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AS IRELAND LOOKS forward to living beyond – or alongside – Covid-19, a major fault line has emerged over one aspect of the public health advice – the two-metre physical distancing rule.
Ministers, opposition politicians, business owners and health officials have all been taking to the airwaves to make points and counterpoints about whether the two-metre distance – a tenet of health advice since the crisis emerged – is sustainable into the future.
Yesterday morning, Minister for Education Joe McHugh said that with the two-metre rule in place “it’s going to look very very difficult to see all students back in September”.
“Even with a one-metre rule,” he added, “it’s very difficult to see all students back in September. So we have to look at the evidence now that the health officials are gathering.”
Fianna Fáil’s justice spokesperson Jim O’Callaghan yesterday morning called on the government to back a decrease to a one-metre physical distancing rule.
“I think we need to recognize that we are being exceptionally cautious in the advice that we’re following here,” he said. “Government must take other factors into account.”
Health officials, however, have stressed that for now the two-metre distance is staying. On Wednesday, Chief Medical Officer Tony Holohan told Cabinet ministers that he doesn’t intend to advise that the two-metre guidance be reduced.
Holohan said that he believes the current advice “represents a reasonable interpretation of the evidence and a precautionary approach to its application”.
The decision on whether to reduce the physical distancing requirement is essentially political and can only be made by the government. But it will also mean balancing risk – a decision made harder by how little we actually know about coronavirus.
Differences
The two-metre guidance, displayed prominently on public signs and in government messaging across Ireland, is not universally applied. Both Singapore and Hong Kong advise one metre, while in Australia the guidance is 1.5m.
In the US, 1.8m is the golden rule, but the UK and New Zealand have also both opted for two metres.
Yesterday evening, France announced that bars and restaurants could begin opening from 2 June – with a distance of one metre required between tables.
As one academic paper has noted:
All governments state that their advice is based on the scientific evidence underpinning the control of pandemics. So how do different countries come up with different recommendations and do the public know what these distances actually look like?
Global health organisations have also produced differing interpretations of physical distancing guidelines.
The World Health Organization, for one, defines physical distancing as keeping a distance of “at least 1m from each other”.
In contrast, the European Centre for Disease Control and Prevention (ECDC), however, still advises two metres.
The WHO’s special envoy on Covid-19, David Nabarro, has said that risk can still be reduced if the physical distance is reduced to one metre, but stressed that two metres was preferable to largely eliminate transmission.
Two or one?
This is where the debate becomes more complex. Dr Kim Roberts, leader of the Virology research group in Trinity College Dublin, says that it would be wrong to portray either one-metre or two-metre distances as competing public health choices.
“In terms of the one metre-two metre rule, it’s all about the activities you’re doing,” she stresses. “It’s about thinking about the situation they’re in at the moment.”
Keeping a two-metre distance from other people outside your household is more likely to reduce transmission than keeping one-metre away. But, Roberts says, having a quick chat with someone standing one-metre away is relatively safe.
That changes if someone is shouting, sneezing or coughing – in that case, coronavirus-carrying droplets travel further, beyond any one-metre limit.
That means looking exactly at the risks involved – and navigating difficult decisions. Sitting inside a restaurant for a few hours is likely to be rendered much riskier if the physical distance is only one metre, while the same could be said of working in an office setting.
“Rules that are very direct and narrow are not helpful. Because the risk changes from one activity to another,” she said.
Another problem is simply that we don’t fully understand the virus we’re trying to suppress. Roberts stresses that we don’t fully know how influenza is transmitted in droplets and aerosols, let alone Covid-19.
Studies are still being carried out to determine how exactly the virus is spread – how far droplets travel, how long it stays on surfaces and how easy it is to pick up. But, as things stand, all that is limited – hence the stress on caution from health officials.
“We don’t have the data yet,” Roberts says.
Schools
As Minister for Education Joe McHugh suggested, physical distancing makes returning to schools particularly difficult.
In Denmark, a return of students to school was accompanied by two-metre social distancing, before being reduced to one metre. It also saw classes split up, more lessons outdoors and a strict system of hand-washing.
And while one-metre has been described as safe in many circumstances, Danish officials have not mandated it as safe in all scenarios – at least two metres of physical distance is still needed in some scenarios where respiratory droplets are more likely to spread.
