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How do you reduce the risk of Covid over Christmas?

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Recently, I have been talking with a few people about their plans for Christmas.

I am not entirely sure about the latest government advice as to what is allowed or recommended. To be honest, I stopped listening to the government months ago – I tend to go with the flow and make up my own mind as to what is right or wrong, what I should or shouldn’t do, after all, what the heck does the government know about me?

Sure, there have been the lockdowns and I have diligently remained indoors or out of sight of crowds, then again, I have never been a fan of crowds or busy places so essentially, I have been doing what I always do.

It must be hell to be a partygirl or boy during Covid. You have my sympathy.

Anyway, back on topic.

Christmas will be upon us in a couple of weeks and people are making plans – here are some of the questions that have arisen…

‘My mum is being allowed out of her care home on Christmas day, what should we do?’

‘We are allowed to see dad in the nursing home at Christmas, should I visit?’

‘My son is being allowed home from university for Christmas, should he see my dad?’

‘It’s holidays, should I visit my brother/sister/friend in England/Wales/Scotland/NI?’

Again, I don’t know what the rules say, this is what I think:

Care Home residents –

Putting aside all the issues relating to the derogation of human rights of people living in care homes in the UK, the reality is that this is a group at very high risk of either dying or spreading Covid – in my experience, given the living conditions in care homes and the way care is provided and work done, if one resident gets Covid, often before you know it (some of this relating to asymptomatic carriage), half a dozen then all the residents and the staff are infected.

Mostly when staff are infected, they pull-through; when residents are infected, anywhere between a quarter and half appear to die.

Covid in care homes is therefore awful.

As to the visiting families in different parts of the country, you probably have to split that into those who are at risk of contracting Covid and dying and the overall stirring up of infectivity that will likely happen – most people are expecting our national rates to increase in the New Year with a third wave. We will see.

So, what do you do?

Well, you could just stay put.

Not see mum, dad, brother or sister.

Inactivity is always an option and, sure, what do you have to lose?

For most, probably not very much, for others, this might be the ‘last Christmas’ either because your mum, dad, uncle might be in their last year of life or less dramatically, next year your kids might have moved on and be doing different things.

We all want to seize the moment, is it worth it?

What I recommend…

In the turgid world of health and social care there is the concept of an Individualised Risk Assessment (they do this in schools and regular workplaces too – most readers should therefore be familiar with the concept).

This is saying that my risk is likely different to your risk, both in terms of my spreading or catching Covid and each of us should probably do things differently.

This is where the government advice often falls-apart as they provide national or regional guidance.

I don’t want to say I told you so, but a theme of my blogs for the past six years has been person-centred care – this is care tailored for the individual; it’s ironic that person-centred risk assessments are what we all need.

Anyway, here is some guidance:

  1. People coming back from university are being tested using lateral flow devices – these (as far as I know as I haven’t used one yet) are the same principle as pregnancy tests; a little hand-held device you mix with a swab taken from your nose and throat.

In my experience pregnancy tests tend to be very sensitive (they pick-up almost everyone who is pregnant) and specific (if they are positive you are probably pregnant and not something else).

There has been lots of discussion as to the sensitivity and specificity of the lateral flow devices – I am not sure anyone really knows; there have been figures ranging from 50 to 100%. The PCR tests which are done in Covid testing units and hospitals are upwards of 70% sensitive and highly specific.

Part of the reason for the variation in figures is the virus may or not be present in certain people in sufficient numbers as to test positive although more commonly, given the test relies on a swab or a little brush being inserted into your throat and nose by a nurse, a swabber or the person taking the test, the variation in success of the swabbing technique is a highly uncontrolled variable.

Anyway.

If your test is positive you either have active Covid – that is within 14 days of infection or you have had Covid – the suggested time for the virus particles to be detected is up to 90 days after infection.

And, if you have tested positive for Covid I would not have granny or grand-dad round for Christmas dinner (you can see them outdoors, maybe with you mask wearing and no hugs and, no shared pigs in blankets).

2. Now, if you are back from university and you have tested negative, you are in a better place, yet you might still have the virus either incubating or you might not have had a valid test (false negative).

You could do what my kids are planning and that is to quarantine themselves before Christmas so they can see their grandparents; this is not straightforward but a good demonstration of love.

How many of my readers realise that our older care home residents after a trip to hospital are quarantined in their rooms for two weeks after the event? If it is OK for them, maybe younger people should try it.

3. If you have tested negative and whether you quarantine or not, as part of your own risk assessment I would then take some additional measures, essentially looking to whether you have symptoms:

Has your sense of smell gone?

Are you coughing?

Do you have a fever?

Do you feel ill or off colour?

Again, you find yourself with these symptoms I would stay away and think about being tested.

4. You want to have grandma over for Christmas dinner – should you? I worry about this as it essentially questions the behaviours of all the different people in the house; some of us (me) are quite reclusive at the best of times and beyond the time I actually spend with patients who have Covid I tend not to associate with others; it is hard to guarantee this for all the attendees. Young people like to hang out with others and even if infected with Covid are mostly without symptoms.

You might ask, would I be happy to drink out of the same cup of coffee as uncle Albert or Cousin Jane? Would I be happy to use the same cutlery, maybe eat their leftover turkey?

5. What to do if you aren’t sure, do you call it all off? I have hated the way those people in care homes have been locked out of society. I have seen people deteriorating and dying because of lack of access to their families. As I have written before, many of the carers I work with every day are amazing individuals; they go above and beyond to provide the best, most sensitive care and support to the residents. They aren’t family however and despite family not being a guarantee of love, the mum or dad bond is unique.

I have been going-on for over a thousand words; has what I have written helped?

I don’t want to say more, and I don’t want to go into the minutiae of each person’s experience.

My closing message I feel is to weigh up the pros and cons, don’t rush in, balance your feelings with the practicalities of test results, exposure and symptoms.

You can still hold hands if someone is wearing rubber gloves; you can still laugh or smile wearing a face mask.

Take care.

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