VIEW, Issue 58, 2021
www.viewdigital.org
Page 6
SPECIAL INVESTIGATION
Virus experts criticise ‘superficial’ report on hospital discharges and Covid-19 in care homes VIEW and The Detail team up to look at Department of Health commissioned research By Rory Winters The Detail report which found no correlation between hospital discharges of patients into care homes and Covid19 outbreaks in care homes in Northern Ireland has been criticised by experts. The Detail teamed up with VIEW magazine to assess the Department of Health (DoH)-commissioned report, produced by Dr Niall Herity – a Belfastbased consultant cardiologist. Dr Herity sought to establish “if there was any correlation between hospital discharges (especially discharges in the absence of testing in early stage of pandemic) and subsequent care home outbreaks”, but he did not find any. His research, published last November, doesn’t “support a hypothesis” that discharges from hospitals into care homes were a “substantial cause” of Covid-19 outbreaks in care homes in Northern Ireland. In the last 12 months in Northern Ireland, more than 1,000 care home residents’ deaths have involved Covid-19, leading to calls for a public inquiry. A DoH spokesperson said Dr Herity’s research “looked at data for discharges, as well as considering if there was any correlation between discharges from hospitals and infection rates in care homes” and that “the work could not identify any such correlation”. However, Dr Connor Bamford, an expert in virology and antiviral immunity at Queen's University Belfast, said the report appears to be a “superficial analysis and needs to be followed up”. He also told us that after “looking at what analysis was done” he was not surprised it took a “short time” – eight weeks or under – to complete. Dr Bamford said: “I would have
A
thought this would take time and a lot of effort on the part of numerous individuals with different expertise, such as clinicians, infectious disease experts, public health doctors, epidemiologists, and people who run care homes. “I am concerned that there appears to be a lack of expertise required to look at this properly, so I do not think the analysis is as good as it could be.” Another QUB academic, Dr Lindsay Broadbent, who specialises in respiratory viruses, also criticised the report. She said that “data is taken at face value” without consideration of “other virology or epidemiology knowledge” of the virus that causes Covid-19. Dr Broadbent said: “The author infers that the peak of discharges into care homes doesn’t correspond to the peak in
care home outbreaks and that there is, therefore, no connection. “However, this does not consider the delay that would occur due to the virus incubation period. The peak of discharge into care homes was week 10-13, and the rate of outbreaks increased sharply from week 13.” Dr Bamford added that the report’s format meant it could not establish “whether discharges from hospitals into care homes of an infectious individual then brought Covid-19 into care homes”. He said: “You would need to do an indepth analysis of discharges, likelihood that individuals being discharged had Covid-19 or not, and care home outbreaks – all in the context of virus levels in the community." Dr Bamford also said that the “size and duration” of Covid-19 outbreaks in care homes would also need “to be looked at”, but that this was not done for the report. He added: “You could compare care homes or linked care homes (staffed by the same people) who accepted infectious discharges versus those who did not. “You would also have to take into account availability of PPE for staff in care homes, that could exacerbate outbreaks. In my opinion this has not been done and has barely been attempted.” Dr Herity’s report also sought to consider the “relationship (or otherwise) between departmental guidance” and the “clinical decision-making process in relation to discharges”. The report concludes that “extensive communication was circulated” by both Minister Swann and the DoH throughout the pandemic and that “subjectively, consultants indicated that departmental guidance had minimal or no impact on their discharge decisions”. This conclusion was drawn after an anonymous “short survey” was addressed