CONCERNS HAVE BEEN raised about the lack of regular Covid-19 testing taking place in some residential settings such as nursing homes.

Some 360 clusters of Covid-19 have been identified in residential care settings around the country, including over 200 in nursing homes (35% of all outbreaks), to date.

More than 20,000 cases of the virus have been confirmed in Ireland, and some 1,200 people have died. About 700 of the deaths are associated with long-term residential facilities including 600 people dying in nursing homes.

Testing has been ramped up in nursing homes for staff and residents in the last two weeks, but relatives of some residents say not enough is being done.

The sister of a man who lives in a nursing home in Meath, where a number of residents and several staff members have tested positive for Covid-19, is concerned that regular testing will not take place at the facility.

Her brother recently tested negative for the virus, but she wants him to be tested regularly as he still faces a high risk of contracting the virus.

Mary* said that when she asked management at the centre if her brother could be tested on a weekly basis, she was told no.

Mary said employees at the centre are “doing their best in a difficult situation”, but she doesn’t understand why residents are not being tested on a regular basis.

My brother may have tested negative last week but could be positive this week.

“The families of the residents are entitled to know if their family member has the virus, and the family should be entitled to have the authority to ask for further testing as long as the virus is in the nursing home,” she said.

Mary noted that some of the residents and staff members who tested positive for Covid-19 were asymptomatic.

Her brother is aged in his 50s and has been living in the nursing home for several years, following a serious car accident in which he sustained a head injury.

She said, in general, her brother receives “absolutely brilliant” care, but the lack of regular testing at the centre is “distressing” for her and other residents’ loved ones.

Mary said she talks to her brother three times a week via Skype and he is “quite happy with life” in general. He is aware a virus is spreading and “is concerned about it”, but she doesn’t want him to know the extent of the outbreak in centre.

“He doesn’t know someone on the same floor as him has it, or that some of the carers have it,” she added.

The nursing home in question said it could not comment on individual cases but said employees “continue to closely follow all HSE and WHO guidelines, and are caring for and protecting our residents and staff to the best of our ability”.

“We would particularly like to thank all of our dedicated staff for their unstinting care and commitment to our residents, and we would also like to thank our residents’ family members for their support and understanding, particularly in relation to visiting restrictions during the Covid-19 crisis,” a spokesperson said.

Testing regardless of symptoms

Speaking at the Department of Health’s daily press briefing on Wednesday, Dr Siobhán Ní Bhriain, the HSE’s National Clinical Advisor, said a sweep of testing would “absolutely” take place in a nursing home where there were a number of confirmed Covid-19 cases, regardless of whether or not people were displaying symptoms.

Dr Tony Holohan, the Department of Health’s Chief Medical Officer, added that such a decision would “be made by an individual public health team in response to an individual incident”.

Ní Bhriain noted that “the index of suspicion” in relation to the virus in the nursing home sector is “very, very high”, adding: “If you’ve any index, you will refer for testing.”

“My colleagues in geriatric medicine, who are putting in a huge amount of work on this, are continuing to update their educational input on a daily basis,” she said.

Ní Bhriain added that if there is the “slightest” indication the virus is present, the official advice is to arrange for testing and ensure the residents are safe.

Holohan said as soon as testing capacity was improved, the next priority was to ensure enough testing was being done in nursing homes and other residential care facilities.

“That was the next priority because there was much more infection there, frankly, than was in the general population, and that in public health terms had to come ahead in priority of broadening a case definition focused on the community. And so that’s why that sequence arose,” Holohan said. 

He noted that where there are clusters in residential care facilities, all residents and staff are tested.

‘Real challenges’ 

Speaking to TheJournal.ie’s The Explainer podcast this week, Dr Cillian de Gascun, Director of the National Virus Reference Laboratory, said he is not aware if a formal decision on repeat testing in nursing homes has been made yet, but said the situation will be “kept under review”. 

“Certainly the nursing homes that have been affected have faced real challenges.

It’s possible that testing in that setting may not be the priority for them. It may be around staffing, it may be around personal protective equipment and those types of issues.

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“However, in the setting of nursing homes that have not been affected by Covid-19, there is certainly a good argument to be made for having a more regular screening process in those centres to ensure that we can protect them and prevent the virus entering into the nursing homes.

“So whether that comes down to the screening of healthcare workers on arrival at the facility, or whether it’s a more formal testing strategy on a weekly or fortnightly basis, as I said, I’m not aware that a formal decision has been made in that area yet.”

Significant risks

Earlier this week it emerged that the HSE has ranked 75 long-term residential facilities, such as nursing homes and mental health residential care centres, in the ‘red’ zone and at ‘significant risk’ due to the pandemic.

As part of its monitoring process around clusters and outbreaks in long-term care facilities, the national health service has established a green, amber and red ranking system.

Within this, it has deemed that 75 facilities – around 18% – are in the red zone and at ‘significant risk’ due to Covid-19, while 129 – or around 30% of those – are in the ‘amber’ zone, meaning they continue to require intervention and enhance supports to continue operating safely.

The remaining 221 facilities are in the ‘green’ zone, meaning that some intervention was needed but they are operating in a stable manner at present.

Nursing Homes Ireland recently said that urgent staffing redeployment within the health service is required to support staffing levels in nursing homes.

In a statement, the organisation said “a huge crisis is now emerging”, adding that mass Covid-19 testing in nursing homes is “likely to exacerbate” the situation.

“The challenge is likely to escalate as mass testing is undertaken within nursing homes across Ireland and the number of staff unavailable increases,” Tadhg Daly, NHI CEO, said.

“In some instances, large numbers of nursing home staff are becoming unavailable and this is placing a huge strain upon nursing homes and the staff available to them. This is about care of our older people during a national health emergency.

“We simply cannot get this wrong.”

*Mary’s name has been changed to protect her brother’s identity.