The Covid pandemic has provided a multitude of harrowing stories of infections running wild in care homes around the world.  It has shed fresh light on the difficulties in keeping residents safe from any viruses, much less those as deadly as Covid-19.

A recent paper from the University of Waterloo’s School of Public Health and Health Systems explores the lessons society can learn from Covid to better prepare us for future outbreaks.

The authors argue that such protection requires a fundamental rethink of staffing, infrastructure, and culture.  What’s more, designing care facilities to be smaller and more homelike would also help to reduce the spread of viruses while also promoting a better quality of life for residents.

“Community outbreaks and lack of personal protective equipment were the primary drivers of outbreak occurrence in long-term care homes, and the built environment was the major determinant of outbreak severity,” they say.

“We need to distinguish between small-scale living and small-scale housing, using architectural features to create uncrowded and home-like spaces – but within a sufficiently resilient infrastructure to avoid critical staff shortages such as those experienced by some very small homes in Italy and the United States.”

Viral spread

Data from across the United States has shown that outbreaks in care homes were far more likely when staff were commuting in from neighborhoods with a high level of viral circulation.  This was especially so in large homes with a lot of staff movement.

In simulations, the researchers found that 31% of infections and 31% of deaths could have been prevented if, for instance, residents were in single rooms.  Such an intervention would have required, however, an additional 30,000 new rooms in care homes.

“Policymakers need to reimagine long-term care infrastructure in a post-pandemic world, keeping in mind that smaller homes support better resident outcomes and are more resilient against infectious outbreaks,” the researchers say. “New large-scale long-term care home developments should be strongly discouraged.”

The paper also advocates introducing a dedicated individual responsible for infection control within care homes, while also doing more to improve staffing conditions.  The authors cite the example of Hong Kong, who after the SARS outbreak in 2003 introduced several such policies, which significantly helped them during Covid.

Such measures were complemented by more societal interventions, such as paid sick leave, full-time caring roles, and strong support for mental health for staff.  The authors argue that the experience of Hong Kong underlines the importance of health systems being able to learn from their experiences and better prepare themselves for the future.