Tag Archives: nursing homes

From top: Sinn Féin’s Pearse Doherty and Independent Roscommon–Galway TD Michael Fitzmaurice this afternoon

By 10pm on Tuesday night, when the results for all tests came back, 25 out of 27 residents were found to be Covid-19 positive.

The virus has also severely impacted on staff at the facility, with in the region of ten care staff and seven nurses infected.

All have gone into isolation to reduce the further spread of the virus.

As a result, the nursing home is operating with a massively reduced number of staff today.

At present, just one nurse and one health care worker are on duty, along with some ancillary staff at the premises.

Majority of residents and most staff at Galway nursing home have Covid (RTÉ)

Previously: Left To Die: Nursing Home Timeline

This morning.

A report by the Special Dáil Committee on Covid-19 has recommended a public inquiry into each of the almost 1,000 coronavirus-related deaths in nursing homes.

Via RTÉ

The report notes how public health authorities “became overly focused on preparing acute hospitals for the ongoing pandemic in February and March” and that the State “failed to recognise the level of risk posed to those in nursing homes”.

Committee members also highlight the State’s “silo type approach…that did nothing to prevent the spread of the disease“.

…The committee recommends the public inquiry should examine the “large scale discharge of patients from acute hospitals to nursing homes at the beginning of March” as well as the response of the HSE, Department of Health, NPHET and Government to virus related difficulties in nursing homes.

The Chief Medical Officer Dr Tony Holohan has consistently defended NPHET’s decision not to recommend visitor restrictions on 6 March – however the committee recommends a public inquiry should examine this decision further.

Meanwhile,

TDs say there should be greater transparency around the data used by NPHET to recommend restrictions- and the data should be peer reviewed by an Independent expert panel.

Committee on Covid-19 recommends inquiry into nursing home deaths (Barry Lenihan, RTÉ)

Previously: Left To Die: Nursing Home Timeline

Minister for Health Stephen Donnelly at the publication launch of the COVID-19 Nursing Homes Expert Panel Report.

This afternoon.

The COVID-19 Nursing Homes Expert Panel Report has been published.

As of July 14, 79% of all notified deaths from COVID-19 occurred in the over 75 age group and deaths in nursing homes (985 cases) represented 56% of total deaths (1,748 cases) in Ireland.

From the report:

‘The COVID-19 public health emergency has shown some of the many strengths of Irish society. It has also shown some weaknesses.

We have a two-tier healthcare system and a two-tier siloed approach to the long-term support and care of older people which favours referral to long-term care settings as opposed to promoting a wider range of home care options. We owe it to our older population and ourselves to do better.’

Also:

During the crisis, leadership and timely decision-making became overwhelmed due to a vacuum of clear guidance, mixed messaging, a lack of access to clinical expertise and resources (oxygen, infusion pumps, PPE).

A submission from academic nursing who took part in the ‘call to arms’ felt that for the vast majority of nursing homes there was no direct clinical governance; GPs’ mainly focused on managing their individual patients either in person or virtually. COVID-19 very quickly exhausted existing governance and escalation pathways.

Read here

More as we read it.

Previously: Left To Die: Nursing Home Timeline

Sam Boal/Rollingnews

 

This evening.

Leaked last week and, in the traditional manner, released late on the Friday of a Bank Holiday.

The 68-page Special Covid-19 Committee report on the impact of Covid-19 in nursing homes calls for an independent review of almost 1,000 coronavirus-related deaths of people in elderly care.

Report here

More as we read it.

Previously: Left To Die: Nursing Home Timeline

This afternoon.

A report on the impact of the virus on nursing homes by The Health Information and Quality Authority (HIQA) has been published.

Via The Irish Times:

“The State health watchdog was granted an emergency court order to shut down a nursing home over fears residents could not be protected during the coronavirus outbreak.

The Health Information and Quality Authority (Hiqa) has also revealed none of the 44 homes where there had been confirmed cases of Covid-19 fully complied with regulations to stem the spread of the disease.

