Deaths from COVID-19 in care homes are starting to stabilise, yet they remain 159% higher than at the start of the COVID-19 outbreak. Why is this?

As we age, our immune system weakens. This makes us more vulnerable to infections of all types. And any sort of challenge to the body can do more damage. But a 159% increase surely is unacceptable?

As days go by we’re learning more and more about the frightening effect that COVID-19 has on our bodies. Being older sadly increases the threat, with an overall death rate from an estimated 0.66% to 7.8% in people aged over 80. 

Links between COVID-19 and Thrombosis are presently being researched, a recently published report by the Radiological Society of North America (23rd April 2020) found that 106 pulmonary CT angiograms performed for COVID-19 patients over a one-month period in a tertiary care centre in France, 32 patients (30%) had acute pulmonary embolus (PE). This rate of PE is much higher than usually encountered in critically ill patients without COVID-19 infection (1.3%,) or in emergency department patients (3 to 10%).

The report authors stress that careful attention needs to be paid to the initial diagnosis and treatment of the prothrombotic and thrombotic state that can occur in a substantial percentage of COVID-19 patients.

In the week ending 1^st May 2020, there were 2,423 COVID-19 related deaths recorded in care homes, 3,214 recorded in hospitals and 254 recorded in private homes. Data shows that the most common factors for developing a deadly blood clot were; hospitalisation (52%), Cancer (48%) and Surgery (42%). Interestingly, these factors can be partial correlations between the cause (hospitalisation, cancer and surgery) and immobility.

Research by Professor Richard Beasley of the MRINZ, highlighted the link between the  development of a DVT (Deep Vein Thrombosis) and sedentary living. Those with increased immobility, be it through hospitalisation, treatment or post-surgery. Research showed that after just 90 minutes, blood flow to the lower limbs had decreased by over 50%. This decrease in blood flow, significantly increases the threat of the patient presenting with a DVT.

Sir Kier Starmer asked Prime Minister, Boris Johnson; “Does the Prime Minister accept that the Government was too slow to protect people in care homes?” Maybe the question should have been; “With reduced mobility, be it through lockdown restrictions, resident’s reduction of mobility through lack of PPE for carers and their safe working conditions, or the isolation from family. Could this attribute to the increase of the 159% increase of deaths pre COVID-19?”

What can be done? Research shows that men and women aged 18 to70, who undertook even moderate exercise, were associated with a lower risk of deep vein thrombosis. Is this possible though during the lockdown in our care homes?

During the COVID-19 pandemic, there has been an increase of on-line exercising. Dame Kelly Holmes and Lady Tanni Grey-Thompson broadcasted a “chair workout” programme, others like Joe Wicks might be a bit too ambitious though.

Simply, to significantly reduce the threat of a resident developing a deadly blood clot, the care homes, the carers, the residents loved ones really need to be addressing the increase in sedentary living during the pandemic.

Key facts:

• During sustained periods of immobility, like flying, the combined effects of venous pooling, reduced flow create the conditions necessary for thrombus activation
• The cost of thrombosis to the NHS is estimated at over £200 million a year.
• Globally this is a cost to health service providers of more than £22 billion each year
• More than 60% of all cases of VTE are associated with hospitalisation, with many events occurring up to 90 days after admission
• VTE affects approximately one in 1000 of the UK population and is a significant cause of mortality, long-term disability and chronic ill-health problems
• In Europe, there are 544,000 VTE-related deaths every year
• In the U.S. and Europe, VTE-related events kill more people than AIDS, breast cancer, prostate cancer and motor vehicle crashes combined 
• In the UK, up to 60% of VTE cases occur during or after hospitalisation, making it the leading    preventable cause of hospital death 
• Hospital-acquired blood clots cause an estimated 25,000 preventable deaths each year  

Risk Factors for DVT

Older Age                                 Immobility                               Obesity

History                                     Pregnancy                                HRT

Surgery                                    Hospitalisation               Oral Contraceptives

Long-Haul Travel                   Cancer                                     Trauma