There have been at least six new outbreaks of Covid-19 in nursing homes so far this month, according to the National Public Health Emergency Team.

The latest figure was announced last night.

When added to the news that two nursing homes have some 30 confirmed Covid-19 cases each in Donegal and Laois, many are questioning if the virus is impacting nursing homes the way it did in March.

The last seven months have been a major learning curve for society and for the nursing home sector in particular.

The Covid manager at Sonas Nursing Home in Co Carlow, Annie Byrne, says a huge level of knowledge has been "built up" since March.

"It came out of the blue, people thought it was the common cold, but no," she says.

In March, Nursing Homes Ireland repeatedly called for personal protective equipment, increased numbers of staff, testing and results in nursing home settings.

This time around, it's different.

CEO Tadhg Daly says while people are concerned, there’s a sense of greater control and a better ability to manage on this occasion.

The sector has been on tenterhooks through the summer, according to Mr Daly, despite the fact that the numbers were decreasing.

However, he says vigilance needs to be maintained across the community.

The rising number of Covid-19 cases in nursing homes is attributed to community transmission.

Warning flags have been raised, including by the Chief Medical Officer.

Dr Tony Holohan expressed concern about cases in nursing homes in his letter to Government last Sunday.

Professor Sean Kennelly, who is a Consultant Physician in Geriatric and Stroke Medicine at Tallaght University Hospital in Dublin, says Covid-19 in the community will always get into nursing homes.

"To suppress Covid in nursing homes, you must suppress it within the community and that entails us taking all the precautions we’ve heard of before," he said.

Prof Kennelly studied the impact the virus had on nursing homes in March and April.

The difference now, he says, is that the testing, the availability of testing and the turnaround has improved.

"We’re aware of the asymptomatic spread and in a previous study we did which was published, we could see that 27% of nursing home residents and 25% of staff were asymptomatic. We’re now able to detect those through the widespread testing," he said.

HSE Chief Clinical Officer Dr Colm Henry said last week that there are multiple points of entry into nursing homes.

With the children of staff back at school and communities reopening in recent months, community transmission was inevitable, according to Prof Kennelly.

From a global perspective, he says, there’s no evidence that visitors bring the virus into nursing homes.

Staff may not be travelling from nursing home to nursing home as they did in the past, says Prof Kennelly, but there are staff with spouses working in other high-risk sectors.

The level of vigilance among staff, according to Tadhg Daly, is "appropriate".

He points out the Trojan work was recognised by the Health Information and Quality Authority and the Covid-19 Oireachtas Committee.

Now that Level 3 restrictions are in place, the aim is for the virus to be kept at bay from settings that are Covid-free, and managed in settings where it exists.

Level 3 means window visits can only be permitted at nursing homes, and no indoor visiting is allowed.

Some nursing homes will not allow window visits because they say it can be distressing or upsetting for residents, particularly those with cognitive impairment.

In those settings, nursing homes place emphasis on communicating through technology.

Prof Kennelly says visits are hugely important because it is a vulnerable group of people who need their families.

"As much as we want to protect them, we need to ensure they have a quality of life. It can’t be a trade-off on one versus the other."

There are a number of factors to take into account.

Firstly, the overall increase in community transmission will allow the virus get into nursing homes and it has done so.

Children are back at school and staff are out in the community more.

The two-week Covid-19 tests are showing up many asymptomatic cases, according to Nursing Homes Ireland.

There are concerns about the rise in cases, as was mentioned by Dr Holohan in his letter last Sunday to Government.

The cases are rising. However, knowledge of the virus has also increased in the medical field and indeed in nursing homes.