Care Homes Warned of Visit Risks With ‘Flawed’ Lateral Flow Tests

Published on: 16 Dec, 2020
Updated on: 17 Dec, 2020

By Julie Armstrong

local democracy reporter

People should not to visit their loved ones in care homes this Christmas, says the Surrey Care Association (SCA). They fear “flawed” rapid test kits mean visitors may unwittingly infect elderly relatives.

Health Secretary Matt Hancock had promised that lateral flow tests (LFTs), which return a result in 30 minutes, would allow “meaningful contact with loved ones by Christmas”.

He said families could be reunited thanks to “unprecedented strides made in testing technology”, and care homes would have enough to test two visitors for every resident, twice a week.

But Liverpool university research, released on December 11 by the Scientific Advisory Group for Emergencies (Sage), revealed the US-made Innova tests most widely used in care homes had only a 48.89% detection rate.

Simon Carter, chair of SCA. Photo: Surrey Care Association

Simon Carter, chair of SCA, said they have “grave reservations”, and the “harsh reality” was “at odds with that being portrayed by topline government messaging”.

He went on: “We of course recognise the huge importance of visits from family members and the positive impact they have, but the consequences of relaxing our guard and getting this wrong are so dire that we need to proceed with the utmost caution.”

The organisation, which supports social care providers in the county, worries care homes are being put under pressure to allow visits, and has asked Surrey County Council to write to the families of care home residents to advise them of the risk.

An SCC spokesman said: “Lateral flow tests are just one of a range of methods that can contribute to safe visiting and this includes the use of personal protection equipment, hand hygiene, taking temperatures, screens, cleaning etc.

“It is very important that a negative LFT does not result in a reduction in appropriate Covid infection control precautions, including PPE, hand hygiene and social distancing in either staff or visitors.

“Registered providers and registered managers are responsible for doing everything they can to ensure residents and staff are safe and maintain a Covid-secure environment.

“Different services and registered managers may come to different conclusions regarding the use of LFTs to facilitate visiting and provided this is based upon a robust risk assessment we will support their decisions.”

Last month, the Liverpool Health Protection Board postponed plans for the test to allow visits in care homes “due to the accuracy statistics”.

Professor of biostatistics Jonathan Deeks wrote in the British Medical Journal: “If a test misses 50% of infections, people with a negative result are not in the clear. Their chances of active infection are simply half what they were before the test.

“Allowing half of infected people, and one-third of those with high viral loads, to unwittingly take the virus into hospitals, family homes, and care homes will not reduce the spread of the infection and could put lives at risk.”

SCA’s Mr Carter said: “Knowing this, and understanding the manufacturers of the lateral flow tests advise against using them in care settings, it would be reckless and irresponsible for our members to admit visitors simply because they’ve returned a negative test result.”

Individual care homes have their own measures, so visits will depend on the particular provider.

Age UK had warned: “The impact of taking visitors away from people on a prolonged basis has been closely observed all over the country, with people and organisations commenting on the raw reality of residents going downhill fast.”

Mr Carter added: “For months, our members, and their staff, have worked tirelessly to create safe environments for their residents, shielding them from undue risk. Their wellbeing and safety is our absolute priority.

“With the vaccine at the point of roll-out across the care sector, we’re on the cusp of being able to gain control of the virus.

“Taking risks at this stage then, purely for short-term benefit when long-term relief is in reach, is something we simply cannot countenance.”

The government says it has “sent out millions of tests, provided free PPE and issued guidance to help bring families back together”.

A Department of Health and Social Care spokesperson said: “Extensive testing has shown lateral flow devices are suitable for use in care homes where they can help to identify people who are the most likely to spread the virus further and therefore support the prevention of transmission of the disease from staff and visitors.

“Testing is only part of the approach and it’s essential visitors wear PPE and follow all infection control methods to keep their loved ones, other residents and staff as safe as possible.

“Care home residents in all tiers will have the chance to see their relatives before Christmas and homes across the country are arranging visits now.”

An earlier University of Oxford and Public Health England study of rapid tests including Innovas found detection rates to be about 79% when tested by Porton Down laboratory scientists, but falling to about 58% by Boots test centre employees.

Mr Hancock told the select committee he did not recognise the 58% figure.

Dr Susan Hopkins, senior medical adviser to PHE and NHS Test and Trace, said: “No test will detect every single case but these lateral flow devices are proving to be accurate and reliable.”

Public health authorities in Greater Manchester require two tests before a care home visit, a PCR test, then within three days a lateral flow test by care home staff.

PCR is the NHS standard test, a swab of the nose and throat sent to a laboratory for analysis.

A review by the University of Bristol found the PCR detection rate to be between 71-98%.