6th April 2020
Adelina Comas-Herrera, CPEC LSE
There are growing numbers of examples of hotels and other accommodation that would otherwise be unused being adapted as quarantine centres to mitigate pressures on hospitals and care homes.
Guidance:
In the United States, the Centres for Disease Control and Prevention of the United States (CDC) have issued guidance for Alternate Care Sites and Isolation Sites. Their guidance covers two types of sites:
1 Isolation Sites (tier one): temporary housing for people with COVID-19 who do not need medical attention but who cannot stay at home (for example due to having high risk family members). It could also apply to facilities for people who have been exposed to COVID-19 and do not have symptoms. These patients would require limited monitoring and would care for themselves (no need for help with medications or activities of daily living (ADLs)).
This type of quarantine centres have already been in use since the beginning of the outbreak as isolation facilities for people who had travelled from areas with high levels of infection. In South Korea (and, very soon Spain), large-scale facilities are now used to house people who test positive and have mild symptoms to prevent spread within the community.
2 Low-acuity Alternative Care Sites (tier two): provide medical care to convalescing cases of COVID-19 after hospital discharge and provide care for other medical conditions in this population (for example assistance managing blood glucose). These type of facilities could also be used to house residents of care homes that are experiencing COVID-19 outbreaks.
These patients would often require some level of assistance such as help with ADLs and medication and a higher level of monitoring than those in isolation sites.
The CDC guidance suggests that facilities with open layouts (e.g. sports facilities) may be getter suited as they allow a limited number of personnel to monitor the status of patients. However, in Spain
The CDC guidance provides specific advice on:
- Physical infrastructure requirements including layout, air conditioning and heating, spacing between patients, storage areas, contamination prevention, accessibility and visitor access.
- Services: food, environmental (cleaning), sanitation, laundry facilities, pharmacy access, diagnostics
- Patient care: staffing (including medical, infection prevention and control, occupational health, administrative and support staff), medical supplies, personal protection equipment (staff should wear an N95 respirator, gloves, gown/lab coats), hygiene, etc.
Examples in practice:
There are also growing number of examples of hotels being used as discharge facilities in Spain. A recent report suggests that 2500 hotel places have been made available for this purpose in Barcelona. We are seeking details of the specification of services used to adapt and staff the hotels and their specific infection control guidance, but so far we have been able to obtain the following information from media reports:
- The army and fire services have been deployed to prepare the hotels
- Once ready, the running of the hotel is taken over by the local hospital for which the hotel becomes a satellite facility for discharge of patients who are still symptomatic.
- A multidisciplinary team, from the hospital and sometimes with the local primary care centre provides care.
- Hotel staff (following training) involved
- Examples of infection control measures:
- separate lifts for personnel and patients
- staff delivering food to outside the door and patients being asked to count to 5 before opening the door
- no visitors allowed but are able to deliver care packages
From Spain, there are also a growing number of examples where hotels have been used to “decant” care home residents, with or without COVID-19. These are used primarily for two reasons: homes that are not able to isolate correctly those with COVID-19 and there is a high risk of the infection spreading to others, and homes that do not have enough staff available. This has usually happened in emergency situations, there are reports so far of 50 residents being moved in Andalucia and 160 in Catalonia.