Nursing homes risk 'was low' if guidance was adhered to - report

A Department of Health report examining the spread of Covid-19 through Ireland's nursing homes says the risk of the disease getting in "would have been low", if guidance which required that patients test negative before being moved, and other measures, had been adhered to.

The report, seen by Prime Time, refers to HSE guidance issued on 10 March on the transfer of people from hospitals to nursing homes. This guidance was later changed.

The 10 March guidance included a requirement that patients with symptoms of the disease in hospitals where Covid-19 had been found test negative before being moved to nursing homes.

The requirement was not included in updated guidance issued on 30 March. 

Instead, the update said, accepting patients being transferred from hospitals was a "necessary risk in the context of maintaining access to a critical service".

Adding, the advice of a doctor should be sought for "all transfers or admissions with current fever or symptoms of acute respiratory tract infection... and subsequent management determined by the outcome of the assessment".

The Department of Health report says of the 10 March guidance: "If the protocols set out in the guidance were adhered to, along with the appropriate use of Infection Prevention Control processes within the facilities, the risk of transfer to and subsequent spread of Covod-19 to Long Term Residential Care Facilities would have been low."

The report does not comment on later versions of the guidance.

Asked why protocols were changed to remove the requirement for testing of patients with symptoms prior to transfer, the HSE said it changed the policy to one which assumed every patient being transferred might be infected with the virus. 

"The requirement for testing was replaced by a requirement to isolate all people transferred to nursing homes in a single room for a monitoring period of 14 days", it said in a statement.

"This was done on the basis that a single test that failed to detect the virus did not give sufficient assurance that the person was not infected. It was decided to manage the transfer of patients without testing because testing would not change the requirement for isolation. This is because everyone transferred would be treated as if they might be incubating infection and testing might delay transfer, contrary to the patients' interests."

It says a further update to the guidance is currently being finalised, in which testing will be reinstated "as there is a sense from discussion with service providers that having the test result is valued". 

The National Public Health Emergency Team (NPHET) is understood to have examined the Department of Health report last week.

887 people, or 55%, of people who have died in Ireland due to Covid-19 were residents of nursing homes. There have been approximately 250 clusters in such homes.

On Tuesday, the Chief Medical Officer, Dr Tony Holohan, was asked about nursing homes and the policies implemented over the course of the crisis. He said "we are not going to say in any way we got everything absolutely right, we're all learning."

And that "there is simply no way of protecting nursing homes or any other institutional setting if you don't control the spread of this infection in the community in general".

In recent weeks, members of NPHET and senior officials in the Health Service Executive have been asked repeatedly for their views on how the virus got into nursing homes. 

The Department of Health report says "an emerging picture from the accounts from other jurisdictions are that the virus is likely to have been carried unwittingly into facilities by asymptomatic or very mildly symptomatic patients or staff, through no fault of either".

"It remains a major challenge and it will inform our planning as to how best to prevent these importations during the coming months," the report says, "reducing the amount of virus in the community will help".

Last week, CEO of the HSE, Paul Reid, told the Oireachtas Special Committee on Covid-19 Response that in his view "there was no evidence whatsoever" that patients transferred from hospitals unknowingly brought the virus into nursing homes.