COVID-19 cluster at MINDSville@Napiri: Why is it so hard to keep the virus out of adult care homes?
SINGAPORE: Since the start of the COVID-19 pandemic, the virus has found its way into adult care homes in countries around the world, and Singapore is no exception.
One of the latest local clusters – at MINDSville@Napiri, a home for people with intellectual and developmental disabilities – has grown to 27 cases in a matter of days. Four cases are staff members and 23 are residents.
This is not the first time Singapore has seen an outbreak in an adult care home.
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It is critical to keep COVID-19 out of care homes for the elderly and disabled, said Professor Dale Fisher, who chairs the World Health Organization’s Global Outbreak Alert and Response Network.
This is because they often house people who are “vulnerable to severe disease and death” – meaning the outcomes of infections are “much poorer”, he added.
But it is particularly challenging to keep these facilities COVID-free, mainly because of the need for close contact between residents and staff members, said experts CNA spoke to.
CHALLENGES OF KEEPING HOMES COVID-FREE
Prof Fisher explained that there is a lot of contact between the resident and others, such as nurses, allied health staff, cleaners, auxiliary staff members and visitors.
"So one person, perhaps asymptomatic, can spread it to many residents and residents can spread it to staff. The more people, the more contact of each individual – the greater the risk of spread."
An adult disability home may be even more vulnerable to an outbreak if there is “more intensive support” with more activities and contact, said Prof Fisher, who is also a senior infectious diseases consultant at the National University Hospital.
But reducing this human contact is tricky because it plays a key role in managing resident’s behaviours, said Mr Ardi S Hardjoe, the chief executive at Thye Hua Kwan Nursing Home. The Thye Hua Kwan group also runs several homes for the disabled.
Mr Ardi noted that contact, activities and interaction help fight against boredom, isolation and despair – which are potential consequences that must be avoided in institutional living.
“If we don't keep the residents fully engaged, and if they're bored and doing nothing every single day … that will trigger them to display behaviours,” Mr Ardi added.
Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection suggested that another challenge in adult care facilities may be that “many individuals may not understand basic hygiene concepts”.
In addition, he said many of these facilities are short-staffed, making it hard for staff to practice “full proper hygiene” in between handling clients.
On top of that, many residents may not be able to recognise symptoms of infections, especially if they are subtle – such as a loss of smell or taste, he noted.
Another challenge he put forth was that there are many different vendors, service providers, and volunteers going in and out of these homes, and it may be difficult to screen all of them or ensure all of them have been completely vaccinated.
THE MINDSVILLE@NAPIRI CLUSTER
Specifically, Prof Tambyah pointed out that it is not the first time that MINDSville@Napiri has seen an outbreak. In July 2019, the care home was the site of a measles cluster.
But he said that this outbreak of COVID-19 cases was picked up “relatively quickly”, with most cases being asymptomatic.
The Ministry of Social and Family Development (MSF) had said that of the 27 cases, 23 were asymptomatic and discovered through proactive testing.
“This may also have been a result of a good vaccination program,” he said. According to MSF, about 91 per cent of the home’s staff and residents were inoculated during vaccination exercises conducted in February and March.
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Since the cases were detected, the home's operator, Minds, said it has disinfected the premises and completed swab tests for all 255 residents and staff. It has also banned visitors and stopped admitting or discharging residents.
It also said that it has implemented safe management measures stipulated by authorities since the start of the pandemic – including limiting interactions, having split zones and conducting daily temperature-taking.
All residents have had their outings and home leave suspended since May 7, but they have been allowed to keep their external medical appointments, said the home’s operator, Minds.
All live-in staff have also not been allowed to leave since then, except for essential purposes, it said.
THE NEED TO BE MINDFUL
In the meantime, Thye Hua Kwan’s Mr Ardi said the cluster at MINDSville@Napiri has made his team “a lot more mindful” about hygiene and safety rules.
“We do reiterate that we have to minimise direct human contact from the visitor screening, have safe distancing measures, split teams, split zones for employees.”
They have also “done their best” to make working from home a default, Mr Ardi said.
“But for running institutions and homes, it could be quite difficult, as we need the clinical team to be present … so this is something that we're juggling with,” he said.
Mr Ardi added that if any cases are to be detected in their facilities, a 10-step safety protocol is in place.
HOW TO PREVENT FUTURE OUTBREAKS
As for what more can be done to prevent future outbreaks in adult care homes, experts say vaccination is key.
Prof Fisher noted: “If an outbreak occurs but no one gets sick because the vaccine makes the disease mild, then there is no problem.
“Until we are all vaccinated, we must really limit contacts – for example, minimise activities and visitors, (and so on).”
Prof Tambyah added that vaccinations must cover not just staff and residents, but also vendors and visitors to the homes.