…In a report on the impact of the pandemic on nursing homes, Hiqa said it began inspecting homes that had “significant outbreaks” and found shortcomings in management, staffing levels as well as infection prevention and control skills.

Hiqa granted order to shut nursing home over Covid-19 risk to residents (Irish Times)

Meanwhile…

The report also outlines the human impact of dealing with the pandemic on staff, residents and their families who contacted HIQA to tell their story.

Residents spoke of the fear of never hugging their family again and of what would happen if a resident of staff member tested positive.

One said he would “not leave the room again until a vaccine was found”.

Others were frustrated and angry that prevention measures meant they were largely confined to their bedrooms and cut out from the friends in the centre.

The only human contact was from staff, many of whom were wearing PPE.

There was also a serious impact on the wellbeing of staff.

One home said “we have some staff that are still out and it is likely they will never return, such is their upset“.

Half of nursing homes with virus outbreaks inspected did not follow hygiene rules – HIQA (RTÉ)

Previously: Left To Die: Nursing Home Timeline

Rollingnews

From top: Adrian Bartley (left), his father Ultan Sheehan; Kilbrew Nursing Home, Ashford, County Meath; Minister for Health Stephen Donnelly

This morning.

On RTÉ’s Morning Ireland, Audrey Carville asked the Minister for Health Stephen Donnelly about the death of Ultan Meehan who died, aged 79, in hospital just over two weeks after being admitted from the Kilbrew Nursing Home in Ashbourne, County Meath.

Mr Meehan had contracted Covid-19 before he died in June. He also had cancer and dementia.

Ultan’s son Adrian Bartley, who was a resident of the same nursing home and who had Down syndrome and dementia, died ten weeks earlier in April. He had also contracted Covid-19.

Yesterday, Simon Carswell, in The Irish Times, wrote about Mr Meehan and Mr Bartley following an interview with Mary Bartley Meehan amid calls for an inquiry into her husband and son’s deaths.

During his Morning Ireland interview earlier, Mr Donnelly was asked about the case of the two men.

Audrey Carville: “His wife and her advocate describe the horrific and distressing condition that she found her husband in when she went to visit him. It was brought to your department’s attention when Simon Harris was in the ministerial position. The department passed it to the HSE who passed it to HIQA. Will Mary Bartley Meehan be told why this happened to her husband?”

Stephen Donnelly: “Audrey, I don’t want to get into the details of an individual case on air if you don’t mind. Obviously it’s a very distressing case. It’s something we will be looking at very closely but I would just prefer it if we don’t get into an individual case like this on air, if you don’t mind.”

Carville: “But will she get answers, I suppose, ultimately, is that broader question. Will she be told the answers?”

Donnelly: “Well, it will be looked at. Absolutely. Of course it will. And, as you said, the previous minister has already looked into it and I will be on it as well. But, other than that, because it is an individual case, I would prefer to…I just don’t think it’s appropriate…”

Carville: “I understand…but the bigger question then that needs to be answered is who has responsibility for clinical governance in private nursing homes?”

Donnelly: “Well HIQA is, well, ultimately the responsibility for running nursing homes is for the nursing homes. HIQA is the regulator. It is incumbent on HIQA to inspect and to enforce but the responsibility for running nursing homes, obviously falls to the owners of the nursing homes.”

Carville: “Thank you very much indeed….”

Previously: left To Die: Nursing Home Timeline

Covid-19: Tragedy of ‘terrible dimensions’ as woman loses husband and son (Simon Carswell, irish Times)

Rollingnews

From top: Minister for Health Stephen Donnelly, Independent TD Catherine Connolly, Independents 4 Change TD Joan Collins at a Dáil sitting in the Convention Centre yesterday

Yesterday.

In the Dáil.

Minister for Health Stephen Donnelly announced a further financial package to assist nursing homes deal with Covid-19.

A four-person expert panel, comprised of Professor Cecily Kelleher, Professor Cillian Twomey (chair), Petrina Donnelly and Brigid Doherty, was scheduled to furnish the Minister for Health with a report on nursing homes and Covid-19 by the end of June but it’s understood this report has yet to be delivered.

