Commentary: COVID in care homes—challenges and dilemmas in healthcare delivery

Abstract The COVID-19 pandemic has disproportionately affected care home residents internationally, with 19–72% of COVID-19 deaths occurring in care homes. COVID-19 presents atypically in care home residents and up to 56% of residents may test positive whilst pre-symptomatic. In this article, we provide a commentary on challenges and dilemmas identified in the response to COVID-19 for care homes and their residents. We highlight the low sensitivity of polymerase chain reaction testing and the difficulties this poses for blanket screening and isolation of residents. We discuss quarantine of residents and the potential harms associated with this. Personal protective equipment supply for care homes during the pandemic has been suboptimal and we suggest that better integration of procurement and supply is required. Advance care planning has been challenged by the pandemic and there is a need to for healthcare staff to provide support to care homes with this. Finally, we discuss measures to implement augmented care in care homes, including treatment with oxygen and subcutaneous fluids, and the frameworks which will be required if these are to be sustainable. All of these challenges must be met by healthcare, social care and government agencies if care home residents and staff are to be physically and psychologically supported during this time of crisis for care homes.

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Is Point-of-Care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of Point-of-Care Polymerase Chain Reaction test for SARS-COV-2

10.1101/2020.11.30.20240010 ◽

2020 ◽

Author(s):

Massimo Micocci ◽

Adam L Gordon ◽

Mikyung Kelly Seo ◽

A. Joy Allen ◽

Kerrie Davies ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Point Of Care ◽

Care Home ◽

Care Homes ◽

Polymerase Chain Reaction Test ◽

List Type ◽

Point Of Care Testing ◽

Chain Reaction ◽

Polymerase Chain ◽

Positive Agreement

AbstractIntroductionReliable rapid testing on COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. Point-of-care testing (POCT) in care homes could provide rapid actionable results. This study aimed to examine the usability and test performance of point of care polymerase chain reaction (PCR) for COVID-19 in care homes.MethodsPoint-of-care PCR for detection of SARS-COV2 was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and use errors were assessed.ResultsPoint of care and laboratory polymerase chain reaction (PCR) tests were performed on 278 participants. The point of care and laboratory tests returned uncertain results or errors for 17 and 5 specimens respectively. Agreement analysis was conducted on 256 specimens. 175 were from staff: 162 asymptomatic; 13 symptomatic. 69 were from residents: 59 asymptomatic; 10 symptomatic. Asymptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2%-99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932 – 0.999). Symptomatic specimens showed 100% (95% CI: 2.5%-100%) positive agreement and 100% negative agreement (95% CI: 85.8%-100%), with overall PABAK of 1. No usability-related hazards emerged from this exploratory study.ConclusionApplications of point-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Agreement between POCT and laboratory PCR was good. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.Key pointsPoint of care tests (POCT) in care homes are feasible and could increase testing capacity for the control of COVID-19 infection.The test of agreement between POCT and laboratory PCR for care home residents and the staff was good.Adoption of POCT in care homes can be considered with appropriate preparatory steps and safeguards in place.Repetitive errors and test malfunctioning can be mitigated with bespoke training for care home staff.Integrated care pathways should be investigated to test the high variability of the context of use.

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Anosmia as a Screening Tool for COVID-19 Infection: A Prospective Cohort Study

Dubai Medical Journal ◽

10.1159/000517483 ◽

2021 ◽

pp. 1-6

Author(s):

Esra AlHamadani ◽

Sania Zia ◽

Ali AlRahma ◽

Firas AlNajjar

Keyword(s):

