1 1 The challenge of policy integration and the complexity of care home responses to the COVID-19 pandemic in Europe Eloísa del Pino and Francisco Javier Moreno-Fuentes Managing nursing homes in a pandemic context: a three-ringed circus During the first weeks of the COVID-19 pandemic, a regional health minister of a European country, responsible for purchasing masks, gloves, and other personal protection equipment (PPE) for his region, asked his fellow regional health ministers on a phone chatting app how they were calculating their purchase needs. All but one replied with formulas that only took into consideration the expected needs for the personnel of hospitals and healthcare centres. The odd one, who was in charge of both healthcare and social services in his region, asked the other regional ministers whether they considered that non-health facilities such as prisons, garrisons, or nursing homes could also need PPE. Surprised by this concern, which had not crossed his mind up to that moment, the regional minister who asked the initial question replied: ‘Please, elaborate on this idea’. This telling anecdote shows how the care homes sector was completely out of the mental framework of the authorities having to deal with the initial stages of the pandemic. This lack of focus on this sector had very significant consequences for the way in which the disease expanded among the residents of this type of institution, and on the measures adopted to respond to this public health emergency in the early stages of expansion of the pandemic (del Pino et al, 2020). On 30 January 2020, the World Health Organization (WHO) declared the outbreak of the novel coronavirus as a Public Health Emergency of International Concern (PHEIC), the highest level of alert under the International Health Regulations. During the first weeks of February, cases began appearing in many European countries, and the situation in Italy, the first European country where the pandemic was identified, was particularly aggravated. Between the end of February and the beginning of March, the number of positive cases increased, with cases that had been admitted to Authenticated eloisa.delpino@csic.es/ Author's copy | Downloaded 07/09/25 10:36 AM UTC