the data is flawed

and it is too soon to say.

It isn’t yet clear how individual

care homes will respond to the

new government guidance and

if similar relaxations will be

recommended outside England.

But with the right precautions,

such as individual risk

assessments and making

sure meeting places are well

ventilated, care home restrictions

can be sensibly loosened.

And that could save lives. ❚

Irrational restrictions

Care home rules to prevent the spread of coronavirus are too strict

and not based on science. This could cost lives, says June Andrews

June Andrews is the

author of Care Homes:

The One-Stop Guide