Odds Ratio ◽

Screening Tool ◽

Index Finger ◽

Upper Respiratory Tract ◽

Chain Reaction ◽

The Public ◽

Single Center Study ◽

Upper Respiratory ◽

Polymerase Chain ◽

Low Sensitivity

Objectives: Several studies promoted anosmia as a possible isolated symptom for coronavirus disease 2019 (COVID-19). No studies used feasible methods of smell testing that the public would use to address the accuracy of these claims. Methods: This is a single-center study conducted between April 2020 and June 2020. The sense of smell was tested in vitally stable suspected COVID-19 patients with no/mild upper respiratory tract infection symptoms prior to nasopharyngeal swabbing for reverse-transcriptase polymerase chain reaction. Patients were instructed to close their eyes. Each nostril was tested separately while the other was blocked with the patient’s index finger. Patients inhaled from 2 concealed vials (coffee and strawberry essence) consecutively, kept within 30 cm of the nostril for 60 s. Patients who could not identify both odors with both nostrils were recorded as “anosmia.” Results: Out of 346 eligible subjects, 43 had anosmia of which 26 (60%) tested COVID-19 positive. χ2 test showed a p value <0.001. The test showed a sensitivity of 30% (95% confidence interval [CI] 21%, 41%) and specificity 94% (95% CI 90%, 96%). Logistic regression revealed an odds ratio of 5.9 (95% CI 3.0, 12) p value <0.001. Conclusion: Given the low sensitivity (30%) of this method in detecting COVID-19 infection, we conclude that this method is not a useful screening tool for COVID-19 infection. The moderate negative predictive value (80%) is nongeneralizable.

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Aerosol-generating procedures in thoracic surgery in the COVID-19 era in Malaysia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320950898 ◽

2020 ◽

Vol 28 (8) ◽

pp. 495-499

Author(s):

Narasimman Sathiamurthy ◽

Narendran Balasubbiah ◽

Benedict Dharmaraj

Keyword(s):

Polymerase Chain Reaction ◽

Thoracic Surgery ◽

Reverse Transcriptase ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Polymerase Chain Reaction Method ◽

Protective Equipment ◽

Chain Reaction ◽

Long Time ◽

Polymerase Chain

Background The Covid-19 pandemic has caused changes in the surgical treatment of non-Covid patients, especially in thoracic surgery because most procedures are aerosol generating. Hospital Kuala Lumpur, where thoracic procedures are performed, was badly affected. We describe our experience in performing aerosol generating procedures safely in thoracic surgery during the Covid-19 era. Methods Medical records of patients who underwent thoracic surgery from March 18, 2020 to May 17, 2020 were reviewed retrospectively. All patients undergoing thoracic surgery were tested for Covid-19 using the reverse transcriptase polymerase chain reaction method. Patients with malignancy were observed for 10 to 14 days in the ward after testing negative. The healthcare workers donned personal protective equipment for all the cases, and the number of healthcare workers in the operating room was limited to the minimum required. Results A total of 44 procedures were performed in 26 thoracic surgeries. All of these procedures were classified as aerosol generating, and the mean duration of the surgery was 130 ± 43 minutes. None of the healthcare workers involved in the surgery were exposed or infected by Covid-19. Conclusion Covid-19 will be a threat for a long time and thoracic surgeons must continue to provide their services, despite having to deal with aerosol generating procedures, in the new normal. Covid-19 testing of all surgical candidates, using the reverse transcriptase polymerase chain reaction, donning full personal protective equipment for healthcare workers, and carefully planned procedures are among the measures suggested to prevent unnecessary Covid-19 exposure in thoracic surgery.

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COVID-19 Autopsies, Oklahoma, USA

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa062 ◽

2020 ◽

Vol 153 (6) ◽

pp. 725-733 ◽

Cited By ~ 261

Author(s):

Lisa M Barton ◽

Eric J Duval ◽

Edana Stroberg ◽

Subha Ghosh ◽

Sanjay Mukhopadhyay

Keyword(s):

