Over half of deaths, 59%, in Scotland where  Covid19 was mentioned on the death certificate took place in Care Homes. This is a shocking statistic in places where there has been a lockdown in force for over 6 weeks.

The weekly figures published by the NRS (National Records of Scotland) as at the 3rd of May covid deaths report as at 3rd May 2020 NRS show a continued shift from deaths in hospital to those in care homes. There has been a slight decrease in the number of people dying from Covid19 in Scotland, however it is still an appalling 2,795.

Home Farm Care Home, Skye

The first case of Covid19 was recorded in Skye last week and over the last few days testing and tracing has moved apace with the army’s mobile units deployed on the island. It was then announced that at the Home Farm Care Home nearly all the residents had tested positive for Covid19 (28 out of 34) as did many of the staff (26 out of 52). Tragically 2 of the residents have since died.

Rhoda Grant MSP, Labour raised the issue in the Scottish Parliament. She said:

“I am deeply distressed for the residents and staff at Home Farm Care Home.

“A constituent with a relative in the home has told me she was raising concerns with senior management of the company weeks ago about its handling of the pandemic and the lack of PPE for staff. She was also concerned staff were being taken in from other care homes without a period of isolation.

“I have written to the Cabinet Secretary and put down a written question asking on behalf of another constituent for a protocol for Care Homes in this Pandemic and have had no response.

“When will there be a protocol for Care Homes to prevent tragedies such as this one in Skye?”

Jeane Freeman, the Scottish Health Minister responded. She said:

“The guidance to care homes is clear and that guidance is that residents should be looked after in their own rooms, there should be no communal socialising or meal times, that visits should be stopped and there should be no transfer of staff from one care home to another because all of this is about breaking the transmission route. That I think is a protocol of type …”

“I would like to point out, however, that many of the issues that members are raising are issues where private care home providers, where the majority of the outbreaks are, have not, in some instances, appeared to follow the guidance that we require them to follow and that is why as government we are now taking a more direct intervention route in those cases.”

Rhoda Grant raised her question after a relative of a Home Farm Care Home resident contacted her for support saying she had raised concerns weeks ago with HC-One which owns the care home about staff not wearing PPE.

She also claimed that she was aware HC-One was moving its own staff between its care homes after the home went into lockdown on March 12 without adhering to seven-day self-isolation rules.

She contacted Rhoda Grant  saying she was shocked and distressed to see how her relative’s health had deteriorated in the last few days since being diagnosed with Covid-19 in the care home.

The woman, who does not want to be named, told Rhoda Grant:

“The sheer volume of this explosion at Home Farm has knocked everybody for six. Hopefully my husband is going to pull through this. But that doesn’t change my stance that somebody is responsible for letting that virus into the home. I am not condemning the care home staff in any way though because I don’t believe they are to blame. They have provided wonderful care to my husband over the years.”

Rhoda Grant will also be raising the issue with  the owner of the care home HC-One, The Care Inspectorate and NHS Highland.

She said:

“This is terrible. It’s shocking. This woman, who until lockdown was visiting her husband six days a week, has managed to see him yesterday on webcam for the first time in a week and the sight of him lying in bed desperately ill miles away from her is something no-one should ever have to see.

“We need to find out why the virus has spread so quickly to so many in this care home and why earlier mass testing was not carried out. There are urgent questions that need to be answered.”

First Minister’s Question Time

The First Minister was asked yesterday at question time in the Scottish Parliament about the Trace, Test, Isolate, Support, strategy announced by the Scottish Government this week. Nicola Sturgeon was pressed on why the testing capacity now available was so underused and what progress was being made on recruiting workers as contact tracers. A lack of testing kits in the Grampian Health Board was also raised.

Scotland now has NHS testing Labs in every Health Board area and the use of UK Government drive throughs in addition to army mobile units. 65,125 people have been tested through the  NHS labs with  52,416  confirmed negative and 12,709  positive (figures as of 6th of May). This is a long way off the number which require to be tested before Scotland can safely come out of its lockdown. Going by the FM’s statement on 5th of May coming out of lockdown also looks a long way off – perhaps at the end of May.

