Do you want to use mouth masks preventively in nursing homes? Not necessary, according to the RIVM in recent months. The risk that staff and residents could be carriers of the coronavirus without complaints and could infect others (the so-called pre-symptomatic infection) was considered too small.
“The expected contribution of pre-symptomatic contamination in nursing homes is small, which means that mandatory mouth masks always do not make a valuable contribution. The argument better safe than sorry does not apply, because face masks provide a false sense of security, ” said a spokesman for the RIVM at the end of May against Het Parool.
New guideline
Research by professors Cees Hertogh (geriatric medicine) and Bianca Buurman (acute care for the elderly) affiliated with the Amsterdam UMC is now changing the institute’s thoughts. A new guideline for nursing homes is in the making and the cabinet has announced a turnaround: if there are many infections in a region, nursing home staff and visitors must wear mouth masks continuously. And as soon as an infection comes to light, residents and staff must be tested weekly – with or without complaints.
In the words of Buurman, it is a ‘paradigm shift’: taking action while apparently little is going on. Maximum safety is the aim. “Our research shows that employees often do not notice when residents have the virus.”
There were indications of this months ago. In April, smaller US studies showed that people without symptoms spread the virus in nursing homes. For example, one in the New England Journal of Medicine published research infects more than half of nursing home residents without having a single disease symptom (fever, cough, respiratory problems). That contributed to the rapid spread of the virus.
Not necessary
From the end of March, many Dutch nursing homes independently tightened up their policies. At the time, RIVM did not consider it necessary to lay down a more generous testing policy and use of mouth masks in the guidelines. Journalists who asked about it were referred to the ongoing investigation that Hertogh and Buurman had started. If the results give reason to do so, the guidelines can be adjusted, the RIVM stated. That is now about to happen.
Burdensome for residents with dementia
At Amstelring, a care organization with 22 nursing homes, they do not plan to test all staff and residents for every outbreak. “You have to deal with that pragmatically,” says director Inge Borghuis. “You should only test the people who have had contact with the infected person.”
The testing itself can also be quite stressful, especially for residents with dementia. “It’s a very nasty experience, with such a stick in your nose.”
The Association of specialists in geriatric medicine (Verenso) states in a press release that it is pleased that there is ‘finally’ the space to test more widely and to use protective agents. The question is whether this could not have been done earlier, given the previous indications about the risk of infection via people without corona symptoms.
‘The elderly are at the back’
For Bert Keizer – specialist in geriatric medicine, former nursing home doctor and philosopher – the course of events proves that ‘the elderly are at the back again’. “That was also the case in the first corona wave this spring, when scarce test material and protective equipment had to be distributed. I know of staff who went to the Gamma for masks. ”
“We don’t like to pay attention and money to chronic care in nursing homes, to the people who have ended up next to the road of life. IC doctor Diederik Gommers is placed on a pedestal in every talk show. How wonderful that you are doing all that! People who are just as deep in corona misery are not taken seriously. They won’t be on TV. ”
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