Diffuse Alveolar Damage ◽

Nasopharyngeal Swab ◽

Protective Equipment ◽

Chain Reaction ◽

Polymerase Chain Reaction Testing ◽

Standard Procedures ◽

History Of ◽

Polymerase Chain ◽

Viral Inclusions ◽

Postmortem Examinations

Abstract Objectives To report the methods and findings of two complete autopsies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals who died in Oklahoma (United States) in March 2020. Methods Complete postmortem examinations were performed according to standard procedures in a negative-pressure autopsy suite/isolation room using personal protective equipment, including N95 masks, eye protection, and gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcriptase polymerase chain reaction testing on postmortem swabs. Results A 77-year-old obese man with a history of hypertension, splenectomy, and 6 days of fever and chills died while being transported for medical care. He tested positive for SARS-CoV-2 on postmortem nasopharyngeal and lung parenchymal swabs. Autopsy revealed diffuse alveolar damage and chronic inflammation and edema in the bronchial mucosa. A 42-year-old obese man with a history of myotonic dystrophy developed abdominal pain followed by fever, shortness of breath, and cough. Postmortem nasopharyngeal swab was positive for SARS-CoV-2; lung parenchymal swabs were negative. Autopsy showed acute bronchopneumonia with evidence of aspiration. Neither autopsy revealed viral inclusions, mucus plugging in airways, eosinophils, or myocarditis. Conclusions SARS-CoV-2 testing can be performed at autopsy. Autopsy findings such as diffuse alveolar damage and airway inflammation reflect true virus-related pathology; other findings represent superimposed or unrelated processes.

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Low Sensitivity of a Nested Polymerase Chain Reaction in Oropharyngeal Washings for the Diagnosis of Pneumocystis Pneumonia in HIV-Infected Patients

CHEST Journal ◽

10.1378/chest.128.1.167 ◽

2005 ◽

Vol 128 (1) ◽

pp. 167-171 ◽

Cited By ~ 8

Author(s):

Kennedy Nyamande ◽

Umesh G. Lalloo ◽

Dennis York ◽

Mogambal Naidoo ◽

Elvis M. Irusen ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Pneumocystis Pneumonia ◽

Chain Reaction ◽

Nested Polymerase Chain Reaction ◽

Polymerase Chain ◽

Low Sensitivity

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COVID-19 automatic diagnosis with CT images using the novel Transformer architecture

10.5753/sbcas.2021.16073 ◽

2021 ◽

Author(s):

Gabriel Sousa Silva Costa ◽

Anselmo C. Paiva ◽

Geraldo Braz Júnior ◽

Marco Melo Ferreira

Keyword(s):

Intelligent System ◽

State Of The Art ◽

False Negative ◽

False Negative Rate ◽

Ct Images ◽

The Novel ◽

Chain Reaction ◽

High False Negative Rate ◽

Polymerase Chain ◽

Low Sensitivity

Even though vaccines are already in use worldwide, the COVID-19 pandemic is far from over, with some countries re-establishing the lockdown state, the virus has taken over 2 million lives until today, being a serious health issue. Although real-time reverse transcription-polymerase chain reaction (RTPCR) is the ﬁrst tool for COVID-19 diagnosis, its high false-negative rate and low sensitivity might delay accurate diagnosis. Therefore, fast COVID-19 diagnosis and quarantine, combined with effective vaccination plans, is crucial for the pandemic to be over as soon as possible. To that end, we propose an intelligent system to classify computed tomography (CT) of lung images between a normal, pneumonia caused by something other than the coronavirus or pneumonia caused by the coronavirus. This paper aims to evaluate a complete selfattention mechanism with a Transformer network to capture COVID-19 pattern over CT images. This approach has reached the state-of-the-art in multiple NLP problems and just recently is being applied for computer vision tasks. We combine vision transformer and performer (linear attention transformers), and also a modiﬁed vision transformer, reaching 96.00% accuracy.

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Experience of use of advance care planning in care homes

10.1093/oso/9780198802136.003.0012 ◽

2018 ◽

Author(s):

Maggie Stobbart-Rowlands ◽

Mandy Thorn

Keyword(s):

Advance Care Planning ◽

Best Practice ◽

Care Home ◽

Training Programme ◽

Best Interests ◽

Care Homes ◽

Care Planning ◽

Home Setting ◽

People With Dementia ◽

Advance Care

This chapter describes the care home setting, aspects that have an impact on use of Advance care planning (ACP) in care homes, examples of challenges and best practice, use of ACP in the GSF Care Homes Training Programme, ACP with people with dementia, and culture change. Many people in care homes are in the last year/s of life, and ACP discussions are especially important for them to ensure that the care they receive is in line with what they want. Care homes lead the way in their extensive use of ACP discussions. ACP is more routinely used by care home staff than is often recognized, and can be easier to introduce in care homes than in other settings. Key challenges include poor means of communication due to dementia/cognitive impairment or physical deterioration, and how staff address the expectations of families, and ensure any interventions are in the best interests of the person.