During his first appearance in the Dáil as minister yesterday, a number of TDs recalled the number of Covid-19-related deaths that have taken place in nursing homes and their views of the situation in nursing homes in general.

Social Democrat TD Roisín Shortall said:

“The Minister often talks about data and data should be driving all decision-making around this. There is now quite a body of data built up and we have many people involved in that. The problem is that most of it has been kept secret. I spent five or six weeks chasing the Department of Health to get data on the prevalence figures. It had it but it just did not produce it.

“…What is the strategy on the containment or the elimination of Covid? I heard about an outbreak in a nursing home. We are being told about potential clusters. What happens if many people come in from abroad? What is the strategy in terms of a rapid response to a threat like that? Is there a plan to target people in a specific locality or setting, such as a nursing home? What is the plan for testing and tracing? Is there a strategy to ensure we respond rapidly to any new outbreak or upsurge?”

Solidarity-People Before Profit TD Gino Kenny said:

“I want to raise a number of issues, the first of which is the effect of Covid-19 on the nursing homes sector. I welcome the additional provision in the Revised Estimates to deal with the crisis. However, the level of death in nursing homes during the Covid pandemic is a national scandal. There is a lot of speculation as to why it happened. That question probably cannot be answered here and will have to be dealt with in a different venue. The relatives of those who passed away will want to know why their loved ones passed away in such a manner.”

Independent TD Michael Lowry said:

“The successful handling of the Covid-19 crisis in our health system required substantial money. Additional staff were brought on board quickly. It took money to do that, but it also took expert management of the situation. The driving force behind our excellent handling of the crisis was the way we managed it. The speed and urgency of the required response to the crisis demanded that it be managed with almost military precision.

“Even before the first case occurred, our hospitals were ready and intensive care beds, critical care beds and step-down beds were made available at rapid pace. Testing centres were also quickly established. The one major glitch in the system was the failure of the HSE to support the nursing home sector in a timely fashion, and we were also slow to roll out testing and contact tracing. That needs continuous upgrading as it is the principal strategy for coping with a virus that is going to remain with us.”

Independent TD Mattie McGrath said:

“Ar an gcéad dul síos, I pay tribute to all the front-line staff and the workers in all areas who did Trojan work. I sympathise with each and every family that lost loved ones. I thank RTÉ for the “RTÉ Investigates” programme last night. It was just shocking. What happened in nursing homes was unforgivable.”

Independent TD Catherine Connolly said:

I fundamentally disagree that we looked after the residents in nursing homes. We did not. I have taken every opportunity to say that because we did not, although we had ample time to do that. While I appreciate how difficult it is for the HSE, we did not put our nursing homes and residential centres at No. 1 on the list. We failed to do that and we failed to be honest about the testing regime from day one. We manipulated and we twisted and we spun.

“I ask for openness and accountability so that we can all work together.”

Independents 4 Change TD Joan Collins said:

I agree with Deputy Connolly about the nursing homes. They were not prioritised and, to a certain degree, I understand that because the HSE and NPHET were scared of its lives about what could have happened in the public hospitals because of the crisis in healthcare. That is where things went wrong, because they were focused mainly on the public hospitals and the public in general and they dropped the ball from the point of view of our nursing homes and our older people.

“We saw what happened as a consequence.”

Transcript via Oireachtas.ie

Previously: What Happened In The Homes?

Left To Die: Nursing Home Timeline

Stephen Donnelly, newly appointed Minister for Health and President Michael D. Higgins at Dublin Castle on Saturday: A tweet from Mr Donnelly in April

Yesterday.

On RTÉ Radio One’s This Week, the new Minister for Health Stephen Donnelly had this exchange with journalist Justin Moran.

Justin Moran: “You’ve been highly critical of the way nursing homes were handled during the pandemic. Will there be a comprehensive inquiry into why there were so many deaths in nursing homes?”

