Did the OMT and the top of the Ministry of Health, Welfare and Sport, and therefore also the cabinet, consider the residents and caregivers in nursing homes less important than patients and staff in hospitals during the first six months of the corona pandemic? That question was central on Wednesday afternoon during the interrogation of former director general of Long-term Care at the Ministry of Health, Welfare and Sport, Ernst van Koesveld.
On the one hand, society was shut down for a long time to protect the weak from the virus. Schools, shops, catering establishments, theaters and sports clubs were temporarily closed and people with office jobs had to work from home. At the same time, there were numerous signals that the most vulnerable, the elderly in nursing homes, were insufficiently protected, as questions from the corona inquiry committee showed on Wednesday.
For example, on March 19, 2020, former minister Hugo de Jonge (Public Health, Welfare and Sport, CDA) announced a national ban on visiting the elderly in nursing homes. “We thought it was a very difficult decision,” Van Koesveld said during the interrogation. “But at that time we considered the risk to the residents of infection through family to be greater than the risk of loneliness.” It soon became apparent in the media that children of nursing home residents often stood in front of the window with banners and that they could hardly say goodbye to their sick parents when they died. There was an exception rule that applied to saying goodbye to parents or partners, Van Koesveld emphasizes. “There was a great need for this. We tried to get as much attention as possible for it.”
Too little protective equipment
At the same time, nursing homes had far too little protective equipment, such as face masks and aprons, to prevent contamination. When it came to distribution, hospitals were at the forefront and nursing homes were not. Nursing home staff were therefore at risk and some became ill themselves, but so did the elderly. In March 2020, Verenso, the association of specialists in geriatric medicine, regularly informed VWS that most nursing homes had far too few face masks. Van Koesveld: “We were surprised by the speed of the virus in March.”
The major shortage of protective equipment in nursing homes was also evident from an email from Hugo de Jonge to Van Koesveld on April 5 of that year. The minister writes that he “doesn’t have a good feeling about it” and “has no insight” into the supplies in individual nursing homes. And, he writes, “there is no fair distribution.”
Ernst van Koesveld, Director General of Long-Term Care at the Ministry of Health, Welfare and Sport, during an earlier technical briefing in the House of Representatives about testing and protective equipment to combat the coronavirus.
Photo SEM VAN DER WAL / ANP
Was the ban on visiting elderly people in nursing homes announced because nursing homes had not received enough protective equipment, inquiry committee member Sangül Mutluer (PvdA) asked on Wednesday. “No,” Van Koesveld replied. However, on April 13, a new distribution model was created for the face masks, gloves and aprons that were available: hospitals no longer replaced nursing homes. It was not until the end of April that the first nursing homes reopened to family. 5,000 nursing home residents had died from Covid-19. “It was very complicated. It is hard to imagine that the virus had really been given free rein in the nursing homes. 120,000 vulnerable people lived there.” Yet there was never a visit ban again. Van Koesveld: “We had learned that closing the doors was socially too difficult for people.”
Check regularly
According to Van Koesveld, during the time when there is no health crisis – the so-called “cold phase”, now – VWS, Regional Organs for Acute Care and nursing homes, should regularly check whether they have enough supplies in case there is ever another pandemic.
Another indication that nursing home staff and residents were not at the top of the priority list came to light in August 2020 when the RIVM changed its guideline for protective equipment in nursing homes: suddenly caretakers and nurses also had to use face masks preventively, including during “fleeting contact” with the elderly. But in March they had heard from the RIVM that such preventive use of face masks was ‘neither necessary nor desirable’, i.e. in case of fleeting contact with a patient, for example. Staff members wondered in August whether they had been doing their work unprotected.
Why did Director General Van Koesveld add ‘undesirable’ to the RIVM guideline on April 14, committee member Mutluer asked. Van Koesveld: “The nursing homes wanted clear advice stating that preventive use was not good. Because there was a great shortage of face masks at the time and too many were used, even at home. I feared a run on protective equipment.” The RIVM adopted ‘undesirable’ from the top official. On closer inspection, have nursing home staff been able to work safely everywhere? the committee asks. “No,” says the former DG.
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