Dr. Siobhán Kennelly:

I thank Deputy Butler. With regard to the staffing issue, it is not in anybody's interest for one sector to deprive another sector of staffing. Clearly, there are going to be major issues to be addressed as a result of this in terms of governance and resilience in general within the private nursing home sector, in particular a need for them to reflect on their own staffing issues and possibly the issues that arise in terms of short-term contracts and the security they themselves can give to those staff.

To move on to the Deputy's question with regard to the transfers, again, the big learning has been around the fact that asymptomatic transmission was not a feature of WHO or ECDC guidance until 18 March and the guidance we had been issuing around the end of February and in early March did not reflect that. In fact, if we look at the WHO guidance, it indicated “possible” asymptomatic transmission, so everybody was still rigorously applying a case definition that was based on people having symptoms. When these patients were moved, they were not tested on the basis they did not have symptoms.

The other key piece was that if staff coming in from the community to work in these care settings did not have symptoms, they were not being tested either. We have learned a lot from the mass testing exercise in that regard. Clearly, the guidance we will be issuing to revisit that will look substantially different on the basis of the learning we have had in terms of that testing piece.

I would like to reiterate it is not the case that testing gives a definitive result where Covid is concerned. People can be Covid-negative today and Covid-positive tomorrow. That is the nature of the condition itself, particularly in the pre-symptomatic phase. It is also the case that we know that about 20% of patients who test as negative or not detected for Covid may actually develop symptoms in the following 14-day period. For that reason, all of these transfers were advised to be isolated and monitored for a 14-day period because these are our best safeguards.