Long a neglected branch of French healthcare, care homes for the elderly are accustomed to working in the shadows, their losses unremarked. As the coronavirus pandemic spreads like wildfire, they are bracing for a “bloodbath” – the full scale of which may never be known.
For someone her age, Sarah Marcenot has an uncommon familiarity with the end of life. At 25, the assistant nurse at a care home in eastern France is used to accompanying the elderly in their twilight years. But she has never witnessed death on this scale — so sudden, so sinister, so lonely.
Located in the Alsace region, the heart of Frances coronavirus outbreak, Marcenots nursing home has been operating in a vacuum for close to a month now. Isolated in their rooms, its residents are dying one by one, their families kept at bay.
“Im terrified at the idea theyll pass away alone in their rooms, far from everyone,” she says in an interview with FRANCE 24. “They only have us now, with whom to share their last breath.”
At Marcenots care home, near the city of Mulhouse, nine residents have died in the last week alone. There are no test kits available to determine the cause of death, but seven of the victims presented the symptoms typical of Covid-19, the deadly disease caused by the new coronavirus.
Other homes, including one in the nearby Vosges department, have reported casualty numbers in the double digits. With elderly people especially vulnerable to the virus, Frances more than 7,000 state-funded “EHPAD” care homes have been described as ticking time bombs.
“The tsunami has entered the building, its a disaster,” says Pierre Gouabault, a care home director, describing the catastrophe underway at one nursing home in the central Loire valley, where ten people have died in recent days and 19 others present symptoms.
With the homes director and other staff members among the infected, Gouabault, who runs a nearby nursing home, has stepped in as caretaker. In a matter of days, he managed to cobble together a new team, hiring students from medical school and reserve nurses from across France. It's in crises like these, he says, “that the true solidarity of a nation comes forward".
Gouabault has worked in an EHPAD long enough to remember the last time the public “woke up” to a tragedy unfolding at Frances nursing homes. During the sweltering summer of 2003, as French holidaymakers lounged on the beaches, a deadly heatwave quietly preyed on the elderly left behind. Officials spoke at first of dozens of casualties, then a few hundred. It would be months before a shocked nation discovered the staggering death toll of more than 15,000.
Years later, the paucity of figures has compounded fears that another carnage — this one even greater — is currently under way, far from the public eye.
Since the start of the pandemic, nursing homes have been excluded from the daily tallies reported by the government, which only count the coronavirus deaths in Frances hospitals — where elderly patients are now seldom admitted, due to a desperate lack of beds.
A first, provisional estimate of “at least 884” deaths at nursing homes was finally announced on Thursday, though officials cautioned that many homes were yet to report. And in the absence of widespread testing of residents, it is not clear how the government plans to collect and verify the figures.
In a letter to the health minister last month, the main association of EHPAD workers had warned that the epidemic “could end up killing more than 100,000 people”.
Body bags over masks
The lack of testing is just one in a long list of grievances voiced by staff at Frances EHPAD homes, long accustomed to being at the bottom of the pecking order when it comes to healthcare funding and equipment.
“Hospitals are the priority, nobody cares about nursing homes,” says Marcenot. “Were not doing real care work here, the conditions wont allow it. Were doing survival work.”
While the countrys hospitals are struggling with a desperate shortage of masks and other protective gear, several nursing homes have received none at all, despite catering to an especially vulnerable public with high rates of infection. With the government unable to provide even basic protection to frontline workers, rules are being rewritten by the hour. Masks were still “mandatory” only a few days ago, but they are now “advised”. Instead, EHPAD directors are encouraged to stock up on body bags before they too run out.
As one director told French daily Le Monde, “Its body bags instead of masks, the message is pretty clear.”
At a care home in the Maine-et-Loire department, near Angers, 43-year-old Muriel says staff have just one mask per day, generally a surgical mask offering limited protection.
“The type of mask changes almost every day, depending on the donor,” she says. “We received some from the local mayor, from dentists and even from building inspectors who go looking for asbestos.”
Muriel was to strengthen the weekend team at the start of the crisis, and immediately assigned to the special isolation zone set up for residents with possible Covid-19 symptoms. Her protective gear included gloves, glasses, a shower cap and a gown, which she shared with the person replacing her on the following shift. Two weeks into the job, she resigned for fear of catching the virus and passing it on to her parents, with whom she is under lockdown.
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