Coronavirus: The Irish Times view on the cluster effect in nursing homes

Catch up is now required to tackle surge in Covid-19 outbreaks in our nursing homes

‘Years of dealing with influenza shows there is no greater trigger to threaten an older person’s health than a severe viral infection.’ File photograph: John Stillwell/PA Wire

With no area of Irish life escaping the effects of the coronavirus pandemic, the novel infection is especially onerous for older people. And among the most vulnerable are our senior citizens who live in nursing homes.

Although much of the contagion has been by community spread of the virus, public health experts are particularly wary of clusters of cases. According to the Health Protection Surveillance Centre (HPSC) a cluster is three or more cases in an institution within a 72-hour period. Latest figures show there are now 86 clusters in nursing homes across the State, representing a sharp rise in recent days. In addition, 33 outbreaks have occurred in residential institutions and 16 in community hospitals or long-stay units.

The initial focus of the HSE and the Department of Health was to increase community testing and improve the readiness of acute hospitals to deal with a surge of coronavirus-related admissions. It meant there was a relative lack of planning for nursing home and long-stay facilities, with a concerted catch-up effort now required.

The Government has announced a series of measures to assist nursing homes to cope, including financial support of up to €72 million, the appointment of national and regional infection-control teams and temperature screening of staff twice a day. And the Health Information and Quality Authority (Hiqa), in a welcome intervention, opened an infection prevention and control hub to provide support and advice to social care services tackling Covid-19. The hub provides guidance on managing outbreaks and is available to providers and staff of nursing homes, residential centres for people with a disability, special-care units and Tusla children’s residential settings.

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In general, older people’s immune systems are not as responsive as younger patients; older people also tend to have a number of chronic illnesses, any one of which may easily be tripped into an acute manifestation of the disease. Years of dealing with influenza shows there is no greater trigger to threaten an older person’s health than a severe viral infection.

The issue of staffing is also a source of concern for nursing home care. A high turnover of staff leads to a risk of greater coronavirus transmission. The recent proposal to move care assistants from looking after older people in the community to nursing homes is questionable and is unlikely to help reduce the number of clusters.

Staff welfare is key to reducing clustering, especially in nursing homes. Healthcare workers must feel supported as part of a system-wide response to the threat. Adequate personal protective equipment (PPE) and training in the use and disposal of PPE must be provided to those working in nursing homes, along with mental health support. They, and the almost 30,000 residents in nursing homes here, deserve nothing less.