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Care homes did not have to be ripped apart by Covid-19: Dr Michael Donnelly spells out what should have happened to protect the most vulnerable

By Dr Michael Donnelly

“To care for those who once cared for us is one of the highest honours.” Tia Walker

The Covid-19 disaster in our care homes could have been averted. It wasn’t inevitable that the virus would rip through our care homes, leaving hundreds of our most vulnerable dead in its wake.

Pandemic control should have begun on 01 January or when the alert was received from the World Health Organisation.

Quarantine of all care homes should have been declared.

All staff should have been issued with full Personal Protective Equipment.

Task forces of Health and Social Care nurses and doctors should have been dispatched to care homes.

All visiting should have been stopped and residents, relatives and staff should have been counselled.

Immediate Randox Health swabbing and Chinese viral screening should have been instituted.

HEROES: Staff at Ambassador Nursing Home accept applause of relatives during Clap for Carers last Thursday. The community rallied to our care home workers but they were left unprotected by the authorities, says Dr Donnelly.

All care home staff or residents with symptoms or index of suspicion of Covid-19 should have been transferred by Trexler isolators to the Covid Unit at the Mater Hospital.

The care home regulatory body, RQIA, should have been advised to step up inspections and badly-infected homes should have been closed for deep cleansing and disinfection.

Good practice indicates that measures such as those taken in South Korea would have dramatically reduced overall mortality, even if hospital mortality increased.

Testing should have been augmented by tracking and tracing positive cases by contact tracers led by primary health care teams who knew the patients and further quarantine for a minimum of 14 days introduced.

Here’s the background which should have informed the response above:
China reported a novel respiratory infection to the World Health Organisation at Christmas 2020, a virus not unlike Sars which had swept Asia.
In 2003 the Chief Medical Officer of Wales, Dame Deidre Hine produced her Report on the epidemic of H1N1 and mentioned the amplification of the disease amongst 
elderly in care homes which was added to in the Report of Exercise Cygnius conducted
by National Health Service England (including the North).

GRATITUDE: Relatives of residents of Ambassador Nursing Home join Noel McCullough to spell out their admiration for care workers

This Exercise apparently flagged up the vulnerability of the elderly in care homes, many run by Health and Social Care Services and the need for personal protection equipment for care 
home staff.
These facts were either not noted (or more likely ignored) in the interest of
‘Protecting the NHS’ which does not really exist in Northern Ireland, given the HSC branding on nurses’ uniforms, ambulances, hospitals and clinics.
These facts were drawn to the attention of the Chief Medical Officer Michael McBride on the BBC but his reassurances proved hollow.
Nightingale Units without ECMO (so-called ‘miracle machines’ which can keep a critically ill patient alive) were set up.
A care home was allegedly threatened to take back a resident without testing. There was no data on how many residents were referred with many dying in unsatisfactory circumstances. About one third of our total deaths occurred in care  homes yet there were examples of good  practice in South Korea and locally where none died.
Bereaved relatives naturally will want an explanation. This may be given through a formal public judicial inquiry where those who knew yet took little
action to shield our nearest and dearest — whose care we had entrusted to health and
Social Care Services — will  be called to account for their stewardship.
This is important not only for the here and now but for the future as well as this virus is not going away.
Many will fall victim to the virus if we do not take appropriate public health measures and ensure those in charge of the response are, in particular, willing and capable of protecting our elderly.
Dr Michael Donnelly MB, BCh, BAO is a clinical epidemiologist. The video at the top of page is from an interview he gave to on 23 April — a month ago today — in which he warned of dangers to care homes and said, “I can’t see that any measures were taken to give extra protection to care homes.” 
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