Excess death toll in care homes from Covid-19 ‘hugely underestimated’

An early draft of a study by University of Manchester health economists and data scientists calculates that up to 10,000 more people may have died in care homes from Covid-19 than previously realised.

The study is the first independent analysis of daily death notification data sent to the Care Quality Commission by 13,630 care homes in the first wave of the COVID-19 pandemic.

In March 2020, there were 15,524 care homes operating in England, offering around 455,600 beds.

The team also reveal that the excess deaths were mainly concentrated among large care homes providing services to older people and people with dementia, affiliated to a branded chain of providers- where staff may be more likely to work in more than one place.

However, there were no significant differences between profit and not-for-profit care homes.

The study used sophisticated statistical analysis to compare data between January 2017 to August 2020 with data from April to August 2020 to calculate excess deaths in care homes during the pandemic.

They linked death notification data at care home-level with the Care Quality Commission (CQC) registers of active care homes in England, providing the data on care home characteristics used for the analysis.

“Thousands of people have died from Covid-19, but because many weren’t tested, some death certificates failed to attribute cause of death to the virus either directly or indirectly, especially at the beginning of the pandemic” said Dr Marcello Morciano, a Senior Lecturer in Health Policy and economics at The university of Manchester.

“This study shows that in care homes, mortality figures attributable in some way to Covid-19 have been hugely underestimated: the figure could be as high as 10,000 people.

“But it also tells us where many of the people who died in excess to what expected based on historical trends were living in care homes that experienced COVID-19-related fatalities and that has important policy implications in terms of prioritising resources in the future.”

The team estimated that 29,400 more care home residents, directly and indirectly attributable to COVID-19, died during the first 23-weeks of the pandemic than expected from historical trends; an equivalent to 6.5% of all care home beds available in England.

Their analysis also showed that almost all the excess deaths were recorded in the quarter of care homes which reported COVID-19 fatalities, mainly care homes that provide nursing services.

Only 65% of the excess deaths were officially reported to be directly attributable to COVID-19, meaning the remaining 35% - or a figure of 10,000 people - have died in those care homes and flagged as non COVID-19 deaths.

Official estimates from England and Wales have reported aggregated excess deaths by place of occurrence.

The aggregates, however, do not account for care home residents dying in other settings such as hospital.

They also fail to provide sufficient information to reflect on the impacts of policies over the period, or to inform new policies for the future.

This study shows that in care homes, mortality figures attributable in some way to Covid-19 have been hugely underestimated: the figure could be as high as 10,000 people
Dr Marcello Morciano

Professor Evan Kontopantelis from The University of Manchester added: “In care homes across Europe, at the beginning of the pandemic staff were left without PPE, testing regimes were poor, and care home residents who needed hospital treatment didn’t get it.

“And in mid-March, Hospital Trusts discharged medically fit patients to care homes to free capacity. Mandatory testing prior to discharge was only brought into effect a month later.

“These factors have all played their part in the higher figure of deaths we have described.

“We also believe that knowing the care home characteristics associated with COVID-19 outbreaks and excess deaths may help in designing rapid responses.”

Dr Jonathan Stokes from The University of Manchester said: “The large excess of deaths in care homes shows England, and other countries, didn’t adequately protect this vulnerable group in the first wave of Covid.

“Care home residents should be a clear priority for managing supply of rapid testing and other interventions in future waves, balancing protection from mortality with quality of life and other important outcomes.”

Using CQC data, there are around 11,000 registered providers operating care homes for the elderly and people with dementia in the UK, housing 300,000 people.

Dr Alex Turner from The University of Manchester said: "We estimated excess deaths by comparing the number of deaths of care home residents during the pandemic to the predicted number of deaths in this period calculated based on trends in deaths between January 2017 and February 2020."

Though the study is not yet peer reviewed, the authors felt there was an urgency to pass on the information to the public and policy makers.

The paper ‘Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study’ ise available on the pre-print server medRxiv 

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