Stephen Donnelly: “So the first thing we’ve got to do, Justin, is we’ve got to wait for the expert report. Minister Harris kicked it off some time ago. There is four people on it. It will be reporting, well I guess to me now in the coming weeks so let’s see what, let’s see what that says. But if a more detailed inquiry is required that is certainly something that we will look at.”

Later

Moran: “So what are you going to do then to make sure that nursing homes, for example, aren’t as badly infected, if there is a second wave, as there were in the first?”

Donnelly: “Well, I’ll be meeting with the officials, meeting with the public health officials, meeting with the nursing homes and listening very carefully. What we have to do is make sure that there’s a comprehensive package of supports and protections in place. I do know that an extraordinary amount of work has been done at a national level and also at a community health organisation.

“There are frontline workers who have been working around the clock with the nursing homes to make sure that they can get the supports they need. The question we will be looking at in the coming days is: are all the supports that are needed in place? If not, what else needs to be done? And let’s make sure we get that done straight away.”

Listen back here

Meanwhile

 

St Mary’s Hospital, Phoenix Park, Dublin

…The team has requested a meeting with the whistleblower, a staff member from St Mary’s, to “confirm and validate an understanding of the nature of the disclosures” and examine any supplementary evidence.

Caoimhe Haughey, a solicitor representing the whistleblower, said she had concerns about the nature of the review and was seeking clarification from the HSE.

The terms of reference are not clear at all,” she said.

“While the documents furnished to my client refer to the Protected Disclosures Act 2014 and the HSE’s own Protected Disclosure Policy document, there is no provision for investigation of St Mary’s which is what was initially promised.”

She added: “As far as I am concerned it is unclear whether this investigation is strictly for the purposes of testing the veracity of the protected disclosure or whether it is for the purposes of commencing a formal investigation into the practices at St Mary’s.

Team investigating HSE nursing home death rate asks to meet whistleblower (Independent)

Previously: Left To Die: Nursing Home Timeline

In St Mary’s

Rollingnews/Maxwells

 

UCD Professor Paddy Mallon

This afternoon.

In the Dail, Leinster House, Dublin 2.

During a Covid-19 Committee meeting.

Fianna Fáil TD Mary Butler questioned Professor Paddy Mallon, professor of microbial diseases in the school of medicine at University College Dublin concerning nursing home deaths.

Prof Mallon had earlier told the committee:

“Failure to learn, or delays in planning and resourcing for what is ahead, would not only be potentially negligent but would be a travesty to the memories of those who have died from Covid-19, some avoidably, during the first wave.”

Mary Butler: “Professor Mallon referred to “the memories of those who have died from Covid-19, some avoidably”. In this committee, I have constantly raised the question of what would have happened if patients were tested prior to entering residential care settings throughout March and April.

For example, we know that in March 1,300 patients were transferred from acute hospital settings to nursing and residential care homes.

We know this virus has borne down hardest on our older people, with 63% of all deaths occurring in residential and care homes. Professor Mallon speaks about avoidable deaths so does he believe that if these patients had been tested prior to entering nursing homes, some deaths could have been avoided?

Professor Paddy Mallon: “When I refer to avoidable deaths, my experience of this is when an individual attends a hospital without Covid-19 but with another illness and enters the hospital environment sick, that person does not expect to contract Covid-19 and die within that setting.

“We need to maintain safe environments for the public to be treated for their illnesses. From the point of view of a physician and on a societal level, that is critical. Whether it is in acute hospitals or in nursing homes, the same thing applies because the consequence of the sick, the vulnerable and the old acquiring this infection is death.

That is a fairly stark consequence that we simply cannot accept. We can talk about bed days and social distancing, but if we enter September, October and November knowing what is coming and we still end up with people dying within our healthcare facilities from nosocomial infection, then, in my view, we have failed.”

Deputy Mary Butler: “I understand that we were learning, everything was done in good faith and capacity was not available, but does Professor Mallon accept the following:I firmly believe that if the capacity had been available in March and April to test people who were being transferred to residential care from acute settings, and if patients had been tested prior to being returned to nursing homes, they could have been isolated for 14 days. It would have certainly made a difference.”

