Care home Covid infections mainly spread by staff, inquiry told

Dr Chris Williams, a consultant epidemiologist for Public Health Wales, told the UK Covid-19 Inquiry that coronavirus is likely to have been spread by care home staff rather than from those discharged from hospital.

Dr Williams’s comments came following a question from Tom Poole KC, the lead counsel for the inquiry.

Mr Poole said: “Am I right in saying (your research) has largely confirmed that transmission to care home residents was driven by their exposure to the community through staff rather than from hospital discharges, is that right?”

Dr Williams said that was the “broad conclusion” he and his colleagues had come to, but he added: “I just want to caveat that by saying it’s possible for care home from discharges, particularly earlier in the pandemic, to have then gone on to cause transmission within those homes.

“I’m not arguing at any point that wasn’t a possibility.

“We just felt that there was a bigger risk and an ongoing risk from the community to staff to the care home.”

He also agreed that testing for care home staff and residents was “possibly more important” than those being discharged from hospital, but said they were both part of the “whole package”.

Mr Poole asked if there was anything being done in the early stages of the pandemic to prepare hospitals and care homes for infections in Wales, to which Dr Williams said he could not remember any “particular preparations”.

The inquiry also heard from Dr Roland Salmon, a former director of communicable diseases for Public Health Wales and one of the few public health experts in the country to argue against lockdowns.

In a statement to the hearing, he argued in favour of herd immunity over lockdowns, calling the former a “time-honoured epidemiological term used to characterise the resistance of a community to an infectious disease”.

Dr Salmon argued against Professor Chris Whitty, the chief medical officer for England, who had said in his evidence to an earlier hearing of the inquiry that herd immunity was not the right course of action.

Quoting Prof Whitty, Mr Poole said: “For most of the major diseases I have worked on, you never acquire full herd immunity, basing a policy on the assumption that eventually immunity and the less at risk population will protect the others is not a safe starting point.”

Dr Salmon said the “underlying virology” of coronavirus meant herd immunity was a “reasonable option”.

He added it was his view that “relatively optimistic predictions” could have been made fairly early in the pandemic.

Dr Salmon argued the pandemic response ultimately disproportionately affected children, often in ways that were not immediately apparent.

He said: “The loss of educational and employment opportunities to younger cohorts, children, students, young adults in work, who bore a disproportionate share of the economic and social burden.

“It’s easy to think ‘well that’s economics and on the other hand we’re saving lives’.

“What I think we lose sight of unless we take a whole life view of public health is that those losses of opportunities and that economic loss will translate into ill health and loss of life expectancy.

“It may not be as immediate, but it will certainly be there.”

He also branded Wales’s short ‘firebreak’ lockdown “expensively bought and hard to justify”.

An opinion not shared by Professor Michael Gravenor of Swansea University, who told the inquiry the late October 2020 lockdown should have been longer.

He said: “Looking back on it now, I do think it should have been longer.

“A longer firebreak, given how effective it was at reducing (transmission) it would have put us in a much better position in December and potentially could have avoided some of the worst of that second wave.”