Repercussions on health and social care in the time of COVID: isolation of elderly people

Reports from my regional hospital in Bolzano, Italy
Submitted by Dr. Laura Valzolgher, MD; Dr. Patrick Franzoni, MD
Emergency Unit, Hospital of Bolzano, Italy

Key Highlights:

• Coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
• The COVID-19 pandemic was declared by WHO on 11 March 2020.
• Public health and social measures to limit the diffusion of the infection included: isolation of the people presenting symptoms, movement restrictions such as quarantine, community containment methods such as social distancing, and personal protective equipment.
• The COVID epidemic meant a health are emergency and also on a psychological level there are increasing cases of depression, anxiety, and re-acutisation of psychiatric disorders.
• Elderly frail people are among the most vulnerable groups of populations: elderly had the highest mortality rate according to age and suffered the most the consequences of social isolation.

As it is unfortunately well-known, Coronavirus disease 2019 (COVID-19) is a potentially severe respiratory infection caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the World Health Organization declared the COVID-19 outbreak a pandemic on 11 March 2020, the Italian Government had already declared a state of emergency by the end of February. Since that time, concern about the diffusion of the novel Coronavirus have led to severe public health and social measures to limit spreading from human-to-human contact. The epidemic and the subsequent restrictive measures had however severe repercussions not only on the health care system but also on our communities and personal lives.

The public health measures applied during the acute COVID phase included: isolation of people with symptoms; movement restrictions like quarantine and social distancing, and the use of personal protective equipment. Further measures used during the state of lock down included: voluntary home curfew, limitations on group assembly, cancellation of public events, closure of mass transit systems, travel restrictions, suspension of commercial activities,  and cancellation of school lessons. The “stay at home” orders became overwhelming, because it was more than a suggestion but was punishable by law. The health care system underwent a profound change with hospitals transforming to adapt to the COVID emergency. Hospital wards and departments were re-structured and equipped to manage COVID respiratory issues requiring proper isolation.

The consequences of the COVID outbreak and related restrictive measures were profound, not only on a socio-economic level, but also on the well-being and psychological health of individuals;  there are reports of increased compulsive behaviour, depression, anxiety, and an increase in psychiatric disorders. Some of the most vulnerable are the elderly and frail with pre-existing social and health issues. In fact, seniors have the highest mortality rate according to age with an estimated risk of mortality of 3.6% for people in their 60s, and 8.0% and 14.8% for people in their 70s and over 80s,respectively. Moreover, the elderly were burdened with the most severe social costs due to social isolation and lack of support. Long-term residential facilities were off limits to visitors and beloved relatives for the protection of residents. Moreover, elderly people, even those living in the community, had limited family and social support, and in some cases lost professional careers due to isolation measures.

As a practical example I can report what happened in my reality in Bolzano, a regional, medium-sized hospital in northern Italy. Firstly, all elective activities were deferred in order to reallocate resources to the COVID emergency. The emergency department was divided into two paths with one for the management of suspected COVID patients and the other for COVID-free patients. All hospital entry points were controlled and no family members were allowed, not even in the case of patients in critical condition. With the exponential growth of COVID patients, a new operational unit specifically designed for COVID management was created on March 26 2020, which has two different corridors with a COVID path and a COVID-free path. A multidisciplinary medical and nursing team was built for the management of COVID patients. Based on the experience of the team, one of the main difficulties associated with managing frail, elderly patients affected by COVID-19 was indeed the absolute lack of physical contact with the staff (always protected by the personal equipment) and isolation from their carers and relatives. For this technology came of great help, one thing that was appreciated by both patients and family members was the introduction terminals to allow video calls with family members.

The whole COVID emergency, or COVID Tsunami as it is often defined, is something that disrupted our social and health care system. It deeply affected our society and changed our lives in a way that will never be the same. From a professional and personal point of view, I can add that the hardest part was the dimension of isolation and watching patients struggling for their lives apart from the love of their family members.

References

Usher K at al. Life in the pandemic: Social isolation and mental health. J Clin Nurs 2020 Apr 6. doi: 10.1111/jocn.15290.

Brooke Joanne et al. Older People and COVID-19: Isolation, Risk and Ageism. J Clin Nurs 2020 Apr 2. doi: 10.1111/jocn.15274.

Lloyd-Sherlock PJ, Martinez R, Ebrahim ES, Sempe L, McKee M. Bearing the brunt of COVID-19: older people in low and middle-income countries. BMJ. 2020; 368 [PubMed] [Google Scholar]

Laura Valzolgher worked as a doctor at the Memory Clinic at the Hospital of Bolzano. She completed her Master of Science Degree in Psychogeriatrics at University La Sapienza Rome in 2017. She is now engaged in the COVID emergency working in the emergency department.