OMT advice: extra protection and many more tests in nursing homes

The corona policy in nursing homes has to change drastically. That’s what the Outbreak Management Team advises the Cabinet. Oral caps must be used preventively and nursing homes must test everyone weekly in the event 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 must wear mouth masks at all times and residents must first be quarantined for ten days if they move to the nursing home or have been hospitalised.

The GGDs 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 now only require nursing home residents with complaints to be tested. Protective equipment is only available for employees working with residents who may or may not be infected.

Weekly testing

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 geriatrics Cees Hertogh. “And we can’t afford to end up in that situation again.”

The research by Hertogh and colleagues shows that about half of the infected residents are not picked up if they are only tested in case of complaints. “With residents with dementia, which is about 70 percent of the 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 do not 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

Criticism of current guidelines

Previously, the guidelines on protective equipment had already 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 (recognizable) complaints. “With this knowledge, we could, of course, have tackled the crisis better at the outset

Infectious without complaints

The researchers actually wanted to know whether 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 can’t distinguish between infected residents who didn’t 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. “In nursing homes you have to deal with the weakest people. 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.