Care home staff have expressed growing anxiety about a rise in hospitalisations and deaths among their most vulnerable residents, after leaked documents from the Department of Health and Social Care (DHSC) revealed an increase in the number of coronavirus cases in England. The UK is experiencing a sharp rise in the number of positive cases, with 3,497 new cases reported on Saturday and an “R” number – the average number of people infected by each person with Covid – above 1 for the first time since March. Data shows the R number for England could be as high as 1.7, with prevalence of the virus doubling every 7-8 days. While this is at its highest among younger adults, experts have warned the virus could spread to more vulnerable populations – as is happening in France. There are signs that hospital admissions have already started to rise in the UK. A letter sent on Friday by Stuart Miller, the director of adult social care delivery at the DHSC, to care providers, said: “You will know already that we are experiencing a rise in confirmed Covid-19 cases, across the UK population. I need to alert you to the first signs this rise is being reflected in care homes too. “Over the past three days, Public Health England (PHE) has reported an increase in notifications of Covid-19 cases in care homes. Testing data has also shown an increase in the number of positive results. “Currently, the infections are mainly affecting the workforce but clearly there is a risk the virus will spread to care home residents, or to other parts of the care sector. Unfortunately, in some care homes with recent outbreaks, this does appear to have occurred, with residents also becoming infected.” According to the Sunday Times, the health secretary, Matt Hancock, was told on Wednesday outbreaks had been detected in 43 care homes, while a DHSC report marked “official sensitive” said the rate of coronavirus recorded care homes via “satellite test centres” had risen by a factor of four since the start of September. While the numbers of homes known to be infected remain low, at about 0.3% of UK facilities, there is rising anxiety among care home managers, said Nadra Ahmed, the executive chairman of the National Care Association, which represents independent care homes. By the end of the spring pandemic wave, 56% of care homes in England were estimated to have had at least one person (staff or resident) infected with Covid-19, according to an ONS study. Ahmed said that in recent days, many operators had decided to close their homes to visitors to prevent a repeat, and further lockdowns are expected this week, which is likely to cause anguish for families. “Providers are living under a cloud of fear,” said Ahmed. “In July, we were promised weekly testing, then we were told testing would all be available by 7 September, but people are still waiting for test results and they are still not coming back on time. We had one member who tested staff last Friday. The results came back this Friday and two staff were positive. In that period they were working, which means they could have spread the virus to the residents.” However, she said homes were better prepared than in the early months of the pandemic, and typically hold a month’s supply of PPE in reserve. Vic Rayner, the executive director of the National Care Forum, which represents charitable care providers, said: “Care homes are operating at exceptionally high states of vigilance around infection prevention and control, but the government must fulfil their part of bargain so homes can act promptly and effectively on the results.” Speaking on the Sophy Ridge on Sunday show on Sky News, Peter Openshaw, professor of experimental medicine at Imperial College London, said action must be taken quickly to prevent Covid cases rising exponentially in the UK. “We must act fast, because it is so much harder to get this sort of thing under control if you delay – even a few days is potentially going to be quite dangerous now at this particular moment,” he said. Openshaw said he agreed with the former government chief scientific adviser, Prof Sir Mark Walport, that the UK was on the edge of losing control of the virus, adding the spread into care homes was of concern. “We know that these are very vulnerable pockets. It is not just in the younger people, it is starting to appear in people who are more vulnerable. And that inevitably is going to be followed by hospitalisations and deaths,” he said. A DHSC spokeswoman said: “Throughout our coronavirus response we have been doing everything we can to ensure all staff and residents in care homes are protected. “We are testing all residents and staff, have provided 200m items of PPE and ring-fenced £600m to prevent infections in care homes, with a further £3.7bn available to councils to address pressures caused by the pandemic, including in adult social care. “There is a high demand for tests and our laboratories continue to turn test results around as quickly as possible and we plan to rapidly expand it in the coming weeks as well as bringing in new technology to process tests faster.” The UK’s testing system has been heavily criticised in recent weeks as a growing number of people have reported being advised to travel hundreds of miles to be tested. As were starting to spread in care homes, the promised weekly testing of staff and monthly testing of residents was not working as planned. At one care home in Cheshire, staff tests took a week to be processed and when they came back, three workers were positive, the Guardian reported last week. They had continued working pending results and a resident subsequently tested positive. The manager described operating under the system as “like Russian roulette”. At the start of the week, testing officials at the DHSC were forced to apologise to care operators for delays. They said by email: “We are aware that recently some care homes have experienced coronavirus test results taking longer than 72 hours, and that in the last week, there has been an increase in the number of unclear/void results … we apologise unreservedly to all care homes who have been affected for the upset these issues have caused you, your residents and your staff.” The government had promised weekly testing for care homes by the end of July, but moved the target to 7 September, citing “unexpected delays”. The government recently announced a project for mass testing, dubbed “Operation Moonshot”, in which 10 million people would be tested every day. However, it has come in for criticism: among other difficulties, the technology for such a plan does not yet exist. In a bid to reduce spread of the virus, new restrictions have been announced around the UK: from Monday, gatherings in England will be limited to groups of six. Meanwhile, the Sunday Telegraph has reported that people at higher risk from Covid-19 could once again be asked to shield. Openshaw warned people should not be out “trying to party as hard as we can” before the rules come into force. While some details of the “rule of six” may seem irrational, he said, such regulations are necessary: “If we don’t do this now we are going to be right back in hard lockdown in short order.”