The news that 26 out of 28 residents of a Co Galway nursing home have tested positive for Covid-19, along with most of the staff, will inevitably evoke fears of a recurrence of the darkest days of the first virus surge last spring.
Most people who have died with Covid-19 in Ireland were in nursing homes, and most of those deaths occurred in a short period last March and April when the disease ripped through their care facilities.
Already in the case of the Nightingale Nursing Home in Ahascragh, one resident has died and two have been hospitalised. It might seem history is about to repeat itself, yet there are reasons for hoping this will not be the case.
Covid-19 moves fast. The first case in this home was identified in a hospitalised patient on Monday and within 24 hours, after they had been tested, most of the residents and staff were confirmed cases.
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Many are asymptomatic, so their experience of the disease is negligible. This may change for some in the coming days but in general, even among very old people, most recover.
Treatment and support
Back in the spring, little was known about Covid-19 and the care sector in Ireland and many other countries was caught off-guard in relation to its lethality among older people. Personal protective equipment was in short supply and doctors had yet to learn that the disease could often manifest itself in unusual ways in this age group, for example through gastrointestinal symptoms.
Today, there is far more testing, including serial testing of staff in nursing homes, along with an ample supply of PPE. Cases are being picked up earlier and options for treatment are greatly improved. A package of supports is available for nursing homes facing outbreaks.
Yet there are chinks in the armour that should protect vulnerable people in care settings against the virus. While visiting can be restricted, no nursing home can operate without staff, and social distancing can be difficult to maintain with some patients, such as those with dementia.
For this reason, public health doctors say it is inevitable the disease will make its way into nursing homes when there is widespread transmission in the community, as there is at present.
When it does, often at great speed, a large number of staff can be knocked out of commission, either through infection or being close contacts. This is what has precipitated the crisis in the Galway home.
Agency staff
The Ahascragh facility, like most nursing homes, is privately owned. While some have pointed the finger at the Health Service Executive (HSE), it is the responsibility of the owners to run their facility and source staff. In a crisis, State supports are available, and these are being provided by the HSE.
The immediate problem is the difficulty in finding carers to staff the home in the current emergency. Agency staff understandably prefer to work in Covid-free locations, not only because of the risk of infection in homes with outbreaks, but also because they have to isolate if working with contacts.
Quite a few of the nursing homes suffering outbreaks in the current surge managed to escape Covid-19 the first time around. Ironically, it seems that facilities that had the bitter experience of a large outbreak in the spring have best learned the new rules of infection control and outbreak prevention.
This is reflected in the wider figures, which show that although cases are rising, only 3.5 per cent of nursing homes have active outbreaks and, up to a few days ago, only four were the subject of significant concern to the HSE.