Aged care deaths mount as Omicron takes a toll

Tim Robertson

20/04/2022 6:00:07 PM

More COVID deaths have occurred in the first 15 weeks of this year than all of 2020 and 2021 combined. But is a return to locked down facilities a viable solution?

Aged care resident in bed with COVID.
More than 1100 aged care residents have died from COVID in the first 15 weeks of 2022.

There are currently 846 active outbreaks in residential aged care facilities (RACFs) across Australia, according to the most recent Department of Health (DoH) statistics.
In the six days between 13 April and 7 April, 50 residents died due to COVID-19, taking the overall death toll for 2022 to 1107. By comparison, 917 RACF residents died from when COVID first arrived in Australia up until the end of 2021.
While vaccination rates are high and Omicron typically causes less severe disease than previous variants like Delta, it still poses a serious risk to those in residential aged care, not least because it’s more transmissible.
Japanese research concludes Omicron is 4.2 times more transmissible than Delta, which is itself up to five times more infectious than the original coronavirus strain that emerged at the end of 2019. And with the even more transmissible BA.2 now becoming dominant in Australia, infection rates will likely continue to climb.
As a result, the Omicron outbreak has seen significantly higher rates of community transmission nationwide, which is a trend that has been reflected among the aged care population. 
‘As expected, there is a significantly higher number of our elderly residents in residential aged care facilities testing positive with COVID-19 than ever before,’ Dr Khayyam Altaf, Chair of RACGP Specific Interests Aged Care told newsGP.
‘On a positive note, from the GP frontline, the relative mortality appears to be reduced in comparison with the initial outbreak we faced prior to the vaccination rollout, where the percentage of deaths appeared higher.
‘The severity of symptoms also appears to have reduced. This confirms the importance of the vaccination program.’
According to data released by the DoH, as of 20 April 2022, 165,163 aged care residents have received three or more doses, which constitutes 95.6% of the eligible population.
But is there more that can be done to protect residents and reduce deaths than maintaining high vaccination rates?
During previous outbreaks, governments and health officials resorted to strict public health measures; over the course of the pandemic, Melbourne experienced six lockdowns, totalling 262 days, while Sydney’s latest lockdown – implemented to combat a Delta outbreak – lasted more than 100 days.
Restrictions were less severe in states and territories with lower rates of transmission, but during every lockdown, RACFs were effectively cut off from the world – preventing residents from seeing family and friends or engaging in other activities that improved their quality of life.
For Dr Altaf, the severe restrictions imposed at the beginning of the pandemic may not be the answer.
‘The prolonged lockdowns adversely affected the mental health of many aged care residents and that needs to be taken into account,’ he said.
‘Ultimately mental health and quality of life versus the risk of infection transmission needs to be balanced in a sensible manner.
‘The risk [of COVID-19 transmission] will never be eliminated and any attempt to do so will have potentially far greater consequences.’
Dr Altaf’s position is supported by a recent study into the impact of COVID-19 on the mental health of Australian RACF residents and staff, which found that both experienced pandemic-related distress.
‘On average, nearly half of their residents experienced loneliness [41%] and a third experienced anxiety in response to COVID-19 [33%],’ the report states.
‘The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19.
‘Participants emphasised the need for increased access to counselling services and improved mental health training amongst staff.’
Instead of social restrictions, Dr Altaf suggests a ‘common-sense approach’ underpinned by ‘absolutely crucial’ high vaccination coverage.
‘It is my firm opinion that when looking at ways of reducing the risk to our aged care residents, strategies utilised need to be patient-centred and reasonable,’ he said.
‘Infection control measures … by staff and visitors who are symptomatic need to be taken to minimise the risk of spread, with swift action with testing and isolation of symptomatic residents, and appropriate PPE.’
Meanwhile, the Aged Care Quality and Safety Commission is already conducting a range of site and non-site activities to monitor and assess residential aged care services as part of a commitment to improve infection control measures, which includes site audits and assessment contacts.
In August 2020, the Commission also commenced an infection control monitoring spot check program in all six Australian jurisdictions.
Likewise, all state and territory governments have mandated booster doses for residential aged care workers, consistent with arrangements already in place through state and territory public health orders and equivalent arrangements.
‘With early action on possible cases or close contacts and symptomatic individuals getting tested and isolating immediately, this can help us to achieve as close to the right balance which we strive for,’ Dr Altaf said.
New oral antiviral medications such as molnupiravir (sold as Lagevrio), which has been available for aged care residents since February 2022, are also playing a role, with outbreak sites prioritised for delivery.
According to the DoH, the National Medical Stockpile has so far deployed 48,134 treatment courses of molnupiravir, and its use could climb as it is now available via the Pharmaceutical Benefits Scheme. Additionally, nirmatrelvir plus ritonavir (sold as Paxlovid) should become more widely utilised once it is listed next month.
But with outbreaks increasing and deaths continuing to rise, the ATAGI-recommended winter booster will likely take on more importance than ever.
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Dr Ian Mark Light   21/04/2022 3:56:44 PM

Antivirals are available to decrease the risk of progression to severe disease in immunocompromised patients including patients in long term care facilities even those triple vaccinated .
Most States have temperate weather days even in winter and outdoor visits are believed safe .
Even indoor visits with open windows can be arranged there is time for this .
Open Windows or doors with the Airconditioning on for more fresh air exchange will hopefully decrease spread .
And frequent testing and paid sick leave with retirees returning with pay exempt from pension deductions plus extra trained students to make up staff shortages is warranted .