Coronavirus (COVID-19) care home outbreaks - root cause analysis: progress report November 2020 to September 2022

5. Testing

The RCA report indicated that timeliness of testing in an outbreak and reporting of results from local HPT teams were common themes in the care homes that were reviewed. There was also reports of long turnaround times in the UK lighthouse network labs which were initially used for weekly asymptomatic staff weekly PCR testing. These labs also did not have the facility for Whole Genome Sequencing (WGS) to understand the genetic code and ultimately new strains of the virus.

Since the onset of the pandemic care home staff have been prioritised for regular screening for COVID-19 and the Scottish Government has continually reviewed testing for this group (and wider social care staff) on the basis of clinical advice.

The winter preparedness plan (2021/22) detailed the commitment to move weekly PCR asymptomatic testing from the lighthouse network to a series of regional NHS labs by the end of March 2021. This had the direct effect of mitigating the peaks in turnaround times due to high demand for PCR across the UK at times of high prevalence. NSS added barcodes specific to each care home which allowed the identification of orphan results (samples that were partially or not filled out at all with information that would allow either the individual or care home to be identified). Unique barcodes allowed positive lab test results to be flagged to the care home immediately.

A number of processes were also made in the winter plan including enhanced support for care homes in the event of a suspected outbreak including where appropriate whole home testing for staff and residents in the event of one positive test.

Recommendations:

5.1 Urgent action should be taken to ensure parity of access to testing and speed of response for care home and wider NHS and agency staff deployed there

Progress

Testing guidelines have applied to those who working in a care home even if not directly employed there. All staff working including agency were eligible for weekly asymptomatic weekly PCR testing and LFD testing. Agency staff could also access PCR and LFD tests from local testing centres/postal service. As widespread testing at the population level was scaled back, care homes had additional stocks of LFDs so they could offer agency staff testing kits to either test on site or take home. Nationally, a number of seminars were undertaken throughout 2021 for social care staff on the benefits of testing and swabbing. Training materials were added to TURAS learn and various guidance was added to the Scottish Government website.

5.2 Urgent action to ensure suspected outbreaks in care homes result in all staff and residents being quickly tested and there are no delays to total turnaround time from sample being taken, to results being reported back

Progress

As highlighted in this section above various actions on testing and general support were put in place to improve turn-around times for testing of suspected/then confirmed outbreaks in a care home. Testing guidance for staff and residents in the event of suspected/confirmed outbreaks changed over the course of the pandemic in response to risk. The response has moved from rapid whole home testing to identify cases and contain/prevent an outbreak to targeted testing.

High levels of vaccination among care home residents and the risk of severe harm lessoning since Omicron means that only symptomatic residents and staff are now tested and in the event of a suspected respiratory outbreak up to five residents displaying symptoms will be tested.