Clusters of cases are to be expected with the coronavirus but the rise in these groups of infection in nursing homes is particularly worrying because of the risk to 25,000 older vulnerable residents.
hey have gone from four last week to 22, mainly affecting nursing homes in the east and north-east.
The number of clusters in private houses has also increased to 22 with 19 in hospitals. It all comes down to infection control and even when the highest standards are followed this transmissible virus has shown its ability to find a weakness in even the most stringent barriers.
Private nursing homes acted swiftly with a visitor ban in early March, when we had a small handful of cases.
No non-essential visiting, children or groups have been allowed since.
All visitors must contact the home prior to attending and should only go there in the most urgent circumstances.
At the time Nursing Homes Ireland was accused of being premature in this restriction but in hindsight it was the right move and is likely to have saved residents from the illness and risk of death.
Nursing homes have a good record in dealing with infection and each winter they face the threat of the flu, which has led to good hygiene practices.
However, it is clear they felt they were not given enough priority in recent weeks.
As recently as March 25 they were asking for guidance as to what nursing homes should do in the crisis. They warned it sadly inevitable that nursing homes will experience severe staff shortages at the very time they are needed most to care for residents.
They faced the situation where the HSE, which had opened the gates to recruitment again, was looking for references for their staff who were on a jobs panel.
The basic tasks needed to reduce the risk from the virus in a nursing home need to be carried out relentlessly, disinfecting surfaces where it can live for more than 72 hours.
Surfaces can be frequently touched by residents who may find it difficult to always follow etiquette while coughing and sneezing.
The nature of disability or infirmity means that some residents need close personal care on a daily basis by staff.
However, nursing homes faced a severe shortage of protective clothing and masks.
After yesterday's meeting members of Nursing Homes Ireland, led by chief executive Tadhg Daly, were more confident that their concerns had been listened to.
"The challenges presented to the minister centred around timely access to PPE equipment and testing within nursing homes, the necessity for the State to recognise the essential need for nursing homes to be supported around the critical area of staffing, and the need for enhanced staffing and logistical arrangements during this emergency to be recognised in Fair Deal," he said.
Private nursing homes have the advantage of having single rooms for a resident who tests positive to self-isolate in.
But this is more of a difficulty in several HSE-run nursing homes where there are several residents per room in old buildings that have already been criticised for lack of privacy by Hiqa.
The Health Protection Surveillance Centre says that a resident who tests positive should avoid communal areas for a minimum of 14 days after onset of illness and with five days free of fever.
They can go outside alone if appropriate or accompanied by a staff member maintaining a distance of one metre.
If there are lessons to be learned from the outbreak of clusters in private homes it is the need for any member of a household who has symptoms to self-isolate.
Frequently touched surfaces like door handles, bedrails, tabletops and light switches should be cleaned frequently, even daily, throughout isolation.
A standard detergent solution can be used for this. Stronger detergents should be used when contamination is more likely.
Mopping of floors should be done with water and detergent.