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Covid-19: Continued outbreaks in care homes risk extending pandemic, say experts

BMJ 2020; 369 doi: (Published 24 June 2020) Cite this as: BMJ 2020;369:m2530

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  1. Shaun Griffin
  1. London

The number of outbreaks in care homes and a lack of important public health information are still affecting the ability to manage the spread of covid-19, experts have warned.

Latest figures from the Office for National Statistics (ONS) showed 100 outbreaks in care homes in England during the week of 8 June—an average of two to three deaths in each care home.

At a Science Media Centre briefing to discuss the data, Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford, said that the figures were worrying. “If we are going to eradicate and reduce this outbreak we have got to get that number down to zero,” he said.

He noted that care homes in some areas had been disproportionately affected, such as in Oxfordshire, where 74% of 129 care homes had had covid-19 outbreaks, and in Islington in London, where outbreaks had occurred in 81% of the 160 care homes.

Heneghan added that, although he had requested data from the ONS, it was still not known how many of the 6000 outbreaks in UK care homes had actually been resolved (or “closed down”)1 and how many of the homes had been covid-free for seven days or more.

“If they are not [covid-free], their staff should be in quarantine and this should clearly be happening [and reported],” he added. “I want to know how many [outbreaks] are now closed down, because it matters. This is important public health information to have right now.” He and others23 have previously voiced concerns about the lack of data on local outbreaks.

Age groups and risk

David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication, University of Cambridge, told the briefing that the ONS data continued to show the “extraordinary impact” of age on the risk of catching and dying from covid-19, a risk that doubled every five to six years.

In the week ending 12 June the number of deaths involving covid-19 did not increase in any age group for the first time since the pandemic started. But the highest proportion of deaths involving covid-19 (14.2%) occurred in people aged 85-89.

Among lower risk age groups, Spiegelhalter calculated how the risk of catching and dying with covid-19 varied. Comparing the ONS data with 2018 data on deaths from other causes, he explained that, in people under 50, the average risk of catching covid-19 and dying with it was lower than the risk of death from injuries. Among under 40s the same risk was lower than that of being killed in a road incident, and people under 25 were more likely to die with flu or pneumonia than covid-19.

Spiegelhalter emphasised that “these are average risks to the individuals themselves, including those with pre-existing medical conditions”—meaning that healthy under 50s had less than a third of this risk but that, because they “can still pose a risk to others, [they] should protect the vulnerable.” He explained that, “without lockdown, these risks would have been higher,” adding that future risks would be “far lower . . . due to the reduced chance of catching the virus after the peak of the epidemic.”

Heneghan also described his own analysis, which showed that the number of people dying with covid in hospitals had been declining considerably since the end of March. Highlighting two dates during this period, he explained that, of the 10 387 people in hospital in England with covid-19 on 2 April, 644 (6%) died, whereas on 15 June around 1.5% of people (50 of 3270) with covid-19 died in hospital.

“You’d expect 190 deaths if there was the same relationship,” said Heneghan, adding that multiple factors might explain this difference, including more patients in June who had recovered but not been discharged or better treatment options. “It is important to understand the reasons,” he said.

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