This includes lecturing – a teacher in a school, speaking loudly across a classroom to a roomful of a pupils would likely need to be more than two metres away from children.
It may take a long time before the full impact of these decisions are fully understood. In the meantime, Ireland and other countries around the world will continue trying to put together a system of public health guidance that can sustain both daily life and prevent dangerous spikes in hospitalisations.
The contingent nature of staying safe from a highly transmissible virus makes it difficult to put down absolute, rigid rules – no one piece of guidance is able to guarantee what’s safe in every scenario.
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How are we still seeing these large scale outbreaks in nursing homes if we have proper testing and PPE in place. I know it is almost impossible to stop cases getting in but they should be detected long before cases climb to 30 in a single nursung home and action taken. That’s a disgrace.
@Enda Flaherty: if I had to guess (and all we can do is guess) is that the staff are bringing it in. Possibly their kids are bringing it home from school or college.
@Enda Flaherty: I was wondering about the PPE. I hope all staff are wearing it constantly. Despite what McConkey said the other night when debating Feeley, it should be worn in all clinical settings. McConkey stated that a positive test would be needed before it’s recommended
@Enda Flaherty: PPE, testing and tracing can only go so far. With the levels of the virus in the wild growing significantly, then it will get into places we don’t want it to get into.
Is we want to avoid this, we all need to follow the guidelines.
It’s all of our responsibility.
@Fozz: As I said I understand one case getting in. That’s going to happen. Over 30 cases in a single nursing home though suggests a bigger issue. The 30 cases didn’t enter the home in one go. It spread in the home. And that is where testing becomes vital. And PPE and other safety measures. We shouldn’t see it at this stage. 1 case in a nursing home and public health should be the place every single day.
@Peter Cavey: far fetched
kids?, your surmising they have kids, its more likely one person brought it in, visitor or staff, and it spread from within
@Enda Flaherty: the staff via their families or via other patients . the type of work in a care home requires such close proximity and maybe there is a lack of good ventilation. It’s happening all over Europe. One positive point is that majority of residents are recovering. There’s not too much that can be done to prevent it, it sadly appears. We can screen everyday , design circuits for staff and patients, split staff by groups , transfer and separate all residents into different units but it still spreads easily in care home & residential care settings. We are having the same issue in Portugal again since late August. The same clusters in Ireland started increasing in late August as well as per the cluster / outbreak reports.
@Enda Flaherty: Long incubation times and largely asymptomatic cases mean it can spread silently for a long time before a case is detected. The schools comment is just wild speculation
@Kavsie: or a patient transferred into the place from another without being tested, or coming back from hospital etc.
@Kavsie: We know now that one positive resident was transferred from the Portlaoise one to another one. This is happening all over the country all the time and has been for years (patients/residents being moved around) so it stands to reason it’s happened more than one (positive case being moved to another place).
@Enda Flaherty: Proper testing?
Tony was right. It’s rampant in communities now and staff are bringing it in unknowingly. Over half of all covid deaths so far have been from care settings. We should have gone to at least level 4. Too many not complying to level 3 or even the simple stuff stuff like wearing a smask properly now.
@Thomas Quinn: Some people can’t even spell “mask” properly
@Thomas Quinn: the reason half the deaths were in nursing homes is that the HSE dumped people out of hospitals into the nursing homes without testing them and the CMO told them in early March they were safe and no need to close.
@Aidan O’ Neill: There are over 120 cases in care homes now and none have been dumped out of hospitals this time around though.
@Aidan O’ Neill: and even when they did test positive they were left there and not moved to hospital for proper care..nursing homes don’t have the same facilities as hospitals
@SquintEastwood: why move a frail person to a hospital when they can’t be treated?
Ventilation of the elderly is cruel and unlikely to help.
@SquintEastwood: but all of that has nothing to do with these current outbreaks. These are privately run facilities where staff and/or visitors are bringing the virus in.
@Fozz: most elderly persons don’t need ventilation. Many do generally need hydration and antiviral therapies that are best given in a hospital general ward with medical supervision if necessary.
@Fozz: so in your opinion you should try nothing and just leave them and watch them suffer until the end
@GrumpyAulFella: did I say it had anything to do with outbreaks? What did I reply too ?
So why can government order privately run businesses to shut down or to do something but not privately run nursing homes ?
