Expert group on Covid-19 in nursing homes says mistakes must not be repeated

The head of an expert group which examined how most coronavirus deaths occurred in nursing homes has said she hopes the early mistakes of the pandemic will not be repeated.

Prof Cecily Kelleher, chair of the Covid-19 expert panel on nursing homes, told the Oireachtas Covid-19 committee at an appearance on Wednesday that there was a “big issue” around the lack of preparedness for the rapid spread of the virus through care homes in March.

She said nursing homes were now more prepared with adequate supplies of personal protective equipment (PPE) but it was crucial homes were prepared fully for the next stage of the pandemic.

“I sincerely hope that the lessons will be learned and we will not see a recurrence of what we saw already,” Prof Kelleher told TDs and Senators on the committee.

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She said a difference with the response between now and at the peak of the pandemic was that current “rolling testing” was picking up many infections in nursing homes.

Another member of the panel, geriatrician Prof Cillian Twomey, said the State needed to “crank up” testing and the rapid turnaround of results to be ready for the next phase.

Prof Kelleher said the fatality rate in nursing homes, accounting for 56 per cent of more than 1,780 deaths, was a “very high rate” but not out of line with rates in other countries.

“It is a deeply regrettable rate but our international review has shown that across the globe we are learning this lesson in relation to this setting. It wasn’t just in Ireland,” she said.

She was confident that if the nursing home expert group’s 86 recommendations could be introduced quickly, it would help prevent a repeat of infections and deaths in nursing homes.

“We are trying to do everything we can to keep it out because that is what we must do to be vigilant and to protect people. We need to roll out what we have set out in this report in order to have as much confidence as we possibly can,” she said.

The expert panel appeared before the committee as new State health statistics showed four new clusters of Covid-19 infections have been detected in nursing homes in the past week.

This brings to 283 the number of clusters in nursing homes during the pandemic to date. Some 41 clusters in care homes remain ‘open’. The homes must have no infections for 28 days before clusters can be deemed ‘closed’.

Prof Twomey told the Oireachtas committee the practice of hardworking, foreign staff in inferior working conditions, assigned by agencies to multiple nursing homes and sharing accommodation, was a “really serious issue” and put care homes in “a dangerous position” - a practice the expert group has recommended should stop.

He said the conditions of employment of some staff in some nursing homes was reported as “a major concern” to the expert group.

Prof Kelleher described there being a “huge crisis” in staffing at the start of the pandemic.

Prof Twomey said nursing home staff were “unbelievable” in their work during the pandemic and he noted in particular that one staff member told him she felt “very guilty” for having to take sick leave after contracting Covid-19 as it left her colleagues understaffed.

The expert panel “cannot overstate” how “hugely devastating” the peak period of deaths in nursing homes in March and April was on residents and their families, but also on staff, he said.

“If there is any incentive we require to concentrate on implementing these [recommendations], it should be a reminder that we cannot go back there again,” he said.

Prof Kelleher said four issues drove the vulnerability in the nursing home sector: the seriousness of disease; the frailty and vulnerability of the older population; a congregated setting that was very risky for the transmission of the virus, and also a lack of preparedness.

Meanwhile, the Department of Health has said there is great concern that heightened community transmission will “bring further unwitting transmission of Covid-19 into nursing homes impacting on those most vulnerable to the virus.

Department of Health assistant secretary Kathleen MacLellan told the Oireachtas committee that nursing homes had not been unaffected by the current increases in the number of Covid-19 cases.

She said there had been four new clusters in nursing homes in the 14 days to September 10th and there were 39 remaining as open clusters in nursing homes

The committee was also told that €39 million has been allocated by the State in financial supports to nursing homes during the pandemic, the majority of which went on staffing costs. The HSE also provided personal protective equipment to the value of about €70 million.

HSE clinical lead for older people Dr Siobhan Kennelly told the committee there was little evidence that visitors brought the coronavirus into nursing homes.

She said much more of the risk was probably through staff transmission.

She said that because of the early lockdown of nursing homes in Ireland, the issue had not really been tested here. However,she said the international experience would be that “visitors in themselves, once the appropriate precautions were applied, constituted less of a risk than was the concern at the start of the pandemic.”

HSE national director David Walsh said the executive was committed to implementing the recommendations of the expert group report on nursing homes.