For people who see headlines and straplines and react before reading the rest, this piece is full of quite measured, well researched information which provides context. As so often, outraged headline doesn't mean outrageous article https://www.dailymail.co.uk/news/article-8302039/Hospitals-probed-sending-elderly-care-homes-despite-KNOWING-coronavirus.html

Crucially the article which is well attributed makes it clear that
1. 7 March acute trusts in fear of overwhelm were told by NHSE to free 15,000 beds and make use of additional community funding to help (but they would have tried to do this anyway as part of escalation)

2. On April 2nd a directive from NHSE, PHE etc told acute hospitals they did not need negative Covid-19 tests to send people to care homes

3. Many of excess deaths (above normal expected rate ) not attributed to Covid-19 which may be underestimation because of lack of testing

4. So there might be something about the offer from the NHS for other (non Covid-19) resdents due to pandemic impact on services e.g. ability/capacity to provide in reach support

what the article does *not* say

1. Elderly Care home residents generally frail, with multiple life limiting long term conditions, have very poor reserve and have limited average life expectancy from the moment they first arrive - it is the only way most people pass threshold

2. Well before Covid-19 we were making considerable efforts to do more advance care planning, try to avoid distressing, bewildering trips to hospital which often result in death. Trying to support them (with moderate treatment or palliative care) in home was *good* practice

3. In March there was insufficient testing capacity to test even acute hospital patients with suspected Covid-19 and those tests were taking days to get back. First tests had a 20-30% false negative rate even in people who looked like Barn door positive cases

4. So the notion of keeping everyone in for days waiting for first and 2nd tests at a time when everyone was concerned acute beds would be overwhelmed not a good one - easy to be wise after the event
5. But *could* have used halfway house accommodation to protect care homes

6. The notion that non conveyance to hospital and people being "denied" hospital treattment does not stack up. In non pandemic times there are c 450 deaths a week in care home residents conveyed to hospital. People with Covid not being admitted cannot account for excess deaths

7 Pandemic or no pandemic and wherever people usually live, we should only be admitting them to hospital of there is treatment that only hospital can provide and where hospital is the best option. In many cases, Oxygen, IV fluids, antibiotics not indicated though pall care might

8 As for "put ventilators in care homes" by definition, the poor underlying health status of care home residents mean that they would very rarely be candidates for ICU and in many cases would not tolerated non-invasive, let alone invasive ventilation. Covid-19 or not

9 ICU admission is not a cosy neutral intervention - people can be there for weeks, hard to wean off ventilation often with delirium, often with a long tail of physical disability, poor fitness, cognitive impairment. And that is 40 or 50 year olds let alone very frail elders

10 And i can remember very few occasions in a long career where a care home resident (unless post hip fracture surgery or serious head injury) in my care was ever felt suitable.
11. Survival from CPR to 30 days in residents is less than 1% (even for those felt suitable for it)

12. In non-pandemic times we have c 5,000 ICU beds and 420,000 care home residents (with c one in three dying each year). Even now, ICU capacity has doubled and tripled in many trusts with those expanded ICUs still full. The maths are clear

13 the "but there are empty hospital beds" argument is fallacious. empty because elective work has been cancelled, because there have been huge efforts with primary community partners to reduce delayed transfers and support more people at home and avoid risks of hospital

14 And because patients are staying away due to worry about exposure to Covid-19
15. We *want* to keep spare capacity in hospital in case of 2nd wave and not run at our usual dangerous, overcrowded 95% plus occupancy
16 Admitting/keeping people for no acute reason not good

17 Most of all, though those of us who are looking after lots of older people with Covid-19 know it hits them very hard, many will deteriorate quickly and die, most deaths round the world are in older age groups.

18 Hits harder than other viral infections like flu

19 So if there *are* outbreaks in care homes death rates will be high. Death rates across western europe and north america in care homes which have outbreaks have been just as high
20 The key lies in infection control, joined up planing, stopping outbreak in first place
ENDS