More people died of Covid in Welsh care homes in the second wave of the virus than the first.

Early on in the pandemic it because clear that keeping the virus out of care homes would be key to keeping the death toll down.

Apart from perhaps hospitals, there are no places more perfect for the virus to spread and take lives than care homes.

Vulnerable people in numbers, often needing very close contact care provide ideal environments for Covid-19.

In the first wave the virus tore through care homes.

A WalesOnline investigation found that discharges from hospital without a test – and staff moving between homes – helped drive the infection.

Between March 1 and August 31, 743 care home residents died of the virus according to the Care Inspectorate for Wales. In the second wave, between September 1 and February 28, a total of 1,248 died.

This chart shows the amount of coronavirus deaths in Welsh care homes in the first and second waves of the virus:

Last Friday, WalesOnline asked the First Minister Mark Drakeford if he had any regrets about his handling of the virus and he said they had learnt lessons from the first wave.

He said: “I don’t use the word mistake myself because I think it is absolutely true that we look back and learn the lessons. I think it is undoubtedly true that if we knew at the start of the pandemic what we know 12 months on from it some early decisions would have been made differently.

“I am sure that is the case but it is not because mistakes were made. People were acting on the best understanding that we had of the circumstances that we were in.

“Many things have changed in our grasp of the virus, the way it behaves and the things we can do to make it different.

“In the first wave back in the spring of last year I don’t think we fully appreciated the significance of the way in which staff circulated between different care homes.

“The standard model of care homes in Wales will be for owners to have two or three care homes so it is a small cottage industry in that way in Wales mostly. The standard way of doing things will be for staff to circulate between them.

“I think in the second wave in the autumn we had arranged with the sector that that would be happening much less. That is because we know something six months on, that we didn’t know near the beginning.

“I think that is one example of how we learnt the lessons we adapted our approach. “

WalesOnline spoke to people inside the sector to find out what the second wave of the virus was like. Despite most saying the authorities handling of the virus improved they paint a harrowing picture of a brutal winter.

Glyn Williams, owner Gwyddfor Care Home
(Image: Care Forum Wales)

Glyn Williams is the owner of the Gwyddfor Care Home in Bodedern on Anglesey.

He said: “I think the hardest moment came when we had a false positive. Second to an actual outbreak, that’s the worst possible thing that can happen to a care home.

“Every week we are waiting for the test results to come through and getting ready to spring into action if there’s a positive test.

“I don’t sleep the night before the test results come through. They start coming through in the early hours and I’m checking them as they drop in and notifying the staff of their results.

“We had a false positive a few weeks ago and all the indications were that it was a false positive but we could not afford to take any chances because she had tested negative before coming into work.

“We had to assume the worst so we isolated all the residents and put them in their rooms and arranged for the whole home to be tested. That was a nightmare. Everybody is on edge because they’re worried we might have an outbreak.

“Then you have residents with dementia who don’t understand why you are trying to keep them in their rooms. It started on the Friday night and the swabs came through on Saturday night for us to start testing the residents on Sunday. Swabbing residents with dementia is just horrendous because they don’t have a clue what’s happening.

“Then on the Sunday afternoon just after we had finished our swabbing and got them to the testing centre, the result of the second test on the staff member came back negative.

“The test and trace people had to do a back pedal and inform her family and contacts that they didn’t need to isolate anymore. Everything had to be undone – but you couldn’t undo the stress the residents went through.”

He does feel that different guidance was needed when it became clear how easily spread new forms of the virus were.

“They should have upgraded the PPE and updated the guidance to take account of the new variant.” he added.

Sanjiv Joshi is the managing director of the Caron Group which has 14 care homes across South and Mid Wales.

“Our experience at Caron Group is that the first wave hit us harder than the second wave in terms of deaths and lack of initial support from the authorities,” he said. “However, the second wave has been more difficult in other ways.

“For instance, it has been so much harder on our staff to keep going day after day, week after week, with all the Covid-specific PPE and infection control procedures.

“Most important, it has been so much harder on residents and their families, only having been able to see each other in person for a few weeks over the summer and autumn.

“We were resourced better for the second wave assisted by Welsh Government financial support. Care Homes were better able to adapt to the evolving health guidance and changes to infection control measures.

“We also had time to organise and implement changes such as employing additional staff, regular testing, arranging virtual visits, creating isolation bedrooms, indoor visiting rooms and/or outdoor pods.”

Sanjiv Joshi
(Image: Care Forumn Wales)

Mr Joshi added that the virus took a real human toll.

He said: “Perhaps the very hardest thing about the second wave is the inability to ‘square the circle’ between keeping people physically safe (which means not letting visitors into the residents’ part of the homes) and keeping people as emotionally and mentally healthy as possible, which would ideally mean lots of face to face contact without any barriers.

“It is very hard for families to understand why we are still not allowing people to come right into the residents’ side of the home, but our experience – particularly of the second wave mutations – is that the virus is so transmissible, and the effects so devastating on our residents, that we simply cannot take the risk. Until the vaccination levels in the general population really start to make inroads on the likelihood of infection and on the outcomes for frail elderly people if they do get infected.”

Dr Bikram Choudhary is Director of the SilverCrest Group, which owns five care homes in South and Mid Wales.

He said that the virus caused serious issues with staffing: “The financial support, particularly the void payments were a big help but in terms of on the ground support there was nothing.

“At times we lost 80% of workforce in particular homes, either because they were infected or self-isolating.

“We only managed because we are a group and we had other homes to call on. There was no other support.

“The only thing that would have helped is if there were teams that were available that could go.

“Agency staff, once they realise there’s an outbreak in a home and a severe outbreak, don’t want to go to the homes, so we were really left to try to scramble around with our own staff.

“Luckily for us we only had one home affected at any period of time so we were able to juggle our staff but it was incredibly difficult.

“In the second we had homes affected in December, January and February so they were one month apart, with people coming back to work. That’s the only reason we managed.

“Without that, we could have potentially closed one of our homes because we didn’t have enough staff. It would have been a disaster.”

He said that he felt the Welsh Government had learn lessons from the first wave.

“During the second wave there has been more testing and the vaccine roll-out for care homes has been prioritised, which is good,” he said.

“They were not so pushy with admissions from hospitals.”

It is clear that the consensus of the care home sector is that Welsh Government did learn lessons. When asked about it Mario Kreft , chair of Care Forum Wales said: “We were so unprepared for the first wave as a nation and there are many lessons to be learned about future preparedness for pandemic.

“We were much better prepared for the second wave, with PPE, better testing and financial support in place because the Welsh Government had listened to the sector.”

Mario Kreft
(Image: Eye Imagery)

So why, if lessons were learnt were there more deaths?

This is a question that can only really be answered by rigorous academic studies. But there are a number of possibilities which could have been contributing factors, including but not limited to:

The Kent variant spread more easily and therefore more people were affected. The virus was out of control for longer in the second wave. From mid September until February there were high cases of the virus consistently as the Welsh Government tried to get it under control. By contrast in the first wave the virus was only really prominent from mid March till mid June. Winter may have also played a factor as the colder weather can often have an impact on people’s immune systems and ability to spend time outside.
Testing may also have been a factor in several ways. In the first wave the lack of tests may have meant that some Covid deaths were not recorded as Covid deaths. In the second, the delays at the Lighthouse Labs meant that people didn’t find out they were positive for several days.

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