Professor Paddy Mallon: “There are probably a number of factors that contributed to what happened in the nursing homes. I had the experience of going out to visit nursing homes during the pandemic. There was huge variation in what was happening in nursing homes.

There could be a nursing home being decimated in one district, with all staff and patients infected with Covid-19 and a number of people dying, yet one could travel 200 m to 300m down the road and see a nursing home that was completely unaffected.

We can talk about hospital discharge and nursing homes, but it is not the only story. There is certainly something at a managerial level within nursing homes that some nursing homes were able to do excellently to maintain the safety of their residents and staff throughout the whole pandemic, but other nursing homes were unable to do.

That is the key. What were the nursing homes that avoided this doing right? We need to learn from what they did right…”

Deputy Mary Butler: “Absolutely.”

Professor Paddy Mallon: “And make sure all the nursing homes follow those sorts of practices because they worked.”

Meanwhile...

 

 HSE CCO Dr Colm Henry

Also at the Covid-19 committee meeting.

Sinn Fein’s Matt Carthy asked HSE CCO Dr Colm Henry if he accepted the claim made by Phil Ní Sheaghdha of the INMO who said, up to the end of May, 8,018 healthcare workers had been infected with Covid-19.

Ms Ní Sheaghdha said this rate of 32% of all Covid-19 cases is the highest among healthcare workers in the world.

They had this exchange:

Colm Henry: “I cannot accept that we can compare like with like country by country. That is what I am saying to the Deputy. I do not dispute the figure of 32%. However, because we have been measuring healthcare workers as a priority from the absolute go even when we had testing difficulties and because we had a very wide definition of healthcare workers – much wider than other healthcare systems in other countries, to me that is as likely a reason as…”

Matt Carthy
: “…I have other questions. Does Dr. Henry accept that 32% is too high and that we really need to strive to improve that figure?”

Henry: “Any case is not just a disappointment, it is a huge risk for us and for healthcare workers. Every case is wrong, and we have to do whatever we can to protect our healthcare workers, be it with PPE, masks, infection and control measures, and education and training. Many of these cases took arose outside acute hospital settings in community settings.”

Asked later by Fine Gael TD Colm Burke if there is a full breakdown of the 8,180 cases and if there’s a breakdown of workers’ respective workplace, Dr Henry replied

“We have a breakdown based on the healthcare setting and based on professions in terms of those associated with outbreaks. We can provide figures to the deputy after this hearing.”

Yesterday: Left To Die: Nursing Home Timeline

Sasko Lazarov/Rollingnews

From top: a Dublin Nursing home; The Citywest emergency ICU facility; Taoiseach Leo Varadkar (centre) with HSE CEO Paul Reid (left) and Minister For Health at the Citywest opening; DrTony Holohan, Chief Medical Officer for the Department of Health and chairman of The National Public Health Emergency Team (NPHET); from left: Mr Reid with Dr Colm Henry (right) Chief Clinical Office, HSE arriving for a Covid 19 Committee meeting in Leinster House on June 6

There are approximately 440 private nursing homes and 120 HSE-run nursing homes in Ireland with around 30,000 residents.

More than 1,680 patients were approved for transfer from acute hospitals to private nursing homes in March (1,363) and April (324), the height of the pandemic.

This was as emergency ICU facilities and private wards secured by the government lay empty.

According to the most recent data, 943 people have died in nursing homes from Covid-19 with a further 5,371 who are Covid-19 positive.

This policy was replicated in seven European countries and five states in America, most notably New York, where before a u-turn, 4,300 recovering Covid-19 patients were sent to nursing homes in the state.

Below is a timeline of events as they pertain to residents of nursing homes in Ireland from the  the beginning of the virus until this week. Any additions or corrections will be made (just leave a comment).

