The latest circular from the Ministry of Health of 30 November, which talks about face-to-face visits for elderly guests in RSA and other social-health and welfare structures, is passing under the radar and above all will feed false hopes for relatives. A document that could be potentially dangerous – if applied in all its parts – certainly for operators, but above all for the elderly.
“Visitor access to residential, social and health facilities and hospices”.
With this circular, the Ministry of Health provides clarifications and indications regarding the safe resumption of visits and contacts with the elderly in residential structures, but will it be true? “The social-health and social-assistance residential structures and hospices – reads the document – host elderly or disabled people who make up a particularly fragile segment of the population and at greater risk of serious evolution if affected by COVID-19. For this reason, particularly stringent infection prevention and control measures were needed to protect the health of the patients in these structures ”.
All this starting from February-March, we add, up to the month last with the DPCM of 3 November, where it is reiterated that “the access of relatives and visitors to hospitality and long-term care facilities, assisted healthcare residences (RSA), hospices, rehabilitation facilities and residential facilities for the elderly, self-sufficient and not, is limited only to the cases indicated by the health management of the structure, which is required to take the necessary measures to prevent possible transmission of infection “.
But the circular of 30 November takes into account the proposals of the “Commission for the reform of health and social health care of the elderly population”, established at the Ministry of Health with Ministerial Decree of 8 September 2020 – we underline in September, before the second wave- and in accordance with the provisions of the ISS report “Interim indications for the prevention and control of SARS-CoV-2 infection in residential, health and social care facilities”, version of 24 August 2020, to ensure uniformity of application of the aforementioned provisions and to ensure full and safe access for relatives and visitors to residential social welfare, health care and hospice facilities ”- we repeat, before the second wave.
In August there was talk, many were convinced, of the end of the drama, unfortunately many structures that followed those indications and that gradually registered many cases of positivity, thanks to the “free all” and then open schools, unsafe transport etc. etcetera … Now, in December, with more than twenty thousand infections a day and a peak of deaths, almost a thousand, recorded the day before yesterday and more than eight hundred yesterday, it is asked to open in presence with contacts, and moreover only two about months from the beginning of the vaccination campaign, but also in contradiction with the Dpcm of two days ago, where it is recommended, even if you have undergone rapid antigenic swabs, to avoid contact with your loved ones at home. Then, instead, we ask to open, and moreover without making any distinctions of colors: yellow, red orange. Relatives, from everywhere, passing from one municipality to another, could go inside the structures and then hug the host relatives. The health departments must – reads the Ministry document – prepare a detailed plan to ensure the possibility of face-to-face visits, “Solutions such as:” room of hugs “, where a safe physical contact can benefit guests,” at in order to ensure the containment of risk and the safety of guests, workers, volunteers and visitors, please note the instructions for tracking all entrances.
Again: in the Ministry document: “It is recommended to promote immediate screening strategies, through the possibility of carrying out rapid antigen tests to family members / relatives / visitors of the patients. These tests can be carried out directly on site – we recommend – and in the event of a negative result, visitors are authorized to access the structure according to the instructions provided by the director, in this way – it is specified in the circular – the safeguarding of health and the need to be close to loved ones are combined ”.
But is it really so? So much for the high percentage of false positives and false negatives that are recorded in these tests. But just a few lines later, things seem to change, and we read this: “In the current epidemiological context, characterized by a high viral circulation, it is highly probable the finding of subjects positive for SARS-CoV-2 who could transmit the infection and therefore the rational use of screening methods that are validated as reported in the circular of the Ministry of Health of 30 October 2020 n. 35324 “. In a nutshell it says that antigen tests quick – look a bit – currently available have a lower sensitivity (ie the ability to correctly detect all positive subjects) e it would be good to trust the molecular test that allows us to identify positive subjects with the utmost sensitivity to protect the frail at risk of complications and large communities at risk of clusters “. This creates confusion, a lot of confusion, but above all a lot of responsibility is discharged on the structures that are already working under pressure and in some regions without the support of the USCA and local health structures. Today the work in Basilicata is different, it must be admitted, where the Region and the Health Authorities are striving to implement a good screening campaign by checking the facilities for some time and periodically, testing the elderly and operators, a practice, we suggest, that will have to continue up to the vaccination campaign, but in many other realities the molecular tests of preventive control, unfortunately, remain a mirage and a hope.
Vincenzo Diego
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