In the tenth of our Living With COVID-19 series, where we learn how fellow health workers are adapting and coping with the ongoing pandemic, we hear from Heiner Schweigkofler, based in Lombardy, Italy. Heiner is the head of Casa San Giuseppe, a care home, and one of our friends within our collaborative network. Lombardy has been one of the hardest-hit regions in Italy during the COVID-19 pandemic. His words here provide a summary of what he has seen and experienced during the ongoing pandemic in Italy.
The virus and the fear of it.
The virus itself is invisible, and once it is in the house, it becomes difficult. The attempt to separate people and put them in a separate department is difficult in the long run or does not succeed so well. It has been shown here that the course is very asymptomatic. Residents who were clearly infected for us because of their symptoms were examined and it turned out that they were negative. Others, on the other hand, who showed no signs at all, tested positive.
This difficulty in assessing the disease has led to helplessness because without testing, it is often not known which resident or staff member is affected and which is not. Nevertheless, one is under pressure to comply with all the guidelines. For example, when staff go from resident to resident, they must change gloves, disinfect themselves and thus try to prevent the transmission of the virus.
No sooner had we set up the infection department, the residents accommodated there suddenly had a completely new status. If you approached them normally and impartially before, they were suddenly only to be met with full protective equipment, without differentiation and without paying attention to which behaviour poses the greatest risk. Here there is no longer any objectivity and one is no longer aware of the probabilities of transmission and is no longer aware of where one must be particularly careful and where less.
Communication with the employees
One has a few possibilities to control and channel communication. Through social media, communication between employees is very fast and often emotionally charged. After the first employees were infected, the news spread immediately among colleagues, and the effects and consequences were sometimes exaggerated and dramatically presented. This also led to a partly unjustified concern, which, increasingly because of media coverage, created a fear bubble that no longer corresponds to reality and real threats.
To counteract this, we have chosen our own form of communication with our employees. A WhatsApp group was set up, in which all employees receive news from a single source of information - the human resources manager. Communication is only one-way, e.g. it is not possible to send replies or start a discussion. The group publishes news, testimonials, photos and videos about the employees and residents so that the sense of belonging is maintained, no one drifts away in anonymity and everyone has the same level of information.
Illness-related losses of 40-50% led to major bottlenecks and difficulties in maintaining all services. The staff shortfalls affect not only the nursing staff but the entire workforce. In the end, staff were absent everywhere except in the kitchen area: personnel management due to excessive demands and exhaustion, doctors, nursing service management and nurses tested positive and therefore dropped out, others were no longer able to cope with the special situation and therefore took sick leave. The successive loss of personnel represents one of the greatest burdens in this situation.
After the first personnel bottlenecks occurred in the home, all employees were urged to contribute to covering the basic needs of the residents and to maintaining nursing care. This means that physiotherapists, recreational and spiritual care were also included in the care and they had to help with food distribution, food supply, disinfection, and personal hygiene. Teams of two were formed, in which a qualified specialist worked together with a helper. In this way, the quality of care could be maintained as well as possible.
Our doctors always made a double evaluation, once about the oxygen saturation levels and once about the body temperature, because we could not do any tests here in the house. We had our oxygen system running at full capacity - up to 500 litres of oxygen per day. There was an additional critical moment when the caretaker also fell to illness and we still had to guarantee that the oxygen bottles would be changed every three hours. Here we then had a volunteer who was reliable and so we managed to maintain the supply of oxygen and the whole supply chain connected to it
Among the residents themselves, I have noticed a relatively low level of fear of infection and disease, although they have seen the outbreak and impact of the pandemic through the media. The sudden distance and the lack of professional and above all human attention was and is much more difficult for them. They see the protective equipment and perceive that those people who have so far, lovingly cared for them suddenly take a greater physical distance and limit themselves to the most necessary standard procedures in care. This often leads to a general unwillingness to live, on the part of the people who are cared for and this is particularly noticeable in the form of increasing loss of appetite.
Some deaths were partly expected due to the symptoms that occurred, others occurred unexpectedly; for example, in residents who had a heart attack or who had a strong recovery within a short time. For example, there were eight deaths within two days, three of which were classified as Covid-19 cases and five deaths due to other causes, such as loss of appetite or heart attack. Each death naturally brings with it a great deal of sadness. The staff have an emotional connection, and there is always a sense of defeat and a feeling of failure, which in turn leads to resignation.
I was present with several residents, at the moment of their death and can say that from my perception it was a peaceful death without fear. In the end, the patients had a lack of oxygen despite a high oxygen supply, i.e. oxygen saturation decreased rapidly.
Through video messages or short films, we have found a way to give the relatives a little report about their loved ones almost daily.
What has proved to be a particular difficulty is, that as the problems and crises have increased, more and more people from outside have wanted information. On the one hand, there are authorities with their daily monitoring, which is very time-consuming as all employees on sick leave must be monitored (temperature, symptoms). On the other hand, there are relatives who call and want to know how their relatives are doing. All this with less and less staff.
The authorities have increasingly issued written orders, i.e. instructions on how certain things and procedures are to be carried out. When you are under time pressure, this is an additional burden and stress. You must comply with the instructions, even if you no longer have the necessary resources to do so. Basically, it can be observed that attempts are made to pass on responsibility from top to bottom. This leads to the fact that, in the daily routine, one lives in uncertainty whether this or that behaviour might not have legal consequences tomorrow, in the sense that authorities or even relatives could file a lawsuit for omissions or wrong actions.
This leads to additional tensions and an even greater burden for managers.
Added to this is the feeling of not being heard or not being properly perceived by the authorities. We have involved the authorities, i.e. there is internal monitoring, where, for example, the body temperature of residents and employees is recorded and reported. However, one has the feeling that this is more of a formality and not really a measure to improve the situation or get it under control.