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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

Covid-19: Are Italian live events at risk of being postponed?

As the infection rate rises sharply across the country, Italian virologists are calling for concerts and festivals to be rescheduled.

Covid-19: Are Italian live events at risk of being postponed?

Italy has seen a large increase in the number of Covid-19 cases in recent days, so much so that a number of virologists across the country are now urging the government to postpone major live events in a bid to curb infections. 

According to a new report by Italy’s independent health watchdog, the Gimbe Foundation, 595,349 new cases were recorded in the week from June 29th to July 5th; a worrying 55 percent increase on the previous week. 

In the same time span, the country also registered a 32.8 percent rise in the number of hospitalised patients, which went from 6,035 to 8,003.  

The latest Covid wave, which is being driven by the highly contagious Omicron 5 variant, is a “real cause for concern”, especially in terms of a “potential patient overload”, said Nino Cartabellotta, president of the Gimbe Foundation. 

As Italian cities prepare to host a packed calendar of concerts and festivals this summer, health experts are questioning whether such events should actually take place given the high risk of transmission associated with mass gatherings.

READ ALSO: What tourists in Italy need to know if they get Covid-19

“Rescheduling these types of events would be the best thing to do right now,” said Massimo Ciccozzi, Director of Epidemiology at Campus Bio-Medico University of Rome. 

The summer wave is expected to peak in mid-July but, Ciccozzi warns, the upcoming live events might “delay [the peak] until the end of July or even beyond” and extend the infection curve.

Antonello Maruotti, Professor of Statistics at LUMSA University of Rome, recently shared Ciccozzi’s concerns, saying that live events as big as Maneskin’s scheduled Rome concert are “definitely not a good idea”. 

The Italian rock band are slated to perform at the Circus Maximus on Saturday, July 9th but the expected turnout – over 70,000 fans are set to attend the event – has raised objections from an array of Italian doctors, with some warning that the concert might cause as many as 20,000 new cases.

If it were to materialise, the prospected scenario would significantly aggravate Lazio’s present medical predicament as there are currently over 186,000 Covid cases in the region (nearly 800 patients are receiving treatment in local hospitals). 

Italian rock band Maneskin performing in Turin

Italian rock band Maneskin are expected to perform at the Circus Maximus in Rome on Saturday, July 9th. Photo by Marco BERTORELLO / AFP

But, despite pleas to postpone the event, it is likely that Maneskin’s concert will take place as scheduled.

Alessandro Onorato, Rome’s Tourism Councillor, said that rescheduling is “out of question” and that “all recommendations from the local medical authorities will be adopted” with the help of the event’s organisers and staff on the ground.

At the time of writing, there is also no indication that the Italian government will consider postponing other major live events scheduled to take place in the coming weeks, though the situation is evolving rapidly and a U-turn on previous dispositions can’t be ruled out.

READ ALSO: At a glance: What are the Covid-19 rules in Italy now?

On this note, it is worth mentioning that Italy has now scrapped all of its former Covid measures except the requirement to wear FFP2 face masks on public transport (though not on planes) and in healthcare settings.

The use of face coverings is, however, still recommended in all crowded areas, including outdoors – exactly the point that leading Italian doctors are stressing in the hope that live events will not lead to large-scale infection.

Antonio Magi, President of Rome’s OMCEO (College of Doctors, Surgeons and Dentists), said: “Our advice is to wear FFP2 masks […] in high-risk situations.”

“I hope that young people will heed our recommendations and think about the health risks that their parents or grandparents might be exposed to after the event [they attend].”

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