February 19, 2020: The CEO of the HSE Paul Reid meets with representatives of nursing homes to discuss Covid-19 preparedness. On April 16, Minister for Health Simon Harris informs the Dáil that this meeting occurred and said:

“I am told by local HSE staff that there was an unprecedented level of engagement by individual HSE officials with nursing homes.

That is not to say in any manner or means that enough has been done. We need to do more.

This is a pandemic in which we take actions every single day. We then take another set of actions and then another set. That is what we are doing.”

In respect of the same February 19 meeting, CEO of the HSE Paul Reid told the Oirecachtas Covid-19 committee on May 19:

“Specifically, on the meeting with Nursing Homes Ireland, I would meet and discuss with Tadhg Daly on a reasonable basis throughout this whole process – in the pandemic over the last few weeks. There have been very good relationships between Nursing Homes Ireland and the HSE throughout this period.

“On the Deputy’s question of 19 February specifically, I can remember the meeting clearly. I have met a wide range of stakeholders since I took over the HSE. That was my first meeting with Nursing Homes Ireland. It was my first meeting with Tadhg Daly and its chairperson, Maurice Pratt. It was really geared towards an informal welcome and discussion…

“We had a brief discussion about how this may impact on Ireland. There was a very brief discussion between both of us. I would be doing it an injustice and indeed the HSE an injustice to say it was an in-depth discussion because we were just learning at the start of this – 19 February was very early stages.”

February 28: Chief Medical Officer Dr Tony Holohan confirms the first case of Covid-19 has been detected on the island of Ireland, involving a woman who travelled through Dublin Airport on her way home to Northern Ireland from northern Italy. She subsequently tested positive for the illness on returning home to Belfast.

February 29: The Health Protection Surveillance Centre confirms the first case of Covid-19 in the Republic of Ireland. The patient is a male in the east of the country.

It’s also reported that the first death of a Covid-19 patient had taken place in the US.

March 1: Scoil Chaitriona secondary school in Glasnevin, Dublin 9, closes for two weeks. Health officials do not publicly name the school but its identified on social media. It follows confirmation that a male student had Covid-19. He had been at an at-risk area in northern Italy.

March 2: Paul Cullen reports in The Irish Times that Covid-19 is especially worrying for elderly people with underlying health conditions.

He writes::

 “In the US, a serious outbreak near Seattle has occurred in a nursing home. Obviously, the risk of something similar happening in Ireland is a huge worry.”

He later added:

 “Nursing Homes Ireland, representing the owners of private nursing homes, has sought to reassure the public that its members have the experience to know what to do if the virus arrives, given their experience in dealing with seasonal flu and the vomiting bug. Some restrictions on visiting may be needed if the threat from the virus rises.”

March 6: It’s reported that visiting restrictions are being introduced in more than 400 private and voluntary nursing homes across Ireland. Nursing Homes Ireland says no non-essential visits by children or groups would be allowed.

March 9: The Government cancels all St Patrick’s Day parades.

March 10: The Department of Health’s Chief Medical Officer Dr Tony Holohan said blanket restrictions on visitors at nursing homes and some hospitals should be lifted as they were premature.

He said visitor restrictions at private nursing homes had a major impact on residents, for whom social interaction was a key part of wellbeing.

While restrictions might be necessary in a particular nursing home depending on circumstances, he said there was no case for across-the-board restrictions, saying: “We want to avoid introducing measures before they are really necessary.”

The National Public Health Emergency Team (NEPHT) announced in a statement that “socially restrictive actions” around hospitals and nursing homes were “not necessary at this moment in time”.

It’s reported that the annual St Patrick’s Day reception in Washington DC has been cancelled but that a meeting between the US President Donald Trump and Taoiseach Leo Varadkar will still take place.

On the same day, Nursing Homes Ireland writes to the Minister for Health Simon Harris and the letter is also sent to the chief executive of the HSE Paul Reid, and the Department of Business, Enterprise and Innovation.

In the letter, the NHI called on the Government to lift curbs on the recruitment of healthcare assistants from outside the EU and warned that older people’s health could be placed in danger if HSE poached nursing home staff following the lifting of public service recruitment restrictions.

