Seán Sherlock (Cork East, Labour)
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759. To ask the Minister for Health the steps persons with asthma and other breathing difficulties should take in respect of face masks; and the way in which they can avoid penalties for not wearing a mask. [17353/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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I would like to assure the Deputy that my Department appreciates the challenges experienced by those who have asthma and other breathing difficulties.

The National Public Health Emergency Team (NPHET) continues to examine all emerging evidence as it arises and has provided advice relating to face coverings on an ongoing basis.

NPHET advises the wearing of a non-medical face covering in a number of circumstances which include:

- when on public transport

- when in indoor public areas including retail outlets

- by people visiting the homes of those who are cocooning

- by people who are being visited in their homes by those who are cocooning

- all visitors to residential care facilities and

- in indoor work environments where it is difficult to maintain a two-metre distance

Individual judgement or preference should be used to consider the wearing of face coverings in other environments.

It is important to emphasise that the wearing of face coverings is an additional hygiene measure and should not take the place of good hand hygiene, respiratory etiquette and other personal protective public health measures. Face coverings should be used properly, in line with the guidance and to wash hands before putting them on and taking them off.

On the 15th June, the Government and the National Transport Authority launched a national communications campaign which outlines best practice for the use of face coverings in retail outlets, on public transport and in other public locations in which it is difficult to maintain social distancing or where this distance cannot be guaranteed, and are communicating to the public about:

- who should wear face coverings

- in what settings, and how to wear and remove face coverings correctly.

Guidance on how to make and safely use face coverings is available on gov.ie/facecoverings and the HSE website.

As the Deputy is aware, on Friday 10 July 2020, having consulted with the Minister for Transport, Tourism and Sport and the Minister for Justice and Equality, I signed the Health Act (Covid-19) (Face Coverings on Public Transport) Regulations 2020. The regulations provide that, from 13 July 2020, members of the public shall not, without reasonable excuse, travel by public transport without wearing a face covering.

Reasonable excuse includes where a person:

- cannot put one on, wear or remove a face covering because of any physical or mental illness, impairment or disability or without severe distress

- needs to communicate with another person who has difficulties communicating

- removes the face covering to provide emergency assistance or to provide care or assistance to a vulnerable person

- removes the face covering to avoid harm or injury, or the risk of harm or injury

- removes the face covering to take medication

The Regulations do not apply to children under the age of 13 years. It is a matter for the person using the transport service to demonstrate that they have a reasonable excuse.

The Government has now also agreed to the mandatory wearing of face coverings in retail outlets, shops and shopping centres. Retail staff will also be obliged to wear a face covering unless there is a partition between them and members of the public or where there is a distance of 2 metres between them and members of the public. Work on the development of relevant Regulations has commenced and it is likely that similar "reasonable excuse" provisions will apply.

As I am sure the Deputy can appreciate, the evidence relating to the SARS-CoV-2 virus and the discussion around face coverings, masks and shields is constantly evolving. I can assure you that the public health advice relating to Covid-19 is kept under continuing review by the National Public Health Emergency Team (NPHET). The Expert Advisory Group (EAG) of the NPHET has also been proactively examining all relevant evidence relating to the virus and the issue of face coverings. The EAG has requested the Health Information and Quality Authority to prepare a revised and updated evidence synthesis on face coverings and I have been informed that this paper is expected to be finalised shortly.

The latest public health advice on face coverings is available at the following links and is updated on a regular basis:

John Brady (Wicklow, Sinn Fein)
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760. To ask the Minister for Health if his attention has been drawn to the outbreak of Covid-19 at a nursing home (details supplied); and if his attention has been further drawn to the transfer of residents to other care units and the manner in which the transfers were carried out. [17355/20]

John Brady (Wicklow, Sinn Fein)
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761. To ask the Minister for Health if his attention has been drawn to the death of 12 residents of a nursing home (details supplied) due to Covid-19 and that 34 staff tested positive for the virus. [17356/20]

Mary Butler (Waterford, Fianna Fail)
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I propose to take Questions Nos. 760 and 761 together.

People living in long-term residential care (LTRC) facilities are particularly vulnerable populations in the context of COVID-19 and have been identified by the World Health Organization (WHO) to be at a higher risk of being susceptible to infection from this disease and for subsequent adverse outcomes.

The very infectious nature of the COVID-19 virus makes it difficult to prevent and control in residential care settings - an experience replicated internationally. Interrupting transmission of the COVID-19 virus is the main goal of public health measures and it is clear from our experience that the scale of effect of interruption of transmission is influenced by a number of factors. The most important way to protect our older population, whether living at home or in a long-term residential care (LTRC) setting, has been to reduce the amount of disease present in our community. The transmission of the virus, particularly in respect of LTRC settings is multifactorial and its introduction into any setting could be the result of a number of factors.

As a new disease, health authorities across the world are learning about COVID-19 and adapting as new evidence and understanding is formed. The HSE in line with all health authorities continuously reviews emerging evidence and guidance. This is evident from the significant package of guidance that has been produced and has continued to be developed and updated in line with new national and international evidence and data.

The actions and measures we have taken in Ireland to support long-term residential care facilities and their residents have evolved on foot of epidemiological data and guidance from the WHO and the European Centre for Disease Prevention and Control (ECDC). These measures have been both society wide as well as focused specifically on residential facilities. Advice from the National Public Health Emergency Team (NPHET) focused on all long-term residential care settings and its recommended actions were relevant for all residential care services - older people, disability and mental health settings.

As some aspects of the Deputy's questions are operational matters I have asked the Health Service Executive to respond directly as soon as possible.

John Brady (Wicklow, Sinn Fein)
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762. To ask the Minister for Health if his attention has been drawn to calls for a public inquiry into the case of deaths in a nursing home (details supplied); if a public inquiry will be held into the matter; and if he will make a statement on the matter. [17357/20]

Mary Butler (Waterford, Fianna Fail)
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Since 2009 the Health Information and Quality Authority, HIQA, is the statutory independent regulator in place for the nursing home sector, whether a HSE managed or a private nursing home. The Authority, established under the Health Act 2007, has significant and wide-ranging powers up to and including withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider. This responsibility is underpinned by a comprehensive quality framework comprising of Registration Regulations, Care and Welfare Regulations and National Quality Standards.

HIQA, in discharging its duties determines, through examination of all information available to it, including site inspections, whether a nursing homes meets the regulations in order to achieve and maintain its registration status. Should a nursing home be deemed to be non-compliant with the Regulations and the National Quality Standards, it may either fail to achieve or lose its registration status. In addition, the Chief Inspector has wide discretion in deciding whether to impose conditions of Registration on nursing homes.

During the response to COVID-19, Nursing homes continue to be regulated by HIQA, who under the Health Act 2007 have the legal authority to examine the operation of any facility under their remit.

Furthermore on foot of a National Public Health Emergency Team (NPHET) recommendation, on 23rd May a COVID-19 Expert Panel on Nursing Homes was established, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort.

The purpose of the Panel is to examine the national and international responses to the COVID-19 crisis, and to examine the emerging best practice. Its main objective is to provide immediate real-time learnings and recommendations in light of the expected ongoing impact of COVID-19 over the next 12-18 months. COVID-19 is a new disease, which can present atypically in the frail elderly, and new evidence and best practice in its management are constantly emerging. I expect the Expert Panel to submit their final report to me later this month.