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Rapid detection of Van genes in rectal swabs by real time PCR in Southern Brazil

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822011000500021 ◽

2011 ◽

Vol 44 (5) ◽

pp. 631-632

Author(s):

Vlademir Cantarelli ◽

Bianca Cavalcante ◽

Diogo André Pilger ◽

Fabiana Souza ◽

Cícero Gomes Dias ◽

...

Keyword(s):

Real Time ◽

Rapid Detection ◽

Surveillance Program ◽

Southern Brazil ◽

Rt Pcr ◽

Chain Reaction ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Polymerase Chain ◽

Low Sensitivity

INTRODUCTION: Laboratory-based surveillance is an important component in the control of vancomycin resistant enterococci (VRE). METHODS: The study aimed to evaluate real-time polymerase chain reaction (RT-PCR) (genes vanA-vanB) for VRE detection on 115 swabs from patients included in a surveillance program. RESULTS: Sensitivity of RT-PCR was similar to primary culture (75% and 79.5%, respectively) when compared to broth enriched culture, whereas specificity was 83.1%. CONCLUSIONS: RT-PCR provides same day results, however it showed low sensitivity for VRE detection.

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Effects of Ozone Treatment on Personal Protective Equipment Contaminated with SARS-CoV-2

Antioxidants ◽

10.3390/antiox9121222 ◽

2020 ◽

Vol 9 (12) ◽

pp. 1222

Author(s):

Bernardino Clavo ◽

Elizabeth Córdoba-Lanús ◽

Francisco Rodríguez-Esparragón ◽

Sara E. Cazorla-Rivero ◽

Omar García-Pérez ◽

...

Keyword(s):

Relative Humidity ◽

Personal Protective Equipment ◽

Healthcare Professionals ◽

Ozone Exposure ◽

Ozone Treatment ◽

Protective Equipment ◽

Equipment Management ◽

Chain Reaction ◽

Ozone Concentrations ◽

Polymerase Chain

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing profound health, economic, and social problems worldwide. Management of personal protective equipment (PPE) and its potential limited availability have created concerns about the increased risks for healthcare professionals at hospitals and nursing homes. Ozone is a powerful oxidant agent. The objectives of this study were to examine the effects of ozone treatment on PPE contaminated with SARS-CoV-2, and to explore whether relative humidity could modify those effects. Methods: PPE contaminated by heat-inactivated SARS-CoV-2 were treated with different ozone concentrations, exposure times, and relative humidity conditions. SARS-CoV-2 gene amplification was assessed by real-time polymerase chain reaction. Results: There was no amplification of SARS-CoV-2 in PPE after the following ozone exposures: 30 s at 10,000 ppm (20 g/m3), 5 min at 4000 ppm, and 10 min at 2000 ppm. At lower ozone concentrations, 4–12 ppm (0.008–0.024 g/m3), the effects were highly dependent on the relative humidity conditions. Conclusions: Oxidative stress induced by ozone exposure eliminated heat-inactivated SARS-CoV-2 in different PPE components under appropriate exposure times, ozone concentrations, and relative humidity conditions. These findings could have implications in decreasing the risk of contamination associated with personal protective equipment management and in increasing its availability. Further research in the original SARS-CoV-2 strain is guaranteed.

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Personal protective equipment training team: a community nursing initiative

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.6.266 ◽

2021 ◽

Vol 26 (6) ◽

pp. 266-270

Author(s):

Kevin Murphy

Keyword(s):

Personal Protective Equipment ◽

Best Practice ◽

Care Home ◽

Community Services ◽

Care Staff ◽

Care Homes ◽

Protective Equipment ◽

Face To Face ◽

Training Team ◽

Training And Support

COVID-19 provided significant challenges for community services and care homes. Residential and nursing care patients are considered highly vulnerable to the coronavirus due to their physical needs and environmental factors. Significant concern was raised with personal protective equipment (PPE) availability and appropriate training and support in local care homes. Members of the district nursing team and community services formed a team to deliver face to face training and support to care home workers to improve PPE adherence and reduce risks of transmission. Visits were offered to all 46 care homes in the locality and over 55 visits for teaching were performed in the first month. Challenges were faced with managing and prioritising frontline clinical duties. Feedback was overwhelmingly positive and care staff benefited from face-to-face delivery of education to support best practice.

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