Mouthguards Directive RIVM for care of the elderly yet based on scarcity

The RIVM has tacitly withdrawn an important advisory report on mouth masks in elder care. This appears after questions from Nieuwsuur. The Ministry of Healths assertion that the guidelines were only based on medical advice and safety is not correct, because scarcity did play a role.

For months, employees in elder care did not have to wear a mouth mask when working close to a (suspicious) corona patient. Not even within a radius of one and a half metres. As long as they only had brief contact – i.e. to indicate medication or have a chat – mouth masks were not necessary, the RIVM advised. A twist has now been made on that point. The profession has not been informed about this.

The RIVM withdrew its advice on 17 August. From now on, mouth masks are necessary, even in case of brief contact, the RIVM says. The institute states that there is no new scientific insight underlying this change. The earlier advice stemmed from a period of scarcity and was also based on this, in combination with the very low risk of becoming infected in the event of volatile contact. The RIVM therefore now estimates the risk to be high enough, without new information, to change the advice.

Healthcare workers may be held liable

Health Law professor Jaap Sijmons says that the risk of infection in the event of short contact may be lower, but that this reasoning does not apply to healthcare in particular. If you always visit many different patients for a short period of time, you end up with a long-term exposure

On 1 May, the guidelines stated that healthcare workers could deviate from them in specific situations, but in practice this did not happen very often. Especially because the government distributed protective equipment on the basis of the guidelines.

Minister Hugo de Jonge always said that the guidelines were there to avoid unnecessarily wasting mouthpieces in a period of scarcity. But what the guidelines said about when healthcare workers should or should not wear protection was about safety, not scarcity.

Sijmons is of the opinion that healthcare workers who become ill after following the RIVM advice can hold the Ministry of Public Health liable. According to Sijmons, the employees relied on a government rule that was presented as a safety rule, but arose from scarcity.

Remarkably, the RIVM did not inform the most important umbrella organisations in elder care, which had been criticising the advice in question for months, about the change. They reacted indignantly. What is now coming out raises confidence in RIVM, says Gerton Heyne of the Association of Nurses & Carers.

Scandalous, says Hans Buijing of the ZorgthuisNL branch association. With the directive a choice was made to allow people to work in an unsafe way, even though they knew that this was not responsible

Conny Helder of sector association ActiZ, who first defended the advice, is also critical and surprised. The National Institute for Public Health and the Environment (RIVM) must be transparent about considerations in guidelines on safety

In July, Nieuwsuur already revealed that a number of important RIVM coronavirus directives have a meagre scientific basis: