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CONFRONTING CORONAVIRUS

Some Swedish care homes have had no cases of Covid-19 – what did they do right?

At least 234 of Sweden's 290 municipalities have elderly care homes with confirmed or suspected coronavirus cases. But a handful seem to have been able to protect residents from Covid-19, in some cases despite staff being infected. So what did they do differently, and could their strategies be applies elsewhere?

Some Swedish care homes have had no cases of Covid-19 – what did they do right?
An elderly care home in Nödinge allows distanced family visits. Photo: Thomas Johansson/TT

“I think the debate on the flaws in elderly care has been lacking nuance. I don't think there have been sufficient efforts to try to describe the underlying reasons for why the spread of infection has been great in different regions. There are almost 60 municipalities which have had better success,” Ebba Gierow, head of social affairs in the Ale municipality, told the TT newswire.

This is one of the municipalities which by late June had not recorded any cases of coronavirus in its five municipal care homes.

Ale is located in Västra Götaland, a region where the spread arrived later and more slowly than for example Stockholm – partly due to the timing of spring school holidays in both regions.

Gierow said that this meant care homes in Västra Götaland had the chance to improve their hygiene routines and make sure that all employees who showed symptoms stayed at home, two of the factors that have long been identified by authorities as decisive in limiting the spread.

Equipment

Beyond this proactive attitude, another tangible factor which has helped certain care homes in preventing or slowing down the spread of the coronavirus in their facilities has been the access to protective clothing.

Gierow explained that Ale decided that “they couldn't sit around and wait for national channels to provide us with equipment”.

Instead, they immediately drove to construction warehouses and other stores to stock up on equipment, and continually kept stock to ensure their supplies would not run out and source more protective clothing. 


Photo: Fredrik Sandberg/TT

Accessing protective equipment when it was in such high demand not only in Sweden but internationally was one of the major challenges for the care sector.

Greger Bengtsson, head of elderly care at the umbrella association for Sweden's municipalities and regions (SKR), told The Local that “we knew we should protect staff and residents, but we didn't have the necessary materials”, which instead went to Sweden's hospitals in the first instance.

“Not until about a month ago did care homes start to receive adequate supplies,” Bengtsson said.

And in Ale, the investment in protective equipment was not only a way to keep staff and residents safe, but also to boost perceived safety.

“It was a challenge, but protective equipment gives a feeling of security. You can't expect staff to go out and do their job well if they're scared. We put a lot of money into this in Ale. We did an evaluation and decided that was the right thing to do,” she said. 

A recent report published by SKR on the situation in care facilities stated that more equipment is not always the best option. For example, certain high grade face masks have valves which mean that, while the wearer is protected, their exhaled air is released unfiltered into their surroundings. Infected but asymptomatic staff wearing this kind of mask could therefore put elderly residents at increased risk. 

Another problem was that funds varied between municipalities, so in early April SKR began acting as a purchaser on behalf of all Sweden's municipalities, as a way to ensure it could act on the world market and ensure equipment was distributed where needed.


Photo: Fredrik Sandberg / TT

Early visitor bans

According to Bengtsson, another major obstacle in protecting care home residents was legislation.  

It was only on April 1st that the government declared a visitors' ban for all municipal care homes. Some municipalities had prohibited visits days or even weeks earlier. This meant they may have broken the law on accessibility of these facilities, which are intended to be an open part of society, but in doing so they may have saved lives.

One of the quickest to act, Luleå, which banned visits on March 20th, has cited this as a factor behind the municipality reporting only one care home death from Covid-19. And the Skåne region, where 85 percent of homes reported no infection at all, introduced a visitor ban 10-12 days before the national one.

However, this was only one of several measures in Skåne which may have had an effect, with others including more widespread testing of staff and residents in care homes than other regions, multilingual information campaigns about the coronavirus from an early stage, and a deal which means specialised hygiene nurses hired by the region work in care homes.

