Coronavirus in Scotland: Care home deaths almost equal those in hospitals

However, while the number of deaths in hospitals started to fall last week, the number in care homes continued on a steep upward trajectory.

Since the start of the pandemic in mid-March, 33 per cent of total confirmed or suspected Covid-19 deaths in Scotland have been in care homes, against 56% in hospitals.

But in the week ending April 19, care homes saw 46% of Covid-19 fatalities, with 297 of the 651 deaths, while hospitals saw 48%, with 311 cases.

The ratio of Covid-19 deaths in homes to deaths in hospitals has doubled each week, from 1-to-8 in the week ending March 29, then 1-to-4, then 1-to-2 and is now just under 1-to-1. 

Over the same period, the number of deaths in Scottish hospitals from all causes has risen by 29%, but has rocketed by 146% in care homes.

The accumulated total for care home deaths doubled last week, from 240 on April 12 to 537 on April 19.

The figures prompted Nicola Sturgeon to warn 40 to 50% of all Covid-19 deaths in Scotland could ultimately take place in care homes, a phenomenon seen in other countries.

But she also stressed care home residents should be transferred to a hospital if it was warranted medically. 

Decisions on whether to move older people from homes to intensive care should be taken on a clinical basis and there should be no blanket restriction on transfers to hospitals, she said at the Scottish Government's daily briefing.

The latest weekly NRS data showed Covid-19 implicated in at least 1,616 deaths up to April 19, a rise of 651, or 68%, in just a week. 

Deaths to date in Scotland's largest health board, Greater Glasgow and Clyde, rose from 315 to 513 last week, while its mortality rate rose from 2.7 to 4.4 per 100,000, the highest in Scotland.

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The figures coincided with news of another multiple fatalities at a Scots care home, with Covid-19 claiming 13 residents at Guthrie House in south east Edinburgh, which is run by Four Seasons Health Care.

Earlier this week, 15 deaths were recorded at Crosslet care home in Dumbarton run by West Dunbartonshire Council.

Health Secretary Jeane Freeman yesterday bowed to opposition pressure and announced blanket testing of all new potential care home residents for coronavirus. 

The latest NRS tally includes cases where suspected Covid-19 was recorded as a factor on the death certificate.

It is considered more accurate than the daily running total produced by Health Protection Scotland (HPS), which only counts laboratory-confirmed cases of Covid-19.

The NRS figure was 79  per cent higher than the 903 deaths recorded by HPS as of April 19.

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The total number of deaths from all causes registered over the week to April 19 was 1,911, a decrease of 67 from the previous week, but 844 more than than the five-year average.

Of the 844 above average, or ‘excess deaths’, 651 involved confirmed or suspected Covid-19, 5% came from increased cancer deaths, 10% came from increased dementia and Alzheimer’s deaths, and 12% were due to an increase in deaths from other causes.

A third (33%) of Covid-19 deaths registered to date related to deaths in care homes, 56%  were in hospitals and 10% of deaths were at home or non-institutional settings.  

Almost three quarters (74%) of all deaths involving Covid-19 to date were of people aged 75 or over.

Medics fear the deaths may be linked to people failing to seek treatment for other health problems because they fear catching Covid-19 in hospitals or don’t want to be a burden.

Earlier this week, Scotland’s top doctor said he was worried by a 72% drop in urgent referrals from GPs for suspected cancer as people ignored symptoms.

In the previous week, to April 12, the excess deaths were 70 per cent above average. 

Ms Sturgeon insisted care home deaths were not inevitable.

She said: "It's not unusual for people to become sick in care homes, residents are often frail and nearing the end of their lives.

"But that does not mean that we consider any of these cases to be inevitable or that we don't do everything we possibly can to prevent them.

"Older people in care homes require as much, if not more, support and protection as anyone else in our society and we're working with care homes and other partners to provide that."

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She denied that it had been “reckless” not to start the blanket testing of potential care home residents until this week, after she initially rejected opposition demands to do so.

She said: “This test is not reliable before people have symptoms. While testing is important, we can never let it be seen as a panacea in all circumstances. It is the infection prevention and control that is the most important thing, and that’s what we’ve got to continue to stress.”

The First Minister also denied Scotland’s care homes were more dangerous than those in England and Wales, as the Office of National Statistics said they were the site of only 10% of all Covid-19 deaths south of the border.

She said: “I’m not able to talk about the ONS fingers for England and Wales, apart to point out they are a week behind Scotland, so Scotland’s are a week more up to date. 

“I’ve read accounts and concerns about under-reporting in England around non-confirmed cases. All I can do is speak for the NRS figures as they are presented to me.

“It is not the case that care homes, in my view, are - it’s not my term - ‘more dangerous’ in Scotland than elsewhere in the UK.” 

Asked why she thought deaths from care homes were increasing at such pace, Ms Sturgeon said the Government was still investigating. 

She said: “We know the susceptibility of older people to become ill or die from this virus, and we know that the virus spreads more easily within institutions.

“There needs to be particular measures to slow that down. 

“We don’t know yet, but we think that as community transmission is slowing down, we still have higher rates of transmission in places like care homes.

