Hospital patients with Covid-19 ‘should not be discharged into care settings’

Hospital patients should not be discharged into care or nursing homes if they have a Covid-19 diagnosis in order to protect “vulnerable” residents and staff, an expert said.

Carl Heneghan, professor of evidence-based medicine at the University of Oxford, said there is a need to think through the strategy to stabilise infections in nursing homes.

Discharging patients with confirmed Covid-19 into care settings and isolating them, as set out in Government guidance “just does not make any sense” clinically, he said.

He told the Science Media Centre he understands about a third of nursing homes have Covid-19 outbreaks.

Discharging hospital patients with Covid-19 into those without the virus “has got to be an utter no-no”, he said.

He added: “If that continues, we will have a problem if we transfer people from hospital in the home setting, there must be a line drawn to say these people have no active infection.”

Government guidance released on April 2 said negative coronavirus tests “are not required prior to transfers/admissions” of hospital patients or people from elsewhere into care settings.

The advice was followed by the Government’s social care action plan released on April 15, as Health Secretary Matt Hancock said all symptomatic residents and staff would be able to be tested.

In the plan, the Department of Health and Social Care said it was moving “to institute a policy of testing all residents prior to admission to care homes”.

HEALTH Coronavirus ONS
(PA Graphics)

But it also said some patients with coronavirus who need ongoing social care could still be discharged into care homes as long as they were able to be properly isolated.

Over the past weeks, social care providers have repeatedly reported shortages of personal protective equipment (PPE) to enable them to adequately control infection spread, and a lack of testing.

And deaths in social care have risen, with care homes notifying the Care Quality Commission (CQC) of 4,343 deaths of residents in homes between April 10 and 24 in England.

Asked if the NHS has “unwittingly seeded coronavirus” into care homes, Prof Heneghan told a Science Media Centre briefing: “Clinically, it just does not make any sense whatsoever to me, to put a person with an active infection into a home setting where other people are in significant numbers and are vulnerable, and to put that person in that setting.

“I just cannot think of a clinical or medical reason why anybody would do that.

He added: “If that’s happened, I cannot understand it from a medical perspective, but I think the most important aspect right now is there has to be a clear message to hospitals that nobody with active infection should be discharged from a hospital into a nursing home setting until they … are symptom-free.”

Coronavirus – Tue Apr 21, 2020
A ward at the NHS Nightingale Hospital Yorkshire and Humber in Harrogate, North Yorkshire (Danny Lawson/PA)

It comes as Mr Hancock extended testing to all asymptomatic care home residents, staff and hospital patients.

He told Tuesday’s press conference: “This will mean that anyone who is working or living in a care home will be able to get access to a test whether they have symptoms or not.

“I am determined to do everything I can to protect the most vulnerable.”

Asked whether care homes were now the Government’s priority in dealing with coronavirus, Mr Hancock said: “Of course care homes have been a top priority right from the start.

“We’ve strengthened the rules around what happens in care homes and tightened infection control, also making testing available throughout the care centre I think is incredibly important as we’ve ramped up the availability of testing.”

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