Why Repeat Social Care Mistakes with COVID-19 In Schools?

Back in March, incredulous care workers were listening to their distressed managers coming out of meetings in which plans to 'safely' discharge elderly people from hospital into care homes had been outlined. If regulations and guidelines were followed, there would be minimal danger of transmitting COVID-19 - and, of course, there was all this stuff called PPE everyone expected to see delivered any day.

All our experience of working with the elderly plus our gut instinct told us something was amiss. What was being suggested was risky, dangerous and, to say the very least, taking a capricious liberty with the lives and manner of death of vulnerable people. I am not writing this with the benefit of hindsight. At the time many of us made protests. I wrote to my MP and the CQC. 

Had we known then that patients who might be or were infected with COVID-19 would routinely be sent to care homes where there was no particular expertise in nursing highly contagious diseases, no PPE and no facilities for isolation, we would have shouted a lot louder. Had we known that GPs would not be allowed to visit and no provision would be made for proper palliative care in some cases, we would have swung from the trees and yelled.  We accepted the situation with huge trepidation because we knew these lovely, trusting, vulnerable, elderly people needed to be cared for. We drew up the very best plans we could in the circumstances. Many homes went to extreme lengths with staff voluntarily isolating themselves from family for long periods, living in caravans and tents and making their own PPE.

It was a disaster. We had known it would be.  Although many elderly people have been successfully shielded, on May 15th the BBC reported more than 18,000 excess deaths in care homes in England and Wales during April here. Members of the Social Care work force are twice as likely as the general population (including NHS workers) to have died here.

Now, the government seems to be making a similar miscalculation about schools. With the reproduction rate (R) scarcely below 1 for a few days, this reckless government has issued guidelines for social distancing in schools, keeping children in 'bubbles' which prevent transmission between too many households. These guidelines are being challenged by teachers who say that they are simply not workable. The teachers have powerful representative organisations (unlike carers) to speak up for them. The BMA has lent its support to voices that are saying not, 'we don't want to go back to school' but 'we don't think it's safe to send reception class pupils back to school, in this way, now'. Experience, gut instinct and scientific data are all crying out, 'this is very risky.' 

I am no expert in children's health but I do know that there are a whole range of studies that suggest we do not accurately know the extent to which COVID-19 affects children. Nor do we know the extent to which children transmit the disease. There have been studies in China here and elsewhere here but the research is at an early stage and they mostly show what we do not yet know rather than draw definitive conclusions. A syndrome has been identified where children who have had the disease later develop an inflammatory condition that has landed some in ICU here. 

We all know the extent to which children bring infections home from school, especially the youngest. A friend's family was affected when her sons contracted the virus at school in March. They were, thankfully, not very ill, but Mum and Dad (a doctor and an agricultural scientist) caught it and were off work for weeks. I've just watched a Conservative MP's youtube video describing the approach to distancing that puts children into groups or 'bubbles' of 15 with a teacher. Should someone contract the disease, only the 'bubble' and their families would need to isolate. If each child has even four people in their family, this would result in over 60 people isolating for 7-14 days or perhaps much longer, many of whom could be vulnerable or might be key workers. 

Children have to get back to school but every instinct and a lot of evidence is shrieking '1st June is too soon.' Why experiment with the safety of our youngest children? (In many countries with excellent educational results, they would not be in school until they were 7.) Why not wait until R has been consistently below 1 for weeks rather than days? 

Teachers are not raising objections because they are cowardly, lazy or obstructive. They are raising professional concerns because they instinctively know that we are taking a huge risk with the well-being of children and families. Just as the carers were back in March, they are extremely worried that the regulations and guidelines they are being given are inadequate to contain the infection and, worse, that all the factors relevant to the situation have not been properly considered. They do not want to see unnecessary deaths or the permanent disabling of children or parents who contract the disease. They remember the false assurances given in early March that it was 'very unlikely the virus would be transmitted to care homes' even as care homes were beginning to report that it was being transmitted. 

