Coronavirus: Wide testing in nursing homes essential, says professor

Everyone in residential nursing homes, including staff, should be tested if Covid-19 is going to be eradicated from them, a consultant geriatrician providing support to the sector has said.

Prof Sean Kennelly, who is based at Tallaght University Hospital, Dublin, is providing support to 14 nursing homes in the southwest of the city, and residential facilities for the intellectually disabled.

Between 45 and 60 per cent of all Covid-related deaths in the UK, Belgium, France, Spain and Italy have been residents of nursing homes, he said.

“I think that is the most important thing to stress. What is happening in Ireland is not an outlier.”

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The fact that the most vulnerable members of the population were gathered together in nursing homes was the key factor, he said. “What we are experiencing, unfortunately, is not unusual.”

He said he and his colleagues are noticing lots of elderly patients who are infected but are not showing the symptoms that were typical in the Chinese outbreak, such as temperature and a cough.

Older people can present with gastrointestinal problems or confusion, and can be infectious for a period before they come to show any significant symptoms.

“Only 30-35 per cent of nursing home residents that have Covid-19 will have a temperature,” he said.

Abrupt decline

On Friday the National Public Health Emergency Team announced that up to 100,000 staff and residents of long-term residential care facilities were going to be urgently tested.

Prof Kennelly said 10 of the 14 nursing homes he is working with have residents with the infection.

“In many of the nursing homes I have been dealing with, an unexpected death has occurred in the preceding week or two.”

It was a feature of the new disease that a person could be very seriously infected but be without symptoms before going into an abrupt decline. This was why comprehensive testing was needed, he said.

There was also an urgent need for a regulatory body to assess those nursing homes where there had been significant outbreaks, to decide if they were suitable places for sending new residents, he said.

“Beds are being freed up in these nursing homes, unfortunately, as a result of people passing away. Most of these are private operators, and they have to be able to pay their staff. The acute hospitals are, as always, under pressure and need to free up beds. We need to find a way of doing that in a safe fashion.”

Unsuitable places

Some nursing homes, through no fault of their own, may no longer be suitable places for elderly residents in the context of Covid-19 because of their physical structure, he said. “There are going to have to be some difficult conversations.”

Prof Kennelly said that the families of residents who were sick or who had died, or who are not able to visit loved ones, had been going through a very traumatic time.

Once the crisis was under control, thought would have to be given to how it might be possible to reopen visiting arrangements.

“Is a life worth living if you spend 18 months away from seeing your family, and run the potential risk of dying without seeing them again at all?”