The elderly are not only more likely to die from Covid-19, but in an overstretched pandemic situation, younger people can be prioritised for care. Farah Hancock reports.
Roughly 500,000 New Zealanders are over 70 and face the greatest risk of death if they contract Covid-19.
It’s a risk one aged-care provider has decided is too great. Yesterday, Radius Care closed the doors of 22 of its facilities to visitors saying it was in the best interests of the 1700 people it cares for.
A Radius Care spokesperson said although doors were locked, it wasn’t a full lockdown – just restricted access – and staff would evaluate if the visit was urgent.
“If your mum has 12 hours to live of course you’re allowed in.”
According to the spokesperson, no resident had been exposed to a close or casual contact of someone with Covid-19, and the restricted access went beyond the current Ministry of Health guidelines for aged-care facilities.
“We really appreciate the fact that it will distress people. It wasn’t a decision that was undertaken lightly.”
Shutting the doors was the best way the organisation could see to contain the spread of the virus and keep residents safe.
Double pandemic risk for elderly
An elderly person’s risk of catching the disease appears to be no different to a younger person’s risk, but the older you are, the higher the chance of severe consequences.
The mortality rates calculated by the Chinese CDC estimate 8 percent of those aged 70-79 die from Covid-19. For those 80 and over the rate jumps to 14.8 percent.
In Italy, as hospital resources were stretched, tough choices were made about who got treatment. The Italian Critical Care Society approved the idea of placing age limits on access to intensive treatments and said doctors should “privilege greater life expectancy”.
Put bluntly, this is a decision that puts young, and otherwise healthy people ahead of the queue for treatment because once they recover from the virus, they’ll likely live longer than an 80-year-old.
In the US, some states’ pandemic plans are using age limits or a list of pre-existing conditions to prioritise care. People who are too old, or with serious heart conditions, metastatic cancer and kidney failure may find themselves off the ventilator list if there aren’t enough to go around.
New Zealand may be faced with making similarly hard calls if the virus takes hold here. Newsroom reported yesterday New Zealand only has 176 ICU beds. Ventilators, too, will be in high demand in an outbreak.
New Zealand does have a pandemic plan in place for influenza, which has different symptoms to Covid-19. The plan does say “public and private hospitals will need to prioritise admissions, rationalise non-acute services and review staff rosters”, but doesn’t explore how to make decisions around who gets priority if equipment is rationed.
For the 500,000 or so over-70s in New Zealand, avoiding catching the virus will be the best possible defence.
No hugs for nana
Overseas doctors in countries where the virus is spreading through the community are advising older people to treat the world as if it is a coronavirus “soup”.
Along with hand-washing and not touching your face, other suggestions include skipping gatherings like church or club events, and to go shopping in off-peak times, cancel travel and no hugging.
Community spread is not currently an issue in New Zealand, so there’s not yet a coronavirus soup to avoid. Age Concern’s advice is less drastic, but with physical distancing of two metres recommended, hugs are off the table.
Chief executive Stephanie Clare stressed the importance of social connection and the need for families and communities to care for each other.
“This is a really important time that no older person is forgotten and left to sit in silence without support from somebody.”
She also said older people shouldn’t worry about being a burden or making a fuss. The organisation had volunteers and staff who could help connect people with the services needed.
The advice is to wash hands regularly and get outside for a walk and some fresh air, but minimise direct contact with others. Crowded places like public transport and shopping malls should be avoided.
In the United Kingdom it’s been flagged there will be advice coming for people over 70 to self-isolate for several months at home or in care facilities. Announced piecemeal without accompanying detail, the idea was immediately savaged.
“Who do you think works at those nursing homes? Highly-trained gibbons?” said one infectious disease epidemiologist.
Rest homes and retirement villages
In New Zealand, more than 38,000 people live in aged residential care in New Zealand, and another 43,000 live in retirement villages.
The risk for residents has come to international attention after a rest home in the United States with 120 residents became the epicentre of disease in their local area. To date, around 26 of the residents with the virus have died.
Earlier this month, the New Zealand Aged Care Association and Retirement Villages Association sounded the alarm about New Zealand’s preparedness.
“Our providers are well-prepared for a normal viral outbreak such as influenza or norovirus, but Covid-19 may be on a bigger scale and require additional staff as well as specialist medical supplies and safety equipment over and above what they are prepared for,” said New Zealand Aged Care Association chief executive Simon Wallace.
Since the concerns were publicly aired, some help has been forthcoming. Wallace said he was confident the Government was taking steps to address the sector’s concerns.
“This includes improved access to personal protective equipment such as masks, gloves and gowns and infection control training.”
He said the care of residents with Covid-19 would be assessed on a case-by-case basis. How many a facility could care for would depend on its size. The point where a patient would need care beyond what an aged-care facility could provide would also be assessed case by case.
There are also still concerns about staff. Wallace said he’d asked for a suspension of the three-year immigration stand-down policy for aged-care workers.
“Under this policy we will see around 1700 caregivers being sent home from August to the end of the year. These are experienced health workers who support our nurses and we cannot afford to lose them at this time.”
He said some staff were in self-isolation after travelling and some were away with cold and flu symptoms. All staff had guidelines to follow around hand-washing, not working while ill, plus strict protocol to follow if a resident has Covid-19.
Rules around visitors have also been updated with a recommendation all visitors be screened prior to entry to ensure they haven’t been overseas in the past 14 days, are feeling unwell, or have been in contact with someone who has returned from overseas, or has Covid-19 symptoms.
The approach taken by Radius Care is a stronger measure than what the Ministry of Health or the New Zealand Aged Care Association has suggested is necessary.