Coronavirus (COVID-19): care home outbreaks - root cause analysis

5. Testing 

Availability of testing in a timely manner to support an outbreak, turnaround time of the test and accurate and timely reporting of results from HPTs to care homes; were common themes across the care homes we reviewed. The local challenges we heard about were based on a number of issues which created bottle necks in the system.

Care homes testing was initially provided through the UK Lighthouse network of labs. Delays were reported by several of the care homes in relation to the receipt of test results. Communication of test results to the care homes were on occasion problematic. Other challenges included: access to drivers to take specimens from the home to laboratory, availability of staff for couriering and bags to transport samples. 

The Lighthouse laboratories have a long turnaround time, which means there is no ability to intervene in a timely manner to prevent further cases based on testing. There is also no return of the specimen to the NHS board and thus an inability to undertake Whole Genome Sequencing (WGS) to better understand the transmission risks. We heard that moving to NHS laboratories recently has been a positive experience, whilst initially this created longer turnaround time in those laboratories, as there was a high volume back log, this has since been resolved. 

Two care homes reported there was a delay in reporting positive cases to the home by the Health Protection Teams. The care homes believed this was what resulted in the attack rate being higher. In one home they reported that the Health Protection Team informed them that this was a second case, however they had not been previously been notified of the first case. 

One board reported they had an issue with staffing, when staff returned to academic institutions as universities started back, and are actively recruiting in support of the testing process. One DPH noted that if the Lighthouse laboratories worked more in collaboration with the NHS laboratories we would be able to work between the two more easily and focus on those samples and results that are needed urgently; such as routine testing in care homes, given the high risk of a single case and its potential impact in that context and particularly in relation to outbreaks and need for immediacy of testing. This is of particular importance because in one outbreak, it took 7 days to confirm results for staff testing, which meant that staff continued to work whilst unknowingly being subsequently confirmed as testing positive. On another occasion, failure to collect samples from the care home in a timely manner, resulted in positive staff continuing to work unknowingly at risk to others. Another care home reported improvement in accessing tests, but had persistent problems with timescales for results; 3 or 4 days was not uncommon and a risk given asymptomatic staff continue to work, whilst awaiting results in line with national guidance.

Recommendations:

• 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 
• 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