Signs on a care home entrance warning of a visitor ban. Photo: Anders Wiklund / TT

Fewer hourly staff

Another factor which has repeatedly surfaced in the debate on how the virus spread in Sweden's care homes so quickly is the high proportion of temporary staff, who often work in multiple facilities. On hourly contracts, these workers were not protected by extended sick pay legislation, which may have given them less incentive to follow national guidelines in staying home if showing the slightest cold or flu symptoms.

A relatively low proportion of hourly workers is a factor common to Ale and other municipalities which have not reported any cases of coronavirus, including Stenungssund and Alingsås. However, it's hard to assess the direct impact of this, partly because in the hard hit care homes, it's almost impossible to know how the infection entered the facility and spread.

Speaking to reporters in early May, the Public Health Agency's Head of the Department for Antibiotics and Infection Control Malin Grape said there was no clear common factor that pointed to how the infection got into affected care homes in Stockholm and Sörmland.

Some of the possibilities the Public Health Agency has pointed to after speaking with care homes include new arrivals to the homes or residents returning from hospital stays, family visits, or asymptomatic staff, as well as a high proportion of hourly workers. 

It is not possible to pinpoint the exact actions that determined why some municipalities avoided outbreaks in their care homes – and luck will have played some part.

But in order to give staff the necessary support and training, provide the right equipment in sufficient quantities, and take further measures as needed to protect staff and residents, quick reaction and adaptation to a fast-moving and unprecedented situation was essential. That can only come from an engaged leadership.

In Ale, Gierow says the strategy was hands-on from the start. 

“Managers have worked with a close leadership. They've spent a lot of time on the ground, answering questions, supporting staff and simply being around,” she said. “This provides support and security, which means a lot for staff being able to manage” with the pressure of protecting the most vulnerable group in society from the virus.

With reporting by Anne Grietje Franssen and TT's Petronella Uebel

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COVID-19

Will France’s Covid-19 health pass be consigned to the past?

France suspended but did not cancel the Covid pass in March - but the government has suggested it might not return, even with the country in the grip of the virus’s seventh wave

Will France's Covid-19 health pass be consigned to the past?

Cases of Covid-19 in France have risen 57.8 percent in the past week with daily cases topping the 200,000 mark on Tueday.

The virus’s seventh wave has the country in its grip – but it seems the government has no plans to reintroduce vaccine pass measures.

READ ALSO How serious will France’s seventh wave of Covid-19 be?

The vaccine pass –  itself a two-month development of the old health pass which had been required for entry to certain venues such as bars, restaurants and cafes – was suspended on March 14th, as cases of Covid-19 in France fell. But the health emergency law that enforced it was still in effect and allowed it to be reactivated at any time.

That law runs out on July 31st. Now, it seems the pass will not return. Reports in the French press last month claimed that the health ministry was discussing the possibility of re-imposing some form of pass sanitaire, a bill intended to replace the current health emergency laws makes no mention of it. 

The new president of the National Assembly, Yaël Braun-Pivet, confirmed this week that the vaccine pass was not included in the new bill, entitled “health monitoring and security”, which will be submitted to the National Assembly for debate from July 11 and will, if passed, come into law on August 1st – the day after the current law expires.

“[It] is not what is planned in the text of the law that will be submitted to parliament this week,” Braun-Pivet said.

Rather, the bill extends epidemic surveillance and contact case identification systems until March 31st, 2023. 

The second provides for the implementation of border control measures – such as requiring visitors to France to show proof of vaccination or a recent negative test – if a so-called variant of concern were to spread rapidly abroad, as confirmed by new government spokesman Olivier Véran. 

Currently, most health rules in place at the height of the pandemic have been relaxed. Masks are only required in French hospitals, health centres and places that have vulnerable residents such as nursing homes. They are also recommended in crowded spaces where it is impossible to practice social distancing.

READ ALSO French public urged to wear face masks again on public transport

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