Mortality rates from Covid plunged among care home residents following the rollout of vaccinations, according to the first study to compare outbreaks across the initial three waves of the pandemic in Scotland.

Academics from Glasgow and Edinburgh universities analysed data on infections and deaths recorded in care homes from March 2020 to October 2021.

They found that the death rate from Covid per 1000 care home beds fell from a peak of 45.8 between March and August 2020 - the first wave - to 29.3 during the second wave from September 2020 to May 2021.

By the third wave from June to October 2021, by which time the vast majority of care home residents were fully vaccinated, it had been slashed to 3.5.


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Published in Age and Ageing - the official journal of the British Geriatrics Society - it is the first study of its kind in Scotland to illustrate the impact of vaccinations on care home residents specifically, as opposed to the elderly population in general.

Dr Jenni Burton, a specialist in geriatric medicine and co-author of the study, said: "We've never been able to show that before because the care home residents, while they've been included in the national analyses, they weren't included as a group on their own.

"They've just been treated as 'all older people'.

"So it's the most clear and striking find we have for looking at that impact on care homes.

"It completely supports the prioritisation care home residents for vaccination and them being the early ones to get access to that."

The Herald: Care homes faced some of the biggest restrictions but also the largest death tolls prior to vaccinationsCare homes faced some of the biggest restrictions but also the largest death tolls prior to vaccinations (Image: Getty)

The study is also the first to examine the characteristics of care home Covid outbreaks in Scotland beyond June 2020 as protections such as routine testing and access of PPE improved, and staff were less likely to be working across multiple premises.

However, the epidemiology of the Covid virus was also evolving over time to become more transmissible - in the case of the Alpha variant in late 2020 - and then more virulent, in the case of the Delta variant which began spreading in Scotland around May 2021.

Bruce Guthrie, a professor of general practice at Edinburgh University and co-author of the study, said: “During and after wave one, there many Covid-19 mitigation measures put in place including closing homes to visitors, regular staff and resident testing, and better isolation and management if residents were infected.

"However, continuing high mortality in residents in wave two emphasises that mitigation before vaccination was limited because of the high transmissibility of the virus and the high mortality of Covid-19 in older and frailer people.”

Larger care-homes were much more likely than smaller premise to have had a Covid outbreak in all three periods, although this risk reduced over time.

Similarly, the prevalence of Covid within the local authority area was strongly associated with the risk of an outbreak.

The Herald: Supplies of PPE improved by the second wave, but the virus had also become more transmissibleSupplies of PPE improved by the second wave, but the virus had also become more transmissible (Image: Getty)

Around a third of all Scotland's Covid deaths occurred in care homes.

Dr Burton said: "The things that people thought might be important - ownership, how long a service had been open for, the regulatory score from the Care Inspectorate, even having a previous outbreak, all of those things were shown not to really be associated with your risk of a Covid outbreak, but the size of the care home and the community prevalence were important.

"Having said that, not all large care homes are the same: some are run as separate units, some are in very modern buildings and some in old buildings, there's lots of unknowns.

"But we do know that there are larger numbers of staff, and although that means you might have a bigger pool of staff to draw on if people are off sick, it also means you have a lot more residents to support and many more interactions."

The death toll and the controversial practice of transferring untested hospital patients into care homes in the early days of the pandemic has been raised during recent hearings at the UK and Scottish Covid inquiries, although previous research by Public Health Scotland - to which Dr Burton and Prof Guthrie contributed - suggested this was not a major cause of outbreaks and deaths. 

Dr Burton added: "I don't dispute there was a problem around that - I have spoken to care home staff who were not told that they were receiving residents known to have Covid from the NHS, and that had an impact for them. 

"I think there's lessons to be learned - not just for an pandemic emergency, but in every day terms - about how we improve communication between professionals from one sector to another.

"Important information that would improve people's healthcare still isn't being passed along very well, even now."