Professor Cecily Kelleher:

In reviewing this in the first instance, we on the expert panel were very concerned as to what the factors that created risk for development of outbreaks in nursing homes might be. Clearly, our report is centred on all these things. The first point to make is that the incidence in the community is a very important driver to risk. That was true, unfortunately, at the outset of this, when we were dealing with it last spring, and now it has again become very clear that as we have been going through this period, in January and February, community incidence and incidence generally is an important driver. That is one important factor. Dr. MacLellan referred earlier to the fact that a report will be published shortly, we hope, which was undertaken jointly between HIQA and the HSE's HPSE and which will look at protective factors and risk factors based on the data that were available. The international evidence all points us to the fact that this is a very serious, highly contagious infectious disease whose natural history and management were, in the early stages, very important features; that congregated settings are risky environments for a whole variety of reasons related to transmission of risk; and that in the nursing home setting older people and those who have underlying conditions were particularly susceptible. Of course, there is also the big question of preparedness that was so important then and remains so now. There are, therefore, a constellation of factors at play here that are very important. In the first six months of our reviewing preparedness, all the things that required stepping up have been stepped up. It remains the case, more so than ever, that they should be sustained and that we should have long-term supports in place that would maintain that level of preparedness going into the future. It was therefore a mixture of factors: the incidence in the wider, general population, the management of the condition, the degree of preparedness in the setting and the fact that congregated settings are inherently risky environments.