The Economist - UK (2022-05-07)

26 Britain TheEconomistMay7th 2022

Carehomesandcovid

Isolatedincidence

N

o group suffered more during the

pandemicthancare­homeresidents.

FiguresforEnglandproducedbytheOffice

forNationalStatisticsshowthatjustover

45,000residentshavediedaftercontract­

ingcovid­19sincethepandemictookhold

inMarch 2020.A groupthatcomprises

fewerthanoneinevery 100 peoplebore

morethanoneinfourcoviddeaths.They

also suffered disproportionately from

measuresdesignedtoprotectthemandthe

widerpublicfromcovid­19.Residentshave

regularlybeenpreventedfromseeingfam­

ilyandfriendsforweeksormonthsata

time.Manyofthevictimsdiedalone.

Thegovernmenthasalreadybeentaken

totaskforthedeathtoll.OnApril27ththe

High Court ruled that the transfer of

asymptomaticpatientsfromhospitalsinto

carehomesintheearlydaysofthepan­

demic,seedinginfectionsthatthenspread

rapidly, was unlawful. The government

“failedtotakeintoaccountthehighlyrele­

vantconsiderationoftherisktoelderly

andvulnerableresidentsfromasymptom­

atictransmission”,thejusticeswrote.

Deathsfromcovid­19haveeasedasvac­

cinationrateshaveclimbed(seechart).But

theissueofrestrictionshasnotgoneaway.

AsBritainwasopeningbackupinJanuary,

SajidJavid,thehealthsecretary,saidcare

homesshould“doeverythingtheycan”to

bring visitors back. The government

scrappeditsguidanceforhomesentirely

inApril. Butinmany cases restrictions

blockingresidentsfromhumancontactre­

main.Therearestill“rollinglockdownsin

somecarehomes,blanketvisitingbansin

somehospitalwards”,saysJuliaJonesof

John’sCampaign,whichadvocatesonbe­

halfofpeoplewithdementia.

Groups likeJohn’sCampaignsay the

laws protecting therights ofcare­home

residents to have contact with family

members—suchasArticle8 oftheHuman

RightsActandclausesondeprivationof

libertyintheMentalCapacityAct—arestill

beingignored.Politiciansaregettingbe­

hind the campaigners. On April 28th a

groupofMPswrotetotheTelegraphand

calledforanendto“allunlawfulvisiting

restrictions”. An overlapping group has

urgedMrJavid tocreate legislationthat

wouldguaranteea “legalright”toreceive

visitsandsupport.Organisationssuchas

Mencap,MindandtheAlzheimer’sSociety

havesignalledtheiragreement.

Buttherealityiscomplex.MikePad­

gham,whorunsa groupofcarehomesin

Yorkshire,saysthat,althoughmanyresi­

dents’ families want restrictionsended,

otherswantthemtostaytoprotecttheir

relativefromcovid.Managingvisitsina

waythatminimisestheriskoftransmis­

sionputs anextraload onstaff.And if

transmissiondoesoccur,thenemployees

whocatchcovidhavetostayawayfrom

work,creatingafeedbackloop.This,he

says,putscareproviders“betweena rock

anda hardplace”.

Hospitalsarealsograpplingwiththe

task of managing visitors, maintaining

stafflevelsandkeepingpatientssafe.Ali­

sonHodge,whocaresforher98­year­old

mother at home in Yorkshire, says her

mother was moved to a covidisolation

ward shortly after arriving at York and

ScarboroughhospitalinlateMarchfora

routine operation, having been a close

contactofacovid­positivepatient.After

testingpositiveherself,MsHodge’smoth­

erendedupbeingkeptinhospitalforsix

weeks. Ms Hodge wasable to visither

twice;shesaysher mother,whoisnow

backathome,beginscryingwhenevershe

isleftalone.

Campaignersarguethatthedangersof

isolationnowoutweighthoseposedbythe

virus.Reliabledataonanycausallinksbe­

tweenhumancontactanddementiaout­

comesdonotexist.Runningcontrolledex­

perimentsinwhicha setofstudypartici­

pantsissystematicallyisolatedwouldbe

unethical.Butqualitativeandobservation­

alstudiessuggestthatmaintaininghuman

contactwitha knowncaregiverimproves

dementiapatients’scoresontestsforde­

pressionandcognitiveability.

MrPadghamhasnodoubts:“Human

contactwithlovedonesisfundamentalto

theirwell­being.Itcanslowdownthede­

mentia.”Onefactisespeciallysalientin

this regard. Dementia and Alzheimer’s

werethesecondmostcommoncauseof

deathincarehomesoverthecourseofthe

pandemic, runningonlyslightly behind

covid­19infections.Nowtheyareagainthe

mostcommon.n

LifeforBritonsincarehomesisstill

fullofrestrictions

Bearing the brunt

England

Sources:ONS;HealthSecurityAgency

100

80

60

40

20

0

10

8

6

4

2

0

2020 21 22

Deaths of care-home

residents, by cause

of death, ’000

Population who have

received at least two doses

of covid-1 vaccine, %

Deaths involving

covid-1

Other deaths

Nutrientneutrality

Bricks and water

N

utrient neutrality came  suddenly

to  Herefordshire,  a  pretty  corner  of

western  England,  in  2019.  “We  had  no

warning.  We  just  got  a  letter  in  the  post,”

says  Merry  Albright  of  Border  Oak,  a  local

house­builder.  Like  others,  Ms  Albright

quickly  discovered  that  she  could  no  lon­

ger  obtain  permission  to  build  homes

across  two­fifths  of  the  county.  She  now

travels  across  England,  as  far  as  Essex  in

the south­east, to seek work. 

The  rules  that  have  paralysed  house­

building  in  Herefordshire  are  designed  to

protect rivers and wetlands. Nutrient neu­

trality means that no development likely to

draw people to an area, from a new home to

a campsite, can be approved if it will result

in more nitrates or phosphates entering a

protected river. That is a severe limitation,

since  water­treatment  plants  do  not  re­

move all pollutants before discharging in­

to rivers. In practice, the rules make build­

ing much harder. 

Like  the  algae  that  thrive  in  polluted

water, nutrient­neutrality rules are spread­

ing  rapidly  (see  map).  In  March  Natural

England,  a  government  agency,  applied

them to new areas including Teesside and

part  of  the  Lake  District—again  without

warning. Natural Resources Wales, anoth­

er  agency,  has  issued  similar  guidance  in

large parts of that country. Both have been

driven to act by a decision from the Euro­

pean  Court  of  Justice,  which  ruled  in  2018

that the Netherlands was failing to protect

Britain is going about reducing river

pollution in a bizarre way