Ministers faced fresh allegations on Wednesday of failing to prepare care homes for a pandemic, as it emerged that Covid-19 may have killed 22,000 residents in England and Wales – more than twice the official toll. Council social care directors in England warned the government two years ago, in a series of detailed reports, about care homes’ exposure to a pandemic, the Guardian has learned. They called for better supply plans for personal protective equipment – warning that “demand for PPE could rapidly outstrip supply” – plus improved infection control and a system to enlist volunteers to help services expected to be stretched to breaking point. The Association of Directors of Adult Social Services (Adass), which represents directors of adult social services in England, told the Guardian it carried out the work to improve government planning for a flu pandemic at the request of the Department of Health and Social Care. But it said: “We are not aware of whether government departments picked up on any of the recommendations set out.” A Department for Health and Social Care spokesperson said: “As the public would expect, we regularly test our pandemic plans – allowing us to rapidly respond to this unprecedented crisis. Our planning helped prevent the NHS being overwhelmed and means we are past the peak of the virus.” The fresh allegations come as Boris Johnson was accused of downplaying the threat to care homes as recently as March, while a study from the London School of Economics (LSE) put the death toll for care home residents in England and Wales at 22,000, more than double the official estimate. On a day of rising pressure over the failure better to protect the elderly and vulnerable against the coronavirus outbreak, Keir Starmer used prime minister’s questions to ask why Public Health England (PHE) had advised in March that care home residents were “very unlikely” to become infected by Covid-19. This was PHE’s position as the World Health Organization declared a global pandemic and people were already dying in the UK. The Labour leader said the government had been “too slow to protect people in care homes”, and Johnson was forced to admit that “the number of casualties has been too high” in the sector. Stamer said the final coronavirus death toll, currently standing at just over 40,000 in the UK, including care homes, hospitals and private homes, would be “deeply horrifying”. The advice on the “unlikely” threat posed by Covid-19 to care homes was changed on 13 March and Downing Street said it was drawn up at a time when there were no infections in the UK. But the clash highlighted growing anger over the attention and resourcing given to preparing care homes as ministers focused on preventing the NHS from being overwhelmed. In a sign of shifting priorities, the government announced a £600m cash injection for care homes to help control infection. The report prepared by Adass for the government in 2018 followed a government pandemic planning exercise known as Cygnus, which uncovered the need to boost the capacity of care homes and staff numbers. They stated that frontline care workers would need advice on “controlling cross-infection” and called for a system for mustering volunteers from families, charities and the community to help overwhelmed homes. They also called for new guidance on increasing stocks of PPE, with a prescient warning that “demand for PPE could rapidly outstrip supply”. Care operators have struggled to limit cross-infection, with outbreaks killing more than two dozen residents in some facilities in the space of a few weeks. Staff absences have been running at 10% to 20% and early in the crisis the care industry complained that it was not covered by the government’s NHS volunteering scheme. A survey of more than 100 care homes published on Wednesday by the Alzheimer’s Society found 43% were still not confident of their PPE supply, with one home resorting to taping bags around carers’ arms, feet and hair. Some 58% of homes said they were unable to isolate residents, and one-third said they had taken in Covid-positive patients discharged from hospital. The latest assessment of fatalities in care settings by LSE academics found that more than half of all “excess deaths” in England and Wales – those above the five-year average for the period from 28 December to 1 May – happened in care homes. They said that from 13 March to 1 May, care homes accounted for 19,938 excess deaths. Only 8,310 of those were specifically linked to Covid-19 by the Office of National Statistics (ONS), reflecting the declarations of care homes rather than on death certificates. The researchers added that deaths of care home residents in hospitals were not currently represented in the ONS figures, and that around 15% of deaths of care home residents happened in hospitals , bringing the total to more than 22,000. The report authors, Adelina Comas-Herrera and José-Luis Fernández, have been tracking virus death tolls in care homes globally since the start of the pandemic. They cited concerns raised internationally about deaths being linked to the residents being isolated in their rooms, without adequate food, drink or medical support, and not to the virus itself. The ONS appeared to support their estimate, saying its data showed just under 20,000 excess deaths registered up to 1 May in care homes since the pandemic started. “Of those, 8,312 have had Covid-19 mentioned on the death certificate,” a spokesman said. “We are undertaking further analysis on all deaths of care home residents which will be published in the coming days.” On Wednesday, Downing Street confirmed that the international comparison of death rates by country had been dropped from the slide at the daily press conference, but denied that it was because of embarrassment that the UK is now shown as having the second worst toll after the US.