Coronavirus: Timeline of a pending ‘catastrophe’ in nursing homes

Six days before the first confirmed coronavirus death in the country, the national body representing private and voluntary nursing homes announced it was moving to stop all non-essential visits.

Nursing Homes Ireland (NHI) represents more than 400 private and voluntary nursing homes, which account for about 80 per cent of homes in the State.

The restrictions, which were announced on March 6th, were being imposed "in the best interests of residents and staff", NHI chief executive Tadhg Daly said.

Given the potential severity of the virus among the elderly and those with underlying health conditions, staff in the sector were fearful of the possible impact on vulnerable residents.

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However, when asked on March 10th about the visiting restrictions, the chief medical officer, Dr Tony Holohan, said they should be lifted because they were premature and impacted on residents' social interactions.

On March 25th, the Health Service Executive (HSE) issued guidance to all nursing homes on how to respond to suspected and confirmed coronavirus cases.

The advice recommended residents with Covid-19 should be kept in the facility and transferred to hospital only where it would “confer additional benefit”.

Where residents were in close contact with a positive case they should “avoid communal areas” for 14 days, and be checked at least twice a day to see if they developed any symptoms, the advice said.

Healthcare workers were advised they were not required to wear personal protective equipment (PPE) if they could avoid physical contact and stay at least 1m from the patient.

Staff providing direct care should wear gloves and an apron, but only surgical masks if residents were coughing and sneezing, the advice said.

Where staff were treating a confirmed Covid-19 case, they were advised to wear a gown, mask, gloves and eye protection if there was a risk “of splashing of blood or body fluids”.

Updated guidance

The Health Protection Surveillance Centre (HPSC) circulated updated guidance on March 30th to all residential care facilities.

By this point there were 2,901 known coronavirus cases in the State and 54 people had died.

The HPSC guidance said testing for Covid-19 among contacts of a positive case was still “not appropriate unless they develop symptoms of infection”.

Staff were advised to check on close contacts at least four times a day for signs of any symptoms. When dealing with suspected or confirmed cases, staff were advised to wear gloves, eye protection, a surgical face mask, and a long-sleeved disposable gown.

If staff were caring for a patient where the task was “unlikely to provide opportunities for the transfer of virus”, they could use a disposable apron rather than a gown, the advice stated.

As clusters of the virus continued to break out in nursing homes, the Government faced increasing criticism over the lack of supports and long wait times for testing of patients and staff.

On April 4th, Minister for Health Simon Harris announced a €72 million support package which included twice-daily staff screening, priority testing and financial support for affected nursing homes.

On Thursday, professor of infectious diseases at the Mater and Rotunda hospitals Jack Lambert warned the spread of Covid-19 in nursing homes was "a catastrophe in the making".

On Friday, the HSE announced it would provide testing for all staff and residents in any nursing home that had a confirmed case – a significant scaling up of testing. Latest figures show 196 nursing homes have coronavirus outbreaks of one case or more.