March 11: A woman in the east of the country dies of Covid-19, the  first death to take place in Ireland.

The World Health Organisation says Covid-19 is a pandemic.

March 12: Speaking from Washington in the US, Taoiseach Leo Varadkar announces the closure of schools and significant public restrictions in Ireland until March 29 because of Covid-19.

Rose Hegarty, an 84-year-old resident of St Mary’s Hospital nursing home in the Phoenix Park, Dublin listens to Mr Varadkar’s speech from her bedroom.

March 16: Dr Tony Holohan says that restrictions will be imposed on visitors to nursing homes, hospitals and prisons.

March 17: During a St Patrick’s Day speech broadcast on RTÉ and Virgin Media One, under Section 122 of the Broadcast Act 2009, Taoiseach Leo Varadkar tells those listening and watching that the restrictions will likely go beyond March 29. He adds:

“We’re in the middle of a global and national emergency. A pandemic. The likes of which none of us have seen before. So far, the number of cases in Ireland has been relatively small. However we believe the number will rise to 15,000 cases or more by the end of the month and rise further in the weeks thereafter.”

He also says:

“At a certain point we will advise the elderly and people who have a long-term illness to stay at home for several weeks. We’re putting in place the systems to ensure that if you are one of them, you will have food, supplies and are checked on. We call it cocooning and it will save many lives, particularly the lives of the most vulnerable, the most precious in our society.”

It’s also reported that Nursing Homes Ireland is appealing for people within hospitality and retail to look for opportunities to care for older people. CEO of NHI Tadhg Daly is reported as saying:

“One considerable concern is to ensure a staffing complement is consistently available to meet the day-to-day social care needs of nursing home residents, especially at a time of emergency and with visitor restrictions.”

“Irish people have a tremendous ability to support one another during difficult times and this has never been more required.”

March 21: In a HSE memo from David Walsh, National Director of Community Operations, to the chief officers of community healthcare organisations, about revised guidance in relation to testing.

Mr Walsh tells his colleagues:

“Following confirmation of a Covid positive diagnosis within the unit/centre then it is assumed that all residents presenting with symptoms are Covid positive. Multiple re-referrals to NAS for potential Covid cases should be avoided.”

March 22: It’s reported that  40,000 people are waiting up to five days for Covid-19 tests. It’s also reported that “when asked about reports of a cluster of positive cases at a nursing home, the HSE said outbreaks of infectious diseases in nursing homes were not uncommon and staff were used to dealing with this issue. However, the scale and numbers would be extremely challenging.”

A cluster is defined as two laboratory-positive cases in an institution.

The report added: “The HSE has asked the media not to identify any nursing homes concerned.”

March 24: Taoiseach Leo Varadkar announces further restrictions until April 19.

March 25: The HSE’s Health Protection Surveillance Centre reports that there have been six outbreak clusters of Covid-19 in hospitals and four in nursing homes.

It’s also reported that 21 male residents of a nursing home in the Vosges in France, all aged in their 90s, are believed to have died of Covid-19. It’s feared as many as 100,000 nursing home residents could die of Covid-19.

March 26: Chief Medical Officer Dr Tony Holohan expresses concern about clusters of cases in healthcare settings such as hospitals and long-stay settings such as nursing homes.

March 27: In a report about the statistic that about 25 per cent of confirmed cases are health workers, at least four Covid-19 outbreaks have occurred in nursing homes and that nursing home operators, and others, are concerned about a lack of guidance and the availability of PPE.

Later, new figures show there have been nine Covid-19 clusters in nursing homes. Dr Holohan says the clusters are a significant concern for public health experts.

Taoiseach Leo Varadkar announces further restrictions for two weeks, until Easter Sunday on April 12, specifically that people must remain at home, with limited exceptions, and must remain within 2km of their homes when shopping for food or exercising. During his speech he mentions the increase of clusters in nursing home and residential care centres.

He also quotes from the movie The Terminator 2: Judgement Day when he says, “There is no fate but what we make for ourselves.”

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