Teachers and carers have one thing in common. They look after the most vulnerable and the most precious members of society - our children, our parents, those who are abused, those who have dementia, those who have disabilities and are disadvantaged. Most disgracefully, this week, parts of the press have turned on teachers. Regularly, the same parts of the press attack carers who are among the lowest paid and least trained workers in society for alleged dereliction of duty over conditions in care homes. The truth underlying such attitudes is that, as a society, we have become so focused on economic growth and workplace productivity that we have no interest in resourcing and supporting those who do the kinds of work that shore up the quality of our children's and parents' lives. We give lip service to the importance of education and the crucial role of teachers; we clap and call care workers 'heroes' as we send them to look after the dying with no protective equipment. We do not listen to them, we do not take their advice, we do not resource them properly. We allow them to be invisible and disparaged and then we blame them for not overcoming the difficulties our demands place upon them. In failing them, we let down the very people we say we love and value most. A civilised society, at the very least, funds care for its infants and its dying and we have failed the test for the latter. Do not let us fail it for the former.

Changing the Narrative on COVID-19

This little mask is one I have been supplied with to use at work. I have to save it in a plastic bag and reuse it for the same client each time I visit. For 4 weeks I have worn this mask on 12 separate occasions for an hour at a time. 

I have been placed in a position where there are three possible narratives I can tell myself about my companion mask. 

1) 'I must wear it as directed because it is the policy of my employer and I would be at fault not to do so.' (This is what I have done.)
2) 'I should not wear it as to do so under these conditions is a hazard. I am likely to pass on infection or become infected myself by repeatedly wearing a dirty mask. To comply with a policy that research shows may result in harm goes against my duty of care to clients and my training as a nurse.'
3) 'I should speak out about the fact that professionals who need PPE are being forced to implement unsatisfactory policies based on specious information and I should campaign for improvement.' (I am also doing this.)

It's immensely stressful to abide by what you know to be a false narrative.

These three narratives co-incide with the possible positions each of us has been placed in by the government. 

1) 'I must follow government lockdown-easing guidelines because not to do so would break the law or breach public trust.'
2) 'I should not follow government guidelines where they create an infection hazard to myself or others and can be shown to depart from properly researched supporting evidence.'
3) 'I should support campaigns to call out incorrect information and unsatisfactory policies.'

Narratives 2 and 3, of course, invite official censure and disciplinary action - dismissal (in the case of masks) or sanctions or a fine (in the case of government guidelines). 

Narrative 1 ought to be the path we could all follow but there's a problem with it. It's becoming increasingly obvious to a large proportion of the population that this narrative is failing because it is a false narrative, requiring us to act in ways based on skewed interpretations of scientific evidence. The government can see that, due to its earlier decisions, it is losing power to control events and that, now, it is beginning to lose control of the narrative about what is happening. The only option then becomes to change the narrative as the Prime Minister did last night. Last night's change of direction was not about infection control or about economic expediency, it was about spin. 

Now that the message has changed from 'stay at home' to 'keep alert', the responsibility for what happens has passed to the individual. It is now my responsibility and your responsibility to prevent the spread of the virus, despite the fact that the tools we need to do so have been found missing, wanting, absent or, in the case of the moderately clear messages about lockdown, have just been pulled from under our feet.

The CQC guidelines tell me, 'if you carry out procedures' properly then there will be minimal risk', the implication being that if I or a client get infected it will be due to my failure to use a mask properly. The government is now telling us 'if you go to work or school and social distance on crowded public transport remaining alert at all times, we can keep R below 1', the implication being that, if we don't, it is due to the failure of the general public.

At some point and by some means we have to be able to say, 'No. You are asking us to play roulette with the nation's health.' You have imposed policies that are the worst of all worlds. The lockdown is massively damaging to the economy (a price most of us thought worth paying to safeguard health), yet you are starting to lift precautions before R (the infection rate) has been consistently below 1 for longer than the incubation period of the infection, thus potentially throwing away all the advantage of the lockdown.

     

Resurrection Hope

This Easter I have been very conscious of the words Jesus spoke to Mary Magdalene when she first recognised Him and went to embrace Him after His resurrection. 'Do not touch me.'

So apt for our strange times on a practical level.

On a spiritual level, also apt. Jesus was risen and that was a cause for joy. But he was telling Mary, 'Things are not going to be the same as they were before.' The resurrection changes everything, you will be different, you will find joy and purpose and new life, but the future will be new. 

Today, for many, perhaps all of us, the future will not be as we expected, but it is there for the shaping and hope, faith and love will triumph.

Christ is risen!

The image is by He Qi, a Chinese artist, Do Not Hold On To Me.