Extra protection and many more tests in nursing homes

The corona policy in nursing homes is going to change dramatically. This was decided by the Cabinet following advice from the Outbreak Management Team. Oral caps will be used preventively and nursing homes will have to test everyone weekly in case of an outbreak.

The OMT bases its advice on a new study led by professors Cees Hertogh and Bianca Buurman (Amsterdam UMC). The new measures mean that as soon as a region suffers from many infections, nursing home staff and visitors will have to wear mouth masks at all times and residents will first have to spend ten days in quarantine if they move to the nursing home or have been hospitalised.

The Municipal Health Centres and nursing homes must consult at a regional level when this so-called ‘code orange’ comes into effect. According to the researchers, in regions where the number of infections is relatively high, such as Amsterdam, the new measures should apply now.

As soon as an infection is detected in a nursing home, the researchers and the OMT advise introducing a systematic testing policy. Residents and staff are then tested on a weekly basis, regardless of whether they have any complaints.

The current RIVM guidelines still require that only nursing home residents with complaints are tested. Protective equipment is only available for employees who work with residents who may or may not be infected.

Insufficient guidelines now

The study by Hertogh and Buurman shows that the current guidelines on the use of tests and protective equipment are insufficient to prevent many nursing home residents from dying again.

“We know how serious the virus can strike in nursing homes, we saw that earlier this year,” says Professor of Elderly Medicine Cees Hertogh. “And we can’t afford to end up in that situation again.”

The research by Hertogh and colleagues shows that approximately half of the infected residents are not picked up if tests are only carried out in case of complaints. “For residents with dementia, which is about 70 percent of nursing home residents, it is very difficult to recognise covid-19 in time. It is impossible for staff members to detect loss of smell and taste in someone with dementia”

The researchers also saw that employees don’t attribute very slight complaints to covid-19 and still continue to work. “That’s why you have to test all residents and employees and use preventive mouth masks.”

The guidelines on protective equipment had previously been the subject of much criticism. Professional associations and care workers thought it was prompted by the scarcity of protective equipment, but according to the RIVM the preventive use of mouth masks was not necessary.

Hertogh and his fellow researchers now say that it is necessary because the virus is also transmitted by people without (recognisable) complaints. “With this knowledge, we could, of course, have tackled the crisis better at the beginning

Infectious without complaints

The researchers actually wanted to know if the virus was transmitted in the nursing home by people without complaints. That question was not answered, because mild complaints such as headaches and sore throats are often not recognised. It could therefore happen that people with complaints stayed around for six days before they were noticed.

The researchers write in their conclusion that they cannot make a distinction between infected residents who did not recognise complaints or who actually had no complaints. Both groups carry the same amount of virus, according to the research. According to Hertogh, that finding has important consequences. “So they can all spread the virus.”

It is precisely for this reason that it is important for him to take these new measures. “You’re dealing with the weakest people in nursing homes. Of course you can inform employees and train them to recognise complaints better, but that’s not enough. You need more to prevent outbreaks,” says Hertogh.