They were able to order them to allow visitors back in after privately run care homes stopped visitors to try keep virus out
@SquintEastwood: I’ll give you a hint. Those privately run nursing homes contain elderly and often sick patients. Where do you propose that they are put, the local Maldron?
@GrumpyAulFella: whats the hint ?
Are you are saying feck them.
Did public hospitals get overrun or were private hospitals overrun or even used to their capacity after paying millions for the use of them.
No the elderly were left together with other infectious elderly and staff.
Infected people should have been separated from others that were at risk
@SquintEastwood: these are privately run facilities requiring specialist geriatric care. I have two relatives in a care home. You don’t just shut them down and taxi the residents to the Mater.
@SquintEastwood: Shut down the nursing homes? Put them in hospitals? As if that were safer. This is not even what medical specialists recommend. For many elderly people taking them from nursing homes would be highly traumatic. Many can be treated in that environment. If they need further treatment they can be moved to a hospital. Some won’t be moved because they are too old and frail and would not survive intubation. It is not possible to completely stop a virus entering a nursing home. The normal flu kills elderly patients in nursing homes as well. As do other illnesses. Please let’s maintain a sense of proportion. With Covid large numbers of people can be infected before a carrier is even aware that they are ill, especially indoors.
@GrumpyAulFella: you should stop adding extra words when you’re reading something..did I say shut anything down ? No
Moving infected people away from healthy people would probably help spreading infections..geriatric specialist also work In hospitals..if it was my relatives I would rather a little disruption to their lives than probable death but everyone has their own opinion
If where you’re relatives are gets the virus will you be happy if it is let spread around the whole premises without trying to separate sick from healthy..I really hope you rethink what care should be given to elderly and sick
@John R: who mentioned shutting down nursing homes?
@Aidan O’ Neill: Closing nursing homes was never suggested, stopping visitors is what you’re referring to. He was right though, visitors weren’t the biggest problem, it was hospitals sending covid positive patients back to nursing homes, patients being moved from home to home (short-stay/long-stay beds issue) and staff going from place to place as well (agency staff).
Agency workers moving between different residential settings is a major problem and is one of the reasons for outbreaks.
My Mother is in a nursing home in Wexford and she tested positive yesterday. I haven’t seen her in 8 months due to the fact I live in Dublin.
Hope she,ll be OK!!
@Bernadette Connaughton: please god she will be ok
@Bernadette Connaughton: Same situation, with two parents in a care home.
Terribly stressful the whole thing is. Hope your Mum is kept safe.
@Bernadette Connaughton: Best wishes to your mother. It is very hard that you haven’t been able to see her for so long.
I have a very elderly relative relative who tested positive in a home 4 weeks ago. She is absolutely fine now.
@Mairead Jenkins: That’s great to hear Mairead my mum has been a heavy smoker all her life up until about 10 years ago.
@Charles McCarthy: Thank you Charles let’s Hope’s so!
@Bernadette Connaughton: so tough for you and others in similar situations, the very best wishes for your Mam’s recovery
@Charles McCarthy: agreed , tough for everyone with parents in nursing homes.
Government wasted the summer playing politics instead of 1) increasing ICU units 2) increasing testing 3) increasing tracking of visitors / holiday makers
@trebloc01: holiday makers are not the issue and we have one of the best testing rates in Europe.
And do what with ICU with what unlimited money and staff resources?
Maybe if people just follow the health guidelines then we can lower the level of the virus out there which is what will save people.
But no, easier to blame others than examine our own behaviour.
All the folks looking to “isolate the vulnerable and the rest of us get on with it”, this is what that looks like as isolating people from this virus is next to impossible.
@trebloc01: I think they are adding 500 acute beds currently and 17 ICU beds. Testing has been ramped up to almost 90,000 per week now with more capacity available from Germany to increase that to over 100,000 pw. We are one of the most tested nations in the world at 254K per 1m of population, more than Germany itself.
@Fozz: they are not the issue is correct, but they are part of the issue , like pubs are like schools are. Its many things making it the issue
@trebloc01: I’m down to no mixing with other people. stopped outdoor club activities. back to one shop a week. just like march.
Irresponsible , Nursing homes are not safe for elderly , Take home you Mom or Dad until is not too late .
@margarita: if you can
Are they really going to seed the nursing homes with COVID again, and act like nobody could have foreseen this?
