Carl Heneghan and Tom Jefferson

Dying of neglect: the other Covid care home scandal

Out of sight, the elderly have remained out of mind during this crisis

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Officially, more than 44,000 deaths in England and Wales have involved Covid-19. But how many have died as a direct result of the disease itself and how many are victims of the fear and neglect that it has engendered?

It is remarkable how many deaths during this pandemic have occurred in care homes. According to the Office for National Statistics, nearly 50,000 care home deaths were registered in the 11 weeks up to 22 May in England and Wales — 25,000 more than you would expect at this time of the year. Two out of five care homes in England have had a coronavirus outbreak; in the north-east, it’s half.

Not all these deaths, however, have been attributed to Covid-19. Even when death certificates do mention it, it is not always clear that it is the disease that was the ultimate cause of death. The data refers to people who died with Covid-19 present in their bodies, whether or not it was the direct cause. This raises questions about whether there’s another reason for many of these deaths which has gone largely unnoticed while attention has been focused on Covid-19. This is not just a British phenomenon, but one seen across Europe.

A recent study in the southern Île-de-France region suggests confinement itself has had catastrophic consequences. In long-term care facilities with excess Covid-19 deaths, researchers found that acute respiratory distress was not the primary problem — deaths were mainly due to hypovolemic shock, or fluid loss. Confined to their rooms in lockdown, with staff absences running at 40 per cent and with a consequent reduction in the usual support, residents were dying of thirst.

Confined to their rooms in lockdown, with staff absences of 40 per cent, residents were dying of thirst

In old age people tend to lose their sensation of thirst, which makes them susceptible to dehydration unless they are reminded and encouraged to drink by staff or family.

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Written by
Carl Heneghan and Tom Jefferson
Carl Heneghan is professor of evidence-based medicine at the University of Oxford. Dr Tom Jefferson is a Clinical epidemiologist and Senior Associate Tutor at the University of Oxford.

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