“I have read in the last number of days, emerging evidence from other parts of the world that would suggest that in some other countries... perhaps 40 to 50% of deaths overall are in care homes. 

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“I can’t say for certain, but I think it is likely that what we are seeing here in Scotland iis potentially going to turn out to be in line with the experience of other countries.”

Asked whether care homes were being too slow to refer residents to hospitals, she said: “There has been concern raised that older people who need hospital treatment for coronavirus will not be getting that treatment, that decisions on a blanket basis have been taken just to keep them in care homes. 

“I want to be clear that is not the case and nor should that be the case. 

“Decisions should be taken on an individual basis. 

“If somebody in a care home requires hospital treatment, if they require and it would be appropriate for them to be in intensive care, that’s what should happen to them.

“It’s important these decisions and clinically-based and also on an individual basis, not on a blanket basis one way or another.

“It will often not be appropriate for an older pe

The Scottish Tories said Scotland should take the lead on mobile testing vans for care workers after “disappointingly low” numbers at fixed hubs such as Glasgow airport.

Highland Council, the UK’s largest local authority by area, has only a single central testing facility in Inverness.

Scottish Tory leader Jackson Carlaw said: “This will make grim reading for anyone with loved ones in care homes.

“It really underlines the need for the Nicola Sturgeon to ensure all facilities get access to testing and PPE as a matter of urgency.

“Much of the focus understandably has gone on the role of hospitals in this crisis.

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“But we should be under no illusion now that the situation in care homes is every bit as desperate.

"The shocking scale of these figures should remind us of the crucial role care homes are playing in this fight.”

Scottish Labour Leader Richard Leonard demanded more support for care homes.

He said: “Over the last few weeks we have all seen just how much we owe to our care workers and the amount of vital, hard work that takes place in Scotland’s care homes.

“Despite this, we have seen tragically high numbers of deaths among care home residents from coronavirus, and serious and persistent issues surrounding PPE availability and now levels of staffing in care homes.

“When the Scottish Government realised the pressure that the NHS would be put under by coronavirus they reacted swiftly by developing the NHS Louisa Jordan. Why then is there no similar collective effort to provide a contingency plan for Scotland’s care homes?

“Scottish Labour is today calling on the Scottish Government to listen to the concerns of care workers and their representatives, and of care home residents and their families, to give additional support to those running, and working in, care homes, and to put in place an appropriate contingency plan for Scotland’s care homes.”

The Scottish Greens also said more must be done to close the gap between testing capacity and the lower numbers of tests actually performed each day.

MSP Patrick Harvie said: “I welcome Scotland’s increased capacity to test people for coronavirus, but yesterday Nicola Sturgeon told me we’re not using this capacity to its full.

“When those working with vulnerable people are crying out for tests, it seems incredible that we have testing labs half empty.

“If Scotland is to implement the test, trace, isolate method experts are calling for, there needs to be a clear strategy which uses the expertise and capacity we have. 

“I hope the First Minister can explain exactly how that will happen.” 

Age Scotland said care home residents must not be "written off" in the pandemic.

Chief executive Brian Sloan said: “In the last week, we have heard about dozens of deaths in Dumbarton, Edinburgh and Aberdeen, as the virus sweeps through homes in Scotland.

"It must be absolutely terrifying for residents, staff and families as they wonder where the next outbreak will be.

“These are not just statistics – each one is a mother, father, grandparent, sibling or friend who will be deeply missed.

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“It is so important that older people in care homes or who are receiving social care in their own home are given every opportunity to get the medical treatment they need to beat this virus and are not written off.

“Every person’s life matters and many older people have made full recoveries with the right treatment. Decisions must be made on a case-by-case basis, and any blanket policies based on a person’s age or residence would be blatant discrimination. 

"We urgently need to redouble efforts to protect the most vulnerable people and ensure that care homes are not treated as a second tier. Staff on the front lines must be supported with access to all of the lifesaving equipment they need, as well as more widespread testing.”

With 161 of the 'excess deaths' in the past three weeks due to cancer, Marion O’Neill, Cancer Research UK’s head of external affairs in Scotland, said: “We’re yet to uncover the full impact of the pandemic on people affected by cancer and on NHS services but these figures are deeply concerning.

“What is certain is that coronavirus has left cancer diagnosis and treatment in a precarious position.

“It’s important that everyone working to manage and deliver cancer services works in partnership to minimise the impact of Covid-19 to ensure lives are not needlessly lost to cancer.

“Essential and urgent cancer diagnosis, treatment and care must continue.”

Pete Whitehouse, Director of Statistical Services, said: “Every death from this virus is a tragedy. These statistics, alongside the other important evidence being made available by the Scottish Government and Health Protection Scotland (HPS), are valuable to the understanding of the progress and impact of the COVID-19 virus across Scotland.

“This week we have carried out new analysis on the excess number of deaths registered in recent weeks when compared to the five year average for the same time of year.

"This analysis provides more context to the statistics and enables identification of potentially significant trends in other causes of deaths. We have also added a further breakdown of the location of death within health boards and council areas.

“Our aim is to ensure that our statistical publication provides information that is as useful as possible and adds value to the understanding of how the virus is spreading throughout the country. We will continue to review and develop these statistics.”