Matt Shanahan Questions Rapid Testing and Nursing Home Defences
Matt Shanahan addressed nursing home protections and the case for rapid antigen testing, urging consideration of new testing technologies alongside existing infection controls. He questioned whether rapid antigen tests should be deployed to curb community transmission and shared that he has provided information to NPHET.
Nursing home protections
Dr Schaefer told the meeting that the situation in nursing homes is far improved since March and April. Measures now include testing of asymptomatic care workers, universal personal protective equipment and universal mask use, which make transmission to residents much less likely if infection prevention controls are followed, though 100% protection cannot be guaranteed.
Rapid antigen testing and limits
Contributors discussed rapid antigen tests as a possible screening tool that returns results in about 20 minutes. Experts cautioned that antigen tests are sensitive when viral load is high but perform less well with low viral loads, so they should be used in appropriate scenarios as part of a wider testing strategy rather than as a direct replacement for standardized diagnostics.
Workplace outbreaks and social conditions
An Irish contributor reported six nursing-home outbreaks since mid-August, with limited publicly available detail about size, source or outcomes. The discussion highlighted outbreaks linked to workplaces and raised concerns about cramped staff housing, crowded transport, insecure contracts and economic pressure that can lead sick workers to attend work, arguing these social conditions need legislative remedies.
Decision-making and scientific oversight
Speakers criticised the current decision-making structures for mass testing investment, describing NPHET as medically conservative and HICWA as thorough but desk-based. They argued for a dedicated scientific advisory committee to monitor international mass-testing developments and to coordinate rapid assessment and deployment of new testing technologies using Irish expertise.
Implications for policy and practice
The contributors collectively urged a balanced approach that combines strengthened infection prevention in nursing homes, targeted use of rapid antigen screening where appropriate, improved workplace and housing conditions for staff, and better arrangements for scientific appraisal of mass-testing options.
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Thank you, Chair, and thank you to our contributors there this morning and for your very candid comments, which I think are welcome. Dr Schaefer, can I just ask you a quick question? You spoke about the new learnings, I suppose, in terms of nursing homes and that the implementation of new infection protocols and the additional uses of PPE was proving very successful. Do you think that that is a strategy that we can continue to use in terms of nursing homes? Would that give us almost 100% immunity or infection, if you like, in terms of community control in nursing homes, do you feel? Well, I think we can never say 100% and we will never be able to achieve 100% protection. But I really think it's important to highlight that the situation for the nursing homes now is totally different to what it was in March and April. We now test house care workers, asymptomatic house care workers, and we now use universal personal protective equipment. We have used universal mask use. So I think we are in a much, much better position to try to keep COVID-19, even if not totally out of the nursing homes, at least at bay at the nursing homes, that even if we have an infected house care worker as long as this house care worker adheres to infection prevention control measures, that it should be very unlikely that it is transmitted to a resident. So I think it's a much better situation, but we can't say 100% that it won't be possible enough. Okay, thank you. And maybe just a question then for all of the guests. And I want to know is, you know, is the perfect the enemy of the good? We've been speaking about the need for testing and for rapid testing. And there are a number of rapid tests that are coming available. I myself have given information to Nephet in recent weeks on rapid testing. And yet they're based on antigen testing. And there doesn't seem to be an appetite to implement something that could turn around a test in 20 minutes. And I'm wondering, you know, do you think that it's about time now that we started looking at deploying some of these technologies to try and get on top of the rate of community transmission? Will I just comment quickly on this as well? So I agree that there is a need definitely, or there is an indication for antigen testing as well. I think we just have to be aware of the limitations of our tests. So these rapid antigen tests are very good in detecting cases when a case has a very high viral load. Then the antigen tests are quite sensitive in detecting these cases. They are not as good in detecting individuals that might have a low viral load. So we have to know when do we want to use the antigen test. But I think there are scenarios where we might be able to use the antigen test as a screening test to just determine if somebody is infected at the moment and has a high viral load. So it's definitely something to kind of consider incorporating into our kind of testing strategy. And the other contributors there, please. Maybe our Irish contributors. If I could come in, I think the data that we get from the Department of Health every evening does show, I believe, six outbreaks in nursing homes since the middle of August. So we don't know exactly how big each of those was. And was it staff or was it patients and residents and the outcomes? We don't know. But we do know that there have been six. So it has been the case that there have been outbreaks, which means at least two people with infection linked to nursing homes. There also have been outbreaks, as we know, over the last few months linked to workplaces. I would add to this discussion we've had about private homes and nursing homes, the need for workplaces to be made secure and safe for people to work there. I don't believe that we've done that well. I believe the housing and accommodation for some of the staff is cramped and crowded in hostels. I believe their transport to work has been in buses and so on. And this is not just the case in Ireland. It's also been the case in Singapore and in North America and in Northern Ireland, actually in Cullabahy, where it's the social conditions and the lack of stable contracts of people in the workforce not being able to take a day off because their nose is running is causing people to go to work when they're not well because they'll lose money if they don't. And I think that really needs a robust legislative approach that our nation is not happy to tolerate these zero-hours contracts, gig economy, people in crowded hostels rather than living in groups of three to five. And I think that really, we're still now in this seven months and the employers haven't changed. So we really, in my view, need a legislative approach. If I could just come back in on the mass testing situation, I think, and I don't say this is a criticism to anyone involved, but we don't currently have a decision-making structure that has the comprehension to invest in mass testing. NPHET are fundamentally a medical body and they look at it from the perspectives of diagnostics and public health. It's very, very conservative in how it views testing. And, you know, none of these new testing technologies is ever going to be as rigorous as the standardized current testing that we do. And that's a problem with decision-making for taking it on board. And then HICWA are very thorough, rigorous. They're also a desk-based research organization where you're going to assess the success of these technologies in other countries, but not necessarily interpret the context of these tests, where they were developed and how quickly they can be made more efficacious. What's missing from the entire situation is a scientific advisory committee that is closely monitoring how we can assess the current state of mass testing in the world and how we can employ it rapidly in Ireland. And we do have many experts in Ireland who are working on this particular topic. And also, the chief scientific advisor is essentially sitting on a committee that was supportive of the research advisory group that was ancillary to NEFIT. And so there hasn't been, in my view, enough scientific input into these kind of questions. If that was to change, I think that we would have a better way of looking at this. Thank you, Professor Ryan. I'm sorry to have to cut you short again. Thank you, Deputy Shannon. Thank you.
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