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Explainer: What is the current situation with Covid-19 in nursing homes in Ireland?

NPHET raised concerns over outbreaks in nursing homes last weekend.

Image: Shutterstock/Dmytro Zinkevych

Updated Oct 7th 2020, 10:53 PM

IN RECENT DAYS, reports have emerged of outbreaks of Covid-19 in nursing homes in counties Laois and Donegal.

This comes after Chief Medical Officer Dr Tony Holohan on Sunday wrote to the government recommending the entire country move to Level 5. 

It was reported that the letter stated the National Public Health Emergency Team (NPHET) is concerned about the rising case numbers among those aged over 65 and about 31 open outbreaks in nursing homes. The CMO reported there had been seven outbreaks reported in the last week.

It is understood that at the NPHET meeting with government on Monday, questions were raised about the mention of the 31 outbreaks. It was pointed out that a nursing home has to be 28-days free of Covid-19 cases before its outbreak can be closed.

The government rejected the advice to implement Level 5 restrictions and instead opted to move the entire country to Level 3. 

Speaking at this evening’s NPHET briefing, Dr Holohan said: “If we do not keep community transmission down we will not be able to keep this out of nursing homes.”

With concerns from NPHET regarding nursing homes and reports of outbreaks in Laois and Donegal, let’s take a look at the current situation. 

Outbreaks

As of midnight on 26 September, according to the Health Protection Surveillance Centre, there were 26 open outbreaks/clusters in nursing homes in Ireland.

A cluster/outbreak is defined as two or more cases of laboratory confirmed Covid-19 infections regardless of symptom status, or one laboratory confirmed Covid-19 case and at least one additional case of illness with symptoms consistent with the virus. 

As noted above, a nursing home has to be 28-days free of Covid-19 cases before its outbreak can be closed. So, in theory, some of those 26 nursing homes could currently be free of Covid-19 cases. 

A number of nursing homes across the country have confirmed over the past two days that they are dealing with significant outbreaks. 

Kilminchy Lodge Nursing Home in Portlaoise, Co Laoise confirmed yesterday that it is dealing with an outbreak involving 31 confirmed cases, 21 of which are among residents and 10 among staff. 

Earlier today, Brindley Manor Nursing Home in Convoy, Co Donegal said there have been 30 confirmed cases of Covid-19 onsite. 

Residents who have tested positive for the virus in both nursing homes are isolating in their rooms.

In his letter to the Minister for Health on Sunday, Dr Holohan expressed concern about the rising number of cases among those aged over 65.

The 14-day incidence in this age group has increased from 6 per 100,000 in early August to 67.3 per 100,000 on 3 October.

Is regular testing being carried out in nursing homes?

Yes, but not as frequently as it had been in early summer. 

Serial testing of staff working in residential care facilities (RCFs), which includes nursing homes, began in June following a request from NPHET. 

The third round of this serial testing – Cycle Three – began on 16 September and testing is being carried out fortnightly. The frequency of testing is determined by NPHET. 

The first round of serial testing – Cycle One – of all staff in RCFs for nursing homes commenced on 24 June and ended on 26 July.

This round involved testing of all staff in RCFs for Covid-19 once a week, for four consecutive weeks. 

During Cycle One, the HSE carried out 99,705 staff tests in 563 nursing homes, of which 132 cases were identified. 

The second round of serial testing – Cycle Two – began on 10 August. 

During this round, staff were offered testing fortnightly, rather than weekly, over four consecutive weeks. 

The HSE carried out 56,675 tests in 562 nursing homes during Cycle Two, of which 111 cases were identified. 

The third round of serial testing – Cycle Three – began on 16 September and remains underway. 

This round involves offering testing to all staff in RCFs every two weeks. 

As of 6 October, some 41,867 tests have been completed in 581 nursing homes, of which 138 cases have been identified so far. 

Are the new outbreaks of concern? 

As mentioned above, Dr Holohan’s letter to the government over the weekend stated that NPHET is concerned about the rising case numbers among those aged over 65 and about the open outbreaks in nursing homes.

On Monday, Tadhg Daly, CEO of Nursing Homes Ireland, told TheJournal.ie that it is “worrying” that there have been seven new outbreaks in nursing homes in the last week, but pointed out that a number of weeks ago the number of open outbreaks was 36.

“Thankfully that means some are coming off that outbreak list,” he said. “But seven new outbreaks is a worrying development and the fact that the CMO mentioned that in his letter to the government is also concerning.

We know there is a direct correlation between high incidence in the community and transmission in nursing homes – that’s the bottom line. The government has to get it under control in the community in order to keep it out of nursing homes.

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Daly said the situation for nursing homes is more secure than it was at the beginning of the pandemic, with better access to personal protective equipment and serial testing, which helps to pick up asymptomatic cases among staff.

When asked by TheJournal.ie today whether serial testing should return to being carried out on a weekly basis, Daly said: “We would be informed by public health on that but I think it’s something we need to monitor on an ongoing basis.” 

What’s next?

Speaking in the Dáil today, Sinn Féin leader Mary Lou McDonald quizzed Taoiseach Micheál Martin on whether Ireland’s nursing homes are “prepared now for this second wave of Covid-19″. 

“What is the plan to get this right and, above all, what is the plan to protect residents and staff in our nursing homes?” McDonald asked. 

Responding, Martin acknowledged that as Covid-19 cases rise in the community, “there will obviously be a consequential danger in terms of the virus spreading into nursing homes”.

The Taoiseach confirmed that “testing will continue with the same intensity”. 

He added that NPHET has been asked to appear before the Covid Oireachtas Committee again, which will meet on Friday, to discuss “any additional measures we need to take to protect the nursing homes”. 

“We are very concerned about them. Obviously, they are a clear priority for us all,” Martin said. 

With reporting by Michelle Hennessy 

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