At Holyrood’s Question Time the FM was also asked about the R number and what it was in care homes. Professor Hugh Pennington had suggested to the Scottish Parliament’s Health and Sport Committee last week that it could be as high as 10 in care homes. The R number for care homes is still not known. Testing Times

What is the R Number and why is it important?

The R number is the reproduction number. That means if 1 person is infectious and they then transmit it to others how many (on average) will it make contagious.

The R number is used in populations to estimate the infectious rate of a virus when there is no vaccine available and no immunity.

• If R₀ is less than 1, each existing infection causes less than one new infection. In this case, the disease will decline and eventually die out.
• If R₀ equals 1, each existing infection causes one new infection. The disease will stay alive and stable, but there won’t be an outbreak or an epidemic.
• If R₀ is more than 1, each existing infection causes more than one new infection. The disease will be transmitted between people, and there may be an outbreak or epidemic

It is estimated that the 1918 flu epidemic which killed upwards of 50million people had an R number of between 1.4 and 2.8

In 2009 the H1N1 flu virus is estimated to have had an R number of between 1.4 and 1.6

Citizens have observed the limitations imposed on them by the lockdown in Scotland now entering its 7th week. This has prevented transmission within the community to a certain extent but if the lockdown is to be successfully eased and eventually lifted, distancing and personal hygiene must continue to be observed. With such limited testing having taken place in Scotland up to now and very little contact tracing currently taking place it is possible for the rate of infection of Covid19 to increase. It has been estimated by experts advising the FM that the R number in Scotland is somewhere between 1 and 0.7. This estimate is based on modelling using the figures currently available and that 26,000 people in Scotland are infectious. It is also suggested that the R number in Scotland is higher than that in the UK as a whole.

Breaking down the statistics

Some work is now being done to break down the statistics in Scotland to provide more detail about how Covid19  is spreading within different communities and age groups.

The newly released stats (as of 3rd of May 2020) show that of the 12,266 confirmed COVID-19 cases, 7,324 (approx. 60%) were women, 4,914 (approx. 40%) were men. People over 85 had the highest rate of confirmed cases.

The Covid19 pandemic is a public health disaster and information broken down into ethnicity, sex ,level of deprivation etc is important to understand not just how the virus spreads but how to control and eradicate it.

Information of this nature has been available in New Zealand for some time and is presented in a clear and informative way. You can find that data here: Ministry of Health New Zealand

New Zealand also has an interactive map and dashboard: NZ COVID-19 Dashboard

You can use it to compare how countries are doing internationally. The level of information is excellent.

It is important for governments to learn from others who have been more successful in dealing with Covid19 and also how better to present information to the public which is easy to find and understand.

New Zealand has (as of 6th of May) 21 deaths from Covid19. They have tested 160,700 people.  The New Zealand  strategy published on 28th of April is  based on Elimination.

You can read that here:testing approach to eliminate covid 19 28 april 2020 New Zealand

Identifying cases of COVID-19 is an essential part of New Zealand’s elimination strategy. It forms the key starting point for the testing, tracking and tracing of cases and their contacts. In order to be confident that the New Zealand elimination strategy is working and that we can move down alert levels, we need to be confident that we are identifying all cases and that there is no ongoing undetected community transmission. We also want to ensure that we have an equitable response to this pandemic, and that we are not creating or exacerbating inequities in our community. Covid 19 Testing in Alert Level

In Scotland the strategy is to Suppress the virus – as outlined in the updated  Coronavirus (COVID-19): framework for decision making

Suppress the virus through compliance with physical distancing and hygiene measures, ensuring that the reproduction number remains below 1 and that our NHS remains within capacity. Framework for Decision Making

Review of Scotland’s Covid19 Plan

Today, Thursday 7th of May, the Scottish Government will review where we are with lockdown – it is most likely there will be no change – and the next date for review will be 28th of May. As the testing taking place is well below capacity and very little tracing has taken place, to come out of lockdown now would potentially unleash another and perhaps more deadly phase of Covid19.

The public are being encouraged to join in the discussion and add their response to the Scottish Government’s Framework .

Click on this link to register and submit your ideas here: Ideas Coronavirus (COVID-19): framework for decision making

The closing date for you to respond is 10pm on Monday 11th of May

Reporter: Fiona Grahame

credit Stewart Bremner