@Alan Wylie: Is it reasonable to expect all staff to live in? How can it be prevented from getting in to the homes when it is spreading so fast in the community? In the case of my relative’s home the outbreak was traced to 3 asymptomatic staff,picked up by serial testing. Luckily that testing meant it was picked up quickly and while there was some spread there were no seriously ill residents or deaths.
Just read that both the Donegal and the laois nursing homes are owned by the same company.
@Anne Marie Devlin: That’s mad.
@Anne Marie Devlin: yes and owners need to take responsibility. It’s easy to point the finger at the state and say take the blame and clean up our mess for us. It’s not as though these homes aren’t massively profitable and need funding.
Poor people.
am I reading this right??
there have been 37 outbrreaks in nursing homes over th past weeks
no mention of deaths, why is that not picked up on
@Kavsie: I don’t think they have to die to be severely impacted by the virus
@Thomas O’ Donnell: well, if I get it and i don’t die I wouldnt call that severely impacted
or, are you refering to the impact on the owners or what
@Kavsie: Go and educate yourself about Long COVID, then decide how big a win not dying is.
@Mark: people acting like Long COVID is a definite thing that happens to everyone out of the 4 people I know that had covid and then me also not one of us have it. It’s considered quite rare currently, currently being the important word.
@Kavsie: if your lung capacity was halved as a result of your Covid battle and/or your heart was weakened as a result, liver damaged due to treatments, muscle wasted due to steroid dosages then yes this would be severely impacted.
We need a full lockdown very soon as per nephets advice. I would lockdown fully for 4 weeks. Guarantee businesses they will be open from December 1 to January 10th. Incentivise bookings during the lockdown. This will only work if we also lock down our ports and airports because its pointless locking down the country and allowing virus to arrive from other countries.
So a full lockdown must include all of our ports and airports. No travel allowed.
Do not ask the people to lockdown via level 5 or 5.5 without locking down our ports and places of entry. It would be highly insulting to the Irish people to say we are an open economy or that we have freedom of movement in the EU. This is a pandemic so we live by different rules. We are trying to crush a virus.
If we do this I could guarantee a covid free island after 4 weeks of lockdown assuming NI mirrors this lockdown.
@Imagine !: and after 4 weeks??? You won’t be at zero just like we weren’t after last lockdown so what happens after 4 weeks? Areyou going to close off Ireland for years??? Nobody can see family. Nobody can travel for work. Nobody can go home. Nobody can come home to Ireland.
If we were a sane country, the way the nursing homes have been thrown to the wolves would ensure that the people currently running things never would again.
More people will contract the virus and unfortunately people will die from it as well, however the economy needs to be kept alive and people’s well being must come first. I’m certain that a single parent of 2 would rather get the virus than lose their job and livelihood in order to provide for their family. Wear the mask while in public and learn to live with it, have some common sense and respect other people’s personal space and realize that the virus can not be stopped, but depression and suicide can!
Deja vu… Nothing learned by Govt or these Private Home owners by looks of it… Hospitality suffers now as a result
” Tadhg Daly told TheJournal.ie yesterday that it is “worrying” that there have been seven new outbreaks in nursing homes…”
Doesn’t help that covid positive patients are being transferred between nursing homes (one from that private nursing home in Portlaoise to name but one).
Look up short-stay bed / long-term beds. Someone in a short stay waiting for a long term gets moved to another home into a short stay while waiting for a long term to become available in their preferred facility. It’s a difficult situation.
But, Tadhg can be as worried as he wants, basic commonsense would dictate you don’t accept patients or transfer them to another place without testing them first. It’s October. This isn’t new. We’ve had 7 months to learn this. They said they were testing the Portlaoise residents as a matter of routine and this is how 20-odd of them were discovered to be positive. Why didn’t they test the patient they transferred out to another home?
He needs to step up and people need to stop blaming the HSE for the nursing homes they’ve no control over and the HSE nee to deal with the little hitlers they’ve got running the HSE ones.
Surgical Masks should be banned in Care Homes …
What is the difference between a mask and a respirator?
Respirators protect from exposure to airborne particles, which carry the virus. In healthcare, respirators protect from exposure to biological aerosols including viruses and bacteria. Surgical masks are a barrier to splashes, droplets, and spit. Respirators are designed to seal tight to the face of the wearer. N95 or N99 FFP2 or FFP3
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