Rapid diagnosis essential for new corona outbreak in nursing home

Since the start of the corona outbreak (SARS-CoV-2) in the Netherlands, many nursing homes have been affected by the virus

“It is very undesirable if nursing homes have to close their doors again during a new corona wave,” say Professor of Acute Elderly Care Bianca Buurman and Professor of Geriatric Medicine Cees Hertogh of Amsterdam UMC. In recent months they have conducted research in various nursing homes to find out what preceded an outbreak and how it could happen that so many nursing home residents became infected. “In the event of an outbreak, a diagnosis must be made quickly. That means more testing and a fast test result. In addition, better use of personal protective equipment is needed and staff training is needed, so that complaints from patients – often residents with dementia – are better recognized, ”said Buurman and Hertogh.

Since the start of the corona outbreak (SARS-CoV-2) in the Netherlands, many nursing homes have been affected by the virus, which has a more serious and fatal course in the elderly. The testing policy is now aimed at people who may have (mild) complaints. It is not certain whether positively tested residents and / or employees without complaints also contribute to the spread, but the research by Buurman and Hertogh does indicate this. And according to them, that would have important consequences for the testing policy in nursing homes and the use of personal protection measures.

Symptomatic en presymptomatic
“The main question in our research was to what extent presymptomatic residents and staff play a role in the spread of corona in the nursing home,” says Hertogh.

A team led by Buurman and Hertogh conducted research in four nursing homes. There, all residents and employees were tested, regardless of whether they had symptoms. In this way, people with complaints (symptomatic) and without complaints (presymptomatic) could be distinguished. Due to the limited number of infections in three of the four nursing homes, it was not possible to find an answer to the research question there. At the fourth nursing home, the investigation coincided with a major outbreak. About 40 people were infected at the start of the study.

The outbreak in this nursing home with 185 residents with dementia can be traced back to a single source, one resident contracted the corona virus in a hospital. The same virus strain was subsequently found in all infected residents and employees. The positively tested residents with and without symptoms have the same significant amount of virus material in their body, and both groups appear to be equally contagious.

Extra training
This nursing home is specialized in dementia care. The residents understand instructions less well and because of the dementia they are not able to communicate complaints. “Recognizing corona-related complaints therefore depends on observations by healthcare workers,” says Buurman. “They need to know more about the possible symptoms and complaints associated with corona. Extra training is therefore necessary. ”

At the start of the outbreak, it sometimes took several days between the first reported complaints and the actual testing of residents. It also appeared – and this is already known from other studies – that healthcare workers have difficulty recognizing or detecting minor complaints in themselves. In addition, the workload is high and employees tend to continue working. As a result, they unintentionally pose a risk to residents and colleagues. In addition, the architecture of the nursing home turned out to be an additional complication in controlling the outbreak. Departments are connected in an open square. Residents therefore have extra room to move around, which contributes to good care for people with dementia. But it also has drawbacks in fighting infectious disease.

The IC of elderly care
Buurman and Hertogh conclude that no distinction can be made between presymptomatic (no complaints yet) and asymptomatic (infected, no symptoms) residents and employees when it comes to the spread of the virus. They therefore recommend a tightening up of the national policy for (short-term and long-term) nursing home care. The advice consists of three phases: green, orange and red. There is still little going on with greenery, but clear agreements can be made in the event of an outbreak. So that everyone knows where they stand. With orange, there is an increasing number of infections in the vicinity of a nursing home. Then measures must be taken to ensure that corona does not enter the nursing home. This can be done by regulating visits, the use of personal protective equipment for both employees and visitors and a quarantine for new residents and residents who return from hospitalization. Red represents an outbreak. A plea is made here for weekly testing of residents and staff, with and without complaints. A quick diagnosis is then essential, as is paying closer attention to (your own) complaints and acting accordingly.

“We must prevent a nursing home from having to close again for visitors,” said Buurman and Hertogh. “The nursing home is the intensive care unit for elderly care. With the proposed recommendations, we hope to fight corona together while safeguarding the quality of life of our most vulnerable elderly. ”

The research into presymptomatic transmission of covid-19 in the four nursing homes was carried out by the Department of Geriatric Medicine of Amsterdam UMC, in collaboration with Erasmus MC (Virology department) and GGD Amsterdam.

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