A Doctor Writes

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Dr Marcus De Brun resigned from the board of the Medical Council, where he was appointed by Health Minister Simon Harris two years ago, over the handling of nursing homes during the coronavirus crisis.

Dear Editor,

There are presently circa 25,000 people residing in Irish Nursing Homes. The vast majority of whom are elderly, have underlying illnesses, and as such are at a significant risk of dying, as a consequence of Covid-19 infection.

The mortality of covid-19 among those over 80 yrs is estimated to be in the region of 7.8%(1). Risk increases in respect of age and underlying medical conditions.

At the Nursing Home that I provide care for, Covid-19 infection has resulted in a 12% mortality.

If we (for the sake of numbers) estimate mortality in Irish nursing homes at 10% and apply this figure to the population of Nursing Home residents (25k) this would give us an expected mortality of somewhere in the region of 2500 deaths within the sector.

At the time of writing, roughly half of the reported deaths to date have occurred within the Nursing Home sector (500), and this leaves us with an expected mortality of some 2000 people, presently residing in Irish Nursing Homes.

The Government has recently begun swab-testing for nursing home residents and staff. This is helpful in the management of cases within the Home as it allows for; isolation of residents, efforts at containment within the home etc.

Testing also provides GP’s with a confirmed diagnosis, and allows GP’s to inform families, attempt to protect staff and put essential measures in place.

However, Government measures MUST amount to more than simply providing a test and secondment of Nursing staff.

Spread within a Nursing Home setting is entirely inevitable. Confining Covid-negative residents within a Covid-positive Nursing Home exposes that resident to a significant risk of mortality.

At the Nursing Home that I provide care for, Covid-19 infection has resulted in a 12% mortality.

If (where possible) Covid-negative residents were permitted to return home to temporarily isolate/cocoon with their Covid-negative families, the risk of transmission and subsequent mortality would be substantially reduced.

It is understood that many Residents would not be medically fit for transfer, and many families would not be capable of providing care in the home setting.

There are however many many empty public and private beds in Irish hospitals at present. It is not unreasonable to suggest that many Covid-negative residents could be cared for in Covid free environments. All that is needed is a degree of political will.

It might be argued that confining Covid-negative residents within Covid-positive Nursing Homes, is tantamount to state sanctioned Euthanasia.

I would urge the Minister to act now upon the behalf of this most vulnerable cohort of people, and their families, before it is too
late.

Dr Marcus de Brun

Previously: Prominent doctor, appointed by Simon Harris to medical board, resigns over coronavirus crisis in nursing homes

Rollingnews/Medical Times

20 thoughts on “A Doctor Writes

          1. V

            Calm Down
            unless you’re Dr Marcus, are ya?

            ’cause that’s who I was talking about

            unless you just want to have a dig
            at me

            then have at it

  1. wearnicehats

    I could be way off here but I thought that the expected annual mortality rate for nursing home residents was around 25-30% normally

    To fully understand the effect of COVOD on nursing home mortality you would have to compare the number of deaths year on year so the actual effect can perhaps not be fully understood until the end of 2020 or, at least, the end of June 2020

    I suspect that, over time, the actual statistical uplift is minimal.

    1. Cian

      You also need to be careful extrapolating from small numbers. e.g. if you have 50 old people tested positive for CIVID and 2 die – that is an 8% mortality (below normal). If a third person dies[1] it suddenly jumps to 12% mortality.

      [1] breaking news: COVID death toll jumps by 50% in nursing home!

    2. SOQ

      I very much doubt if that is the case but even if it was, what you are saying is ‘oh well they are going to die anyways’. These are human beings who’s loved ones want to carry them to a place of safety- it is a perfectly natural and normal thing to want to do.

      When this is over there should be a tribunal because the way in which these people have been treated is an absolute disgrace. Because they are old and frail is no excuse, if anything the opposite should be the case- like all our elders, they deserve to be treated with the utmost dignity and respect.

      And if our society cannot do that then it is nowhere near as civilised as it thinks it is.

      1. wearnicehats

        I’m just commenting on his overemotive use of – possibly meaningless – statistics. I’ve done a bit of googling actually and I think I’m pretty close on those mortality rates.

        I’ve posted before on this – I suspect that there absolutely was a conscious decision made to leave nursing home patients insitu in order to protect the greater proportion of society once the contagious nature of the disease became clear. Personally I think, if so, it was the right decision.A harsh one, maybe, but definitely the most practical solution.

        And I am saying that most of them would probably die anyway, not for any shock value – just a simple fact of mortality. If you really want me to be brutal, It takes me back to watching my father die a slow and horrible death through dementia. If Covid19 had been around then I would have been hoping that he caught it just to put him out of his misery.

        1. SOQ

          Yes I too believe there was a decision made to leave insitu- particularly as the homes were instructed to reopen which IMO- was criminal negligence.

          I also understand what it is like to watch a loved one suffer and to pray they are taken so it would end. But that is only some elderly people- my mother for example- could take a fly out with a dishcloth until the day she died.

          They did not need to understand the finite transmission details of CoVid-19 to know that ANY contagious virus of this nature would wreck havoc in such situations. Shoring up those homes should have been a priority from very early on but we are where we are.

          Above all, it is not up to politicians or Health officials to be making judgements on the quality of life of these people- whether they live or die- they have no right to play God.

          1. Cian

            When you say that the “homes were instructed to reopen […] criminal negligence” what do you mean?

            As far as I can tell, the advice from HSE at the time was that based on current WHO advice that homes don’t need to close. There is a world of difference between the two. I’m open to correction if the homes were instructed to reopen.

          2. Cian

            That link doesn’t say the homes were “homes were instructed to reopen”.

            Will you retract your statement that they were “instructed to reopen” then?

  2. Lilly

    Seems like a reasonable proposition that people could be temporarily moved to a safe care environment.

  3. Orla

    Below is Dr De Brun’s recent paper on covid19 in Ireland, it’s worth your time as a supplement to all the other “experts” out there like the UK’s Ferguson who is the equivalent of a tarot card reader based on his past predictions, let’s not forget the well spoken Tony holohan another empty vessel like Leo, two human amplifiers/microphones for the infallible WHO. #playingablinder #wereallinthistogetherexceptthebanksandbigcorporategroups

    The more people get wind of De Brun the more he will labeled non expert-expert, we were been told that the entire medical profession in Ireland is in agreement and everyone else is a tin foil hat manufacturer.

    https://sway.office.com/PwTN7GCvJWDgn9yd?ref=Link&loc=play

    1. Cian

      Thanks for that link Orla – it is very interesting.

      I think he is being very selective – hindsight is always 200% accurate. One example: at the start he berates the government for not realising that COVID-19 was only a threat to old folks – and since Ireland has relatively few old people (compared to Italy/UK) and low population density that a full lockdown was never needed…. later he asks why children aren’t affected by COVID19 – and mentions that Irish children should be more affected that other countries’ kids (as we have 4th highest asthma rates and high levels of childhood obesity – both increase the risk) … but ignores the fact that Irish children being a higher risk group would be another reason to lockdown. With hindsight we now believe that Irish children aren’t likely to get COVID – but this wasn’t known back in Feb/March.

  4. Truth in the News

    Dr DeBrun’s paper needs widespread circulation, in reality Private Nursing Homes
    need scrutiny and a detailed report is needed to determine the exact number of
    residents who have died from the virus and the name/ location of the Homes, there
    is also the issue of the so called “Fair Deal Scheme” where property has been
    escheated which is almost akin to feudalism.

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