Michael Clifford: Nursing homes needed much quicker response during Covid-19

The unfolding tragedy in the State’s nursing homes was foretold writes Michael Clifford.
Michael Clifford: Nursing homes needed much quicker response during Covid-19
Staff numbers have been depleted through infections and the requirements of self-isolation. File picture.

The unfolding tragedy in the State’s nursing homes was foretold. There was always potential for the Covid-19 virus to spread like wildfire through a sector of the population which are both vulnerable and living in close proximity to each other.

A crystal ball was not required to project what could happen. The worst-case scenario had already occurred a month before the virus reached these shores.

The Lifecare Centre is a nursing home in Kirkland, Washington State, in the US. On January 15, Patient Zero, the first known infected case in the US, arrived back in Seattle from visiting family in Wuhan. Four days later, he felt unwell.

The following day, he was confirmed as infected. 60 people he’d had contact with since his return were contacted and told to self-isolate.

Something, however, was missed along the way.

The following week, a number of patients in the Lifecare Centre began to feel unwell. Kirkland is about 40km from where Patient Zero lives in Seattle. Firefighters, who substitute for ambulance staff, answered up to 30 calls from the centre in February.

On the 26th that month, priests visited the 120 residents to daub ashes for Ash Wednesday. Three days later, public health officials announced that three residents in the centre had died and 50 people had been infected.

According to the latest figures, up to 30 residents have since died and another 10 fatalities are attributed to the spread of the virus in the home.

The political and health authorities in this State have done a reasonable job in tackling the pandemic. Some commentators have been gushing in their praise, but in reality, leadership has been good but hardly worthy of some of the fawning accolades.

Like everybody else, the leaders have been thrown into this with no chance of rehearsal. Yet the handling of social distancing measures, hospital, and particularly intensive care, admissions and generally flattening the curve have been marked by astute timing and judgement.

Unfortunately, the same cannot be said for the handling of both preparation and response to the pandemic in care settings. There are now over 200 clusters of infections between nursing homes, residential care units, and community hospitals.

Deaths from Covid-19 among residents of these facilities now account for around 45% of total casualties.

One of the earliest cases in this country at the beginning of March was a GP in the west of the country who had worked in a nursing home and other healthcare settings.

Residents and staff in the nursing home did not test positive as a result of contact tracing, but the danger signals should have been flashing wildly at that point.

The authorities were live to the dangers that staff posed in hospital settings, both in terms of infection and spreading, but the same consideration does not appear to have attached to what could occur in care homes.

Apart from medical personnel, care assistants and catering and cleaning personnel were moving between various homes. Some staff in residential homes are living in direct provision centres, where dangers are equally prevalent.

On March 4, Nursing Homes Ireland announced a blanket ban on visitors to narrow the possibilities of infection. Six days later, the chief medical officer Tony Holohan said such a ban was “unnecessary” at that point.

In retrospect, this was an extremely unusual call from Mr Holohan.

The logic behind his comments was the same logic that applied to the overall “lockdown” measures for the general populace.

He and the National Public Health Emergency Team didn’t want to impose restrictions too early, in an effort to avoid fatigue or cabin fever setting in before it was appropriate to lift the restrictions.

But nursing and residential settings were always different. Certainly, residents’ mental health and requirements for socialisation had to be considered, but the dangers lurking from infection were surely far greater at that time.

Three days after Mr Holohan made that announcement, the fuller restrictions were announced.

Testing is another area where questions arise.

The criteria for testing has been changed twice, first to make it more widely available, and then on March 25, more restrictive in response to capacity issues.

There is a case to be made that the specific issues around care settings should have ensured that a separate testing regime was introduced.

On Monday last, Mr Holohan stated that the health authorities were now looking at sample testing in nursing home settings that haven’t yet identified any clusters.

“As we’ve said all along, one of the things we want to try to do in as much as we can is prevent this infection getting into nursing homes that haven’t got any identified cases,” he said.

Why, then, was this not proactively tackled much earlier, before arriving at the current position where there are now over 150 clusters in nursing homes?

Further delay in recognising the particular issues in nursing homes resulted in full guidelines from the HSE only being issued on April 10.

Staffing is another issue. Staff numbers have been depleted through infections and the requirements of self-isolation.

Many nursing homes are now operating with a skeleton staff at a time when they should have excess. The staff are being forced to work in conditions in which personal protective equipment is at a premium.

On RTÉ on Tuesday, the chief executive of Nursing Homes Ireland described the supply of PPE in the sector as “patchy”.

In the Irish Examiner yesterday, Áine Kenny interviewed staff who are at their wits’ end, including one person who stated the following:

“We have been begging for PPE for the last three weeks. Every single mask and gown was counted. We were left short constantly.

“Masks were rationed to three per day. We needed respiratory masks, not surgical masks.”

That’s a pretty damning indictment.

The flow of information is the other notable shortcoming.

There is a suspicion that fatalities attributed to the virus in residential care settings is inaccurate.

Families have claimed not to have been kept informed of developments. The lack of solid information has opened up avenues of fear and rumour, which is entirely natural when the people at the centre of the issue are at a vulnerable stage of life.

A lot has been done to tackle this pandemic, but as far as residential settings are concerned, there is a lot more left to do.

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