A Primary Care Physician
Covid-19: A failure to protect the most vulnerable in our society
10th March 2020 to 3rd April 2020 – the 24 days Covid-19 was allowed to silently infiltrate our local care home. The 24 days it spread, suspected but unconfirmed, like Japanese knotweed embedding its roots so deep it becomes impossible to get on top of it. The 24 days that patients and staff mingled unknowingly infecting each other and sealing their own fate. The 24 days that the rules set by those elected to protect the citizens of this country failed a generation. The 24 days we could have made a difference and will never get back.
On the 10th of March 2020, a patient developed signs consistent with Covid-19. Following government advice 111 was called to ask for a test and to express our concern that an outbreak in a care setting would be catastrophic. We were advised that the government were not swabbing people in a care home setting - a swab was not possible.
Over the next 24 days we had many patients come down with symptoms. We contacted 111 on numerous occasions, but our pleas fell on deaf ears, our patients continued to fall ill and as they had no confirmed outbreak, the care home staff could not access PPE. Not willing to give up we turned our attention to Public Health England – they too refused to come and swab our patients. We contacted our local pathology department to ask if they would process tests if we took them ourselves using our in-house supplies. We were told ‘No’ this would not be possible.
On the 31st March we heard news that a patient had fallen-over in the home, had been admitted to hospital and tested positive for Covid-19, this despite being asymptomatic. Our greatest fears now finally confirmed. Four days later, after several more calls to 111 and Public Health England it was agreed that our 5 most symptomatic patients could at last be tested. They were all positive.
After those first 5 confirmed cases, we were refused further testing in line with government guidelines. Once there are 5 confirmed cases this is deemed an outbreak and any further suspected cases are deemed to have the virus without a positive test– or so we were told. Any patient who developed symptoms was isolated and tended to by staff wearing PPE. However, we know people are most infectious 1-3 days before showing symptoms and we know that many people are asymptomatic carriers. Once the virus is established, without rigorous testing and isolation of patients, it is almost impossible to contain it in this setting.
I listened with relief when the government first announced they would now be testing all symptomatic patients and carers in care homes and subsequently that they would test all care home staff and residents regardless of symptoms. Alas, whilst I would not accuse our elected government of lying to its public (as I’m sure there was at least one home for which this stands true) this was not our experience. Despite multiple calls to Public Health England in the week after this announcement we were told that further testing was not possible. Staff could register for testing online but being a small community where many people do not drive they were unable to get to the test centres some 40 minutes away. We were advised they should register for self-tests but found these were rapidly unavailable. Finally after a further day on the phone and a rather brisk conversation demanding to know why the Health Secretary was standing in front of the country declaring testing for all, when this was not the reality, we have been informed we will finally get all our patient’s tested - some 53 days after we first asked for help.
Since that first positive patient in March our practice has had over 30 residents and many staff from this care home with suspected Covid-19. Sadly around 50% of these have succumbed to this deadly virus. It has been an exceptional example of team work and courage from the care home staff, district nurses and primary care team who have tended to these patients in their last days, ensuring their comfort and giving them a death free of distress and surrounded by the people and places they know. But it could have been prevented. It should have been prevented.
The government are now including deaths from care homes in their daily figures. A long-awaited change that many have been calling for. It turns out that for these deaths to count the patient does not only need to have had Covid-19 on their death certificate but also must have had a positive swab. Given the challenges in obtaining these swabs and the 5 cases rule, I can only believe this is an intentional distortion of the official figures. I agree that it does nothing to bring those patients back, but finding a loop hole to not include them not only makes their death in the hand of this virus less valid but it is insulting to clinicians who are well versed at deciding a cause of death and have done so for many years without the need for confirmatory testing.
If testing had been done earlier, we could have isolated the sick and reduced transmission substantially. I do not blame the individuals we spoke to over the phone, they were simply following the rules, but there is no mechanism to drive through the layers of bureaucracy that exist. No matter how loud we shout the people at the top are not hearing the cries of those on the front line. Why was it that when we were preparing for significant casualties in the care home setting as early as the end of March, making sure patients had care plans in place protecting their wishes should they fall ill, that it took the Government a further month to realise this same fact and take action. Perhaps if those making decisions asked people in the community what they needed, what problems they faced now and what problems they could foresee then the government strategy would not constantly remain behind the curve.
I will forever more think of those early days in March as the 24 days we let down the most vulnerable people in our society. The 24 days our outbreak could have been prevented. The 24 days those who went to war for us were forgotten. The 24 days this country should have done better.