Since its emergence, Covid-19 has spread rapidly, presenting an unprecedented global challenge. Of the more than eight million cases worldwide, some 25,000 have been in Ireland, where, very sadly, as of last night, 1,710 people had lost their lives. The deaths in our nursing homes are the most difficult aspect of our national experience, and each person who has died is deeply mourned by his or her family and all of us collectively. Nursing homes are what more than 30,000 of our citizens call home. Residents of nursing homes are vulnerable because of their age, underlying medical conditions and the extent of their requirement for care involving close physical contact. The National Public Health Emergency Team, NPHET, the Department of Health, the HSE and HIQA placed a focus on supporting older people from the outset of the pandemic.
Responding to Covid-19 involves an all-of-society, public health-led approach, with interruption of virus transmission the main goal. Suppressing the virus in the general population is a key action to limit spread to nursing homes and other settings. In addition, specific protective measures for nursing homes were introduced, including general infection prevention, social distancing, visitor restrictions, cocooning, guidance, training, testing and enhanced HSE supports for providers. The public health advice suggests that the key to protecting patients and staff in nursing home settings is to follow the whole package of infection control. Compliance with infection control standards forms part of the legal responsibilities of persons in charge of nursing homes.
Whereas Ireland recorded its first case of Covid-19 on 29 February, it was not until 16 March that the first case in a nursing home was notified by the Health Protection Surveillance Centre, HPSC. Cases peaked in the general population on 28 March but, around this time, cases in nursing homes commenced their increase in numbers. The peak in nursing homes occurred almost four weeks later on 22 April. Since then, the number of new cases has steadily declined and, today, 50% of all nursing home clusters are closed, meaning they have been Covid free for 28 days or longer. This has been a very challenging time for the residents, staff and families. Some 18% of the 30,000 residents of nursing homes have had a confirmed diagnosis of Covid-19. I want to recognise the enormous efforts of staff in nursing homes throughout the period and others who have supported them. Owing to their efforts, 56% of all nursing homes have remained virus free and the great majority of residents never contracted the virus. This is in the context of a highly infectious virus, much more infectious than influenza, smallpox or measles.
On 29 and 30 March, the Department convened a series of meetings to examine the disease trends in nursing homes, strategies adopted to date and further measures available. The Department, HIQA, the HPSC and the HSE participated. HIQA’s regulatory programmes provide it with a unique knowledge of the nursing home sector. In response to a specific request from the Department, on 30 March HIQA provided details of nursing homes considered potentially at risk, having been found in previous inspections not to have fully met regulations in areas such as infection control and risk management. On the next day, NPHET requested HIQA to risk assess all nursing homes and liaise with nursing homes and the HSE nationally and regionally as necessary. On 3 April, HIQA established an infection prevention and control hub and commenced a Covid-19 daily escalation pathway to the HSE, which has informed the HSE’s targeting of supports to private nursing homes.
Ireland is one of the few countries that have undertaken mass testing in nursing homes. More than 95,900 tests have been completed in long-term care settings. In addition, our commitment to recording all deaths associated with Covid-19 means our figures are more accurate than in many other countries. This was highlighted by Dr. David Nabarro, the WHO’s special envoy who appeared before this committee last week, who stated Ireland’s data were more "honest” than those of many other countries.
Guidance, personal protective equipment, PPE, staffing, accommodation and financial support issues have been addressed as speedily as possible. On 9 March, availability of PPE was provided by the HSE through local teams to private nursing homes. Up-to-date figures show that over the course of the pandemic, PPE of a value of €27 million has been provided. Furthermore, a €72 million temporary support package is in place. In the earliest period, the HSE experienced difficulties in securing supplies and scaling up testing and PPE operations. Such difficulties were experienced in many other health systems, sometimes with less success in overcoming them than the HSE achieved.
Ireland will continue to manage the impact of Covid-19. It has taken the efforts of the entire country to suppress the virus in recent months, and it will take great vigilance on all our parts to prevent a further surge in the future. The priority now is to maintain high-quality prevention measures in all healthcare settings. The recommendations of the Covid-19 nursing home expert panel established by the Minister will be available in the coming weeks to provide further guidance in respect of nursing homes.
The social care sector in many jurisdictions has been hit hard by Covid-19. There is a need for greater integration between health and social care. Hospitals tend to be better endowed with expertise and resources, while the continuum of care for older people is not sufficiently integrated. The HSE's mobilisation of 23 Covid-19 multidisciplinary response teams demonstrates the type of integrated approach needed. Integration of services and structures at the population level is key to the Sláintecare reform programme. It will be extremely beneficial in addressing the